Clinical validation of PD Adequest software: modeling error assessment.
OBJECTIVE
PD ADEQUEST software (Baxter Healthcare, Deerfield, IL, U.S.A.) is used in peritoneal dialysis for calculating the indices of dialysis efficiency and for the mathematical simulation of the results of various dialysis regimens. The aim of our study was to quantify the modeling errors and find the methods which give best results.


METHODS
Nonrandomized, repeated measurement, clinical validation study.


METHODS
The study included 78 patients on continuous ambulatory peritoneal dialysis (PD), daytime ambulatory PD, and automated PD.


METHODS
We used 207 collections of dialysate and urine associated with peritoneal equilibration tests (PETs) performed with different glucose concentrations (1.36%, 2.27%, 3.86%). The measured urea Kt/V, creatinine clearance (CRCL) and ultrafiltration (UF) were compared with the same data simulated mathematically using the PD ADEQUEST software version 1.4.


RESULTS
The Kt/V, CRCL, and UF measured values were significantly correlated and in agreement with modeled data [concordance correlation (rc) was 0.849, 0.839, 0.625 respectively]. The errors (modeled - measured) were: Kt/V = -0.04 +/- 0.27 (p = ns), CRCL = 2.1 +/- 7.7 L (p < 0.001), UF = -121 +/- 711 mL (p = 0.016). Applying ANOVA to both the peritoneal transport data calculated by PD ADEQUEST (mass transfer area coefficient of the solutes, fluid reabsorption, and hydraulic permeability) and the modeling errors, significant differences were found in relation to the PET glucose concentrations.


CONCLUSIONS
PD ADEQUEST proves to be a useful instrument in peritoneal dialysis, although there is undoubtedly still room for improvement in its prediction efficacy, which is influenced by the glucose concentration used in the PET.
Amici
G
G
Nephrology and Dialysis Division, Regional Hospital St. Maria dei Battuti, Treviso, Italy.
Mastrosimone
S
S
Da Rin
G
G
Bocci
C
C
Bonadonna
A
A
D003198:Computer Simulation; D015314:Dialysis Solutions / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010530:Peritoneal Dialysis / Q000592:standards / Q000706:statistics & numerical data; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012986:Software Validation
D015314:Dialysis Solutions