title: The occurrence of increased intraperitoneal volume events in automated peritoneal dialysis in the US: role of programming, patient/user actions and ultrafiltration.
abstract: BACKGROUND, OBJECTIVES AND METHODS: Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultrafiltration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively.
  
  
  RESULTS
  Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed.
  
  
  CONCLUSIONS
  IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient's UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Borut
authors.initials: B
authors.lastname: Cižman
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Lindo
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Bilionis
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Davis
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Brown
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Miller
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Gerald
authors.initials: G
authors.lastname: Phillips
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Kriukov
authors.affiliation: Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Sloand
mesh_terms: D000368:Aged; D015314:Dialysis Solutions / Q000737:chemistry; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D010537:Peritoneum / Q000503:physiopathology*; D014462:Ultrafiltration; D014481:United States
chemical_list: D015314:Dialysis Solutions
keywords: Automated peritoneal dialysis; increased intraperitoneal volume; tidal peritoneal dialysis; ultrafiltration