Computerized urea kinetic modeling to prescribe and monitor delivered Kt/V (pKt/V, dKt/V) in peritoneal dialysis. Fresenius Randomized Dialysis Prescriptions and Clinical Outcome Study (RDP/CO).
A computerized urea kinetic model of peritoneal urea transport (PACK-PD) has been developed and used to calculate prescription parameters which would result in the prescribed weekly peritoneal urea clearance (pKpt/V) required to achieve levels of weekly summed renal + peritoneal urea clearance (pKprt/ V) targeted at 1.75 and 2.16. Baseline kinetic data were obtained and analyzed with PACK-PD on 88 patients, and the program then used these data to calculate the required pKpt/V and subsequently the delivered Kpt/V (dKpt/V) from the dialysate collections. A total of 108 prescriptions were written and compared to dKpt/V measured over one to 24 months in the 88 patients. Both continuous ambulatory peritoneal dialysis and automated peritoneal dialysis (APD) were studied (APD consisted of PD+ with one or two diurnal and two to four nocturnal cycler exchanges). The correlation of dKpt/V to pKpt/V showed r = 0.93 with 95% confidence limits (CL) on agreement of +/-20% over a range of pKpt/V 0.52-2.55. The 95% CL on (dKpt/V-pKpt/V) were +/-0.30. We concluded: (1) that the prescription can be modeled as reliably in peritoneal dialysis as in hemodialysis (HD) where dKt/V and pKt/V agree to +/-25%, (2) that any individual weekly dKpt/V may vary as much as 0.3-0.4 from pKpt/V, and (3) that frequent measurement of dKpt/V and adjustment of pKpt/V as needed are required (as in HD) to control mean dKpt/V to within +/-10% of mean pKpt/V.
Gotch
F A
FA
Davies Medical Center, San Francisco, California.
Lipps
B J
BJ
Keen
M L
ML
Panlilio
F
F
D002199:Capillary Permeability / Q000502:physiology*; D002940:Circadian Rhythm / Q000502:physiology; D003198:Computer Simulation; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000628:therapy; D007700:Kinetics; D008838:Microcomputers; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000295:instrumentation; D055656:Prescriptions; D012984:Software; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome; D014508:Urea / Q000097:blood*
D014508:Urea