Small-solute and middle-molecule clearances during continuous flow peritoneal dialysis.
Previous theoretic and clinical studies have shown that continuous flow peritoneal dialysis (CFPD) provides a high dose of small-solute removal; however, the dose of middle-molecule removal with CFPD therapy has not been evaluated. We used a variable-volume, two-compartment model to calculate theoretical steady-state solute kinetic profiles during CFPD, continuous ambulatory peritoneal dialysis (CAPD), and hemodialysis using a high-flux dialyzer (HFHD), for an anuric 70-kg patient and two measures of dose: equivalent renal clearance (EKR) and standard Kt/V (stdKt/V). Dose measures during each therapy were calculated for five solutes: urea, creatinine, vitamin B12, inulin, and beta 2-microglobulin. Fluid (1 L daily) was assumed to accumulate in and to be removed from the extracellular space, and non renal clearance was assumed to be zero for all solutes except beta 2-microglobulin. Calculated doses for CFPD were higher than for CAPD or HFHD when assessed by either EKR or stdKt/V. Dose enhancements for CFPD were highest for small solutes, but were still considerable for middle molecules. We conclude that CFPD achieves higher doses than CAPD or HFHD for both small-solute and middle-molecule removal.
Leypoldt
John K
JK
Research Service, Salt Lake City VA Health Care System, Departments of Internal Medicine and Bioengineering, University of Utah, Salt Lake City, Utah, USA.
Burkart
John M
JM
D001002:Anuria / Q000378:metabolism / Q000628:therapy; D003198:Computer Simulation; D003404:Creatinine / Q000378:metabolism; D015314:Dialysis Solutions / Q000737:chemistry / Q000378:metabolism*; D006801:Humans; D007444:Inulin / Q000378:metabolism; D007668:Kidney / Q000378:metabolism*; D008962:Models, Theoretical; D008970:Molecular Weight; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D006435:Renal Dialysis; D014508:Urea / Q000378:metabolism; D014805:Vitamin B 12 / Q000378:metabolism; D001613:beta 2-Microglobulin / Q000378:metabolism
D015314:Dialysis Solutions; D001613:beta 2-Microglobulin; D014508:Urea; D007444:Inulin; D003404:Creatinine; D014805:Vitamin B 12