Abstract: SA-PO445
Ultrafiltration Patterns during Automated Peritoneal Dialysis
Session Information
- Home Dialysis - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- El Shamy, Osama, The George Washington University, Washington, District of Columbia, United States
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Wyatt, Nicole, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Patel, Sagar, Renal Associates LLC, Columbus, Georgia, United States
- Abudaff, Naief N., Arizona Kidney Disease and Hypertension Center, Phoenix, Arizona, United States
- Golper, Thomas A., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Guide, Andrew, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Greevy, Robert, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Arroyo Ornelas, Juan Pablo, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Background
With the growing use of automated peritoneal dialysis (APD), it is important to improve our knowledge of the clinical patterns and physiology of APD treatment sessions. The ultrafiltration achieved during each cycle of an APD treatment is assumed to be relatively linear if the delivered prescription is the same. We set out to determine if that is case.
Methods
Single-center, cross-sectional study of APD patients > 18 years old, who had been on APD for >3 months were included. CAPD patients or those with peritonitis within 3 months were excluded. Individual treatment data from 7 consecutive APD treatment sessions with consistent dialysate composition were collected.
Results
39 subjects were enrolled. A total of 273 APD treatment days were analyzed. The probability of yielding a positive UF was 48.9% for cycle 1, gradually rising to 90.5% by cycle 6. Adjusting for average dextrose concentration, dwell time, tidal PD status, fill volume, solute transfer rate, and number of cycles, we observed that cycles 2 through 6 achieved progressively higher UF volumes than cycle 1 (p < 0.001). To adjust for a potential "last cycle effect", assessment of a middle cycle compared to the first and last cycles demonstrated statistically significantly cycle UF volumes (-230 ml and 277 ml, respectively, p < 0.001), in-line with our other findings.
Conclusion
This is the first study investigating variations in UF volumes achieved between APD cycles. Adjusting for all potentially confounding factors, as the APD treatment progressed, the UF achieved per cycle increased. While the exact explanation of these findings is unclear, peritoneal surface area recruitment, mesenteric elasticity, and cumulative glucose concentration in the interstitium are possible factors.