A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis.
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BACKGROUND
Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. ♦


METHODS
We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). ♦


RESULTS
Ultrafiltration averaged 653 ± 363 mL/4 h - twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload (p < 0.01) and inversely proportional to final peritoneal glucose concentration (p < 0.05). ♦


CONCLUSIONS
This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Spain Department of Medicine, Dermatology and Toxicology, Facultad de Medicina, Universidad de Valladolid, Spain vperez5651@gmail.com.
Vicente
V
Pérez-Díaz
Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA.
Alfonso
A
Pérez-Escudero
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Spain.
Sandra
S
Sanz-Ballesteros
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Spain.
Guadalupe
G
Rodríguez-Portela
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Spain.
Susana
S
Valenciano-Martínez
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Spain.
Sofía
S
Palomo-Aparicio
Department of Nephrology, Complejo Asistencial de Palencia, Spain.
Esther
E
Hernández-García
Department of Nephrology, Hospital Universitario Rio Hortega de Valladolid, Spain.
Luisa
L
Sánchez-García
Department of Nephrology, Hospital Clínico Universitario de Valladolid, Spain.
Raquel
R
Gordillo-Martín
Department of Clinical Analysis, Hospital Clínico Universitario de Valladolid, Spain.
Hortensia
H
Marcos-Sánchez
D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport / Q000502:physiology; D003131:Combined Modality Therapy; D015314:Dialysis Solutions / Q000378:metabolism / Q000494:pharmacology; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006440:Hemofiltration / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009995:Osmosis; D061214:Patient Safety; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism; D010865:Pilot Projects; D058996:Quality Improvement; D018570:Risk Assessment; D012494:Sampling Studies; D016896:Treatment Outcome
D015314:Dialysis Solutions; D005947:Glucose
Ultrafiltration; fluid overload; fluid transport kinetics; glucose concentration; hydrostatic pressure; intraperitoneal pressure; osmotic gradient; technique failure