Continuous flow peritoneal dialysis: current state-of-the-art and obstacles to further development.
Peritoneal dialysis (PD) is still underutilized as home based renal replacement therapy and in-patient treatment of acute renal failure. Hindering the expansion of PD is poor solute clearance, which is a result of the intermittent dwell technique. Continuous flow PD is an old concept that has demonstrated urea clearances from 2-5 times higher than standard PD. It relies on a 2-3 l dwell volume and continuous dialysate flow at 100-300 ml/min. This high flow rate dictates the need for an efficient dual lumen catheter, or two separate catheters with ports separated maximally, as well as a means to generate or regenerate large volumes of fluid. A modified hemodialysis system can easily be adapted to regenerate sterile peritoneal dialysate, and a dual lumen catheter with excellent flow characteristics has been designed. Ultrafiltration control and a means to accurately balance transperitoneal with external ultrafiltration persist as technical challenges. Continuous flow PD remains an attractive modality for daily home dialysis and treatment of acute renal failure.
Ronco
Claudio
C
Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy.
Amerling
Richard
R
D004867:Equipment Design; D006437:Hemodialysis, Home / Q000379:methods; D006801:Humans; D010530:Peritoneal Dialysis / Q000295:instrumentation / Q000379:methods*