Continuous flow peritoneal dialysis: principles and applications.
ABSTRACT Continuous flow peritoneal dialysis (CFPD) is a technique of renal replacement therapy (RRT) dating back to the 1960s. Its essential features are a fixed intraperitoneal volume and rapid, continuous movement of dialysis solution into and out of the peritoneal cavity. Inlet and outlet catheters and a means of generating a large volume of sterile dialysate are required. External regeneration of dialysate via conventional hemodialysis (HD) equipment or sorbent technology mitigates the need for large volumes of sterile fluid and makes the technique feasible. Clearance depends on the peritoneal mass transfer coefficient, rate of dialysate flow, and efficiency of external regeneration. Studies to date all demonstrate small solute clearances three to eight times greater than conventional automated peritoneal dialysis (PD). Catheter design is crucial to the clinical success of the technique and will be discussed. Potential applications include daily home dialysis, treatment of acute renal failure in the intensive care unit (ICU), and ultrafiltration of ascites. Clinical experience with the latter will be presented in detail.
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ABSTRACT: The management of patients with acute renal failure (ARF) is very complex and requires meticulous attention to fluid, acid-base and electrolyte balance as well as the removal of uraemic toxins. Peritoneal dialysis (PD) is an important option for treatment of selected patients with ARF, particularly those who are haemodynamically compromised or have coagulation abnormalities. Due to continuous therapy, its efficacy is the same as on haemodialysis, even better. Advantages of PD in ARF therapy: it is widely available and easy to perform; insertion of PD catheter is relatively easy, PD does not require special staff or expensive equipment, arterial or venous puncture and anticoagulation; dosing is easy; there is no interaction between blood and dialyser and there are no episodes of hypotension like in haemodialysis (HD) patients; acid-base and electrolyte imbalance may be easily and gradually corrected, large amounts of fluid can be removed in haemodynamically unstable patients, which allows parenteral nutrition. PD is less efficient than HD in therapy of acute complications (pulmonary oedema, intoxication or hyperkaliaemia) and is not the therapy of choice in patients with extreme catabolism who require daily HD or some other kind of continuous renal replacement therapy. The absolute indication for acute PD is the need for dialysis and inability to perform any other renal replacement technique. Relative indications for acute PD in adults are the following: haemodynamically unstable patients, the presence of bleeding or haemorrhagic conditions, difficulty in obtaining vascular approach, removal of high molecular weight toxins, heart failure refractory to medical treatment. Absolute contraindications for PD are the following: recent abdominal or cardiothoracic surgery, diaphragmatic peritoneal-pleural connections, faecal or fungal peritonitis. Other contraindications are relative. Accordingly, acute PD is the mode of therapy in some specific patients with ABI, especially patients in intensive care units. Survival of ARF patients is similar in PD and HD patients, so acute PD is very important in their therapy.Srpski arhiv za celokupno lekarstvo 135(7-8):478-85. · 0.19 Impact Factor
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ABSTRACT: Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand, it is widely assumed that exposure of the peritoneal membrane to high glucose concentrations contributes to both structural and functional changes in the dialyzed peritoneal membrane. As in diabetes, glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end products, may contribute to peritoneal membrane failure. Although efforts to reduce glucose toxicity have been made for years, only a few suggestions, such as dual-bag systems with bicarbonate as buffer system, have found broader acceptance. Recently, some interesting new approaches to the problem of glucose-related toxicity have been made, but further investigations will be necessary before they can be used clinically. This review will focus on adverse effects of glucose in PD solutions and summarize different aspects of glucotoxicity and potential therapeutic interventions.Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis 25(5):415-25. · 2.10 Impact Factor