Abstract: SA-PO450
Initial Feasibility Pilot Study of Interdialytic Peritoneal Ultrafiltration to Manage Volume Status in Patients on Hemodialysis (iPUF-HD)
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
- Deleaval, Patrik, London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada
- Penny, Jarrin D., London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada
- Freeman, Amy, London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada
- McIntyre, Christopher W., London Health Sciences Centre London Kidney Clinical Research Unit, London, Ontario, Canada
Background
Increased dietary sodium (Na) and reduced Na excretion drive interdialytic weight gain (IDWG). High ultrafiltration (UF) rates are associated with mortality in hemodialysis (HD) patients. Achieving complete removal of IDWG is often challenging with conventional HD. Combination therapy with peritoneal dialysis (PD) allows additional UF but significantly increases treatment burden. We report first use of short dwell PD, delivered passively, immediately after HD for 2/3 sessions per week. To maximize Na removal and address congestion we instilled low volume 0% sodium fluid with short dwell time.
Methods
We studied 5 anephric HD patients with history of difficult to manage IDWG [(> 4% of dry weight) within conventional HD regimen. After catheter implantation/healing, patients underwent two short dwell (2 hours) peritoneal treatment sessions per week (immediately after HD), using 10% dextrose. Low volume (500ml) was used to limit glucose exposure (no more than conventional 2.5% dextrose/sodium containing PD fluid). Patients were treated for 3 weeks with additional one-washout. IDWG, hemodynamics, effluent composition, tolerability, serum sodium/osmolality and intradialytic serial echocardiography (HD-induced myocardial stunning) were assessed.
Results
Low volume Na-free peritoneal solution effectively removed 4.83±1.37g of Na and 251±190ml UF per session. Na-free 10% dextrose PD solution was well tolerated without treatment interruption (pain score 0 -1/5). During intervention period, IDWG progressively decreased (from 1820 to 950ml), markedly greater than achieved peritoneal UF. Serum potassium, hs-troponin, calcium, and hemoglobin concentrations remained stable. Serum Na modestly decreased from 136.64±4.46 to 132.11±2.96mmol/L (p < 0.0001), with no adversity attributable to hyponatremia. Systolic blood pressure and continuous intradialytic hemodynamics remained unchanged throughout. Of those with viable echo images (for strain analysis), HD-induced myocardial stunning was reduced in 2/3 patients.
Conclusion
This pilot study suggests that additional Na removal can be achieved with use Na-free peritoneal fluid delivered post-dialytic. Such a regimen appears to be capable of improving the congestive state (and its consequences) in patients otherwise unable to be adequately managed with conventional HD.