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Abstract: FR-PO669

Simultaneous Optimization of Ultrafiltration and Solute Transport in Automated Peritoneal Dialysis (APD)

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis


  • Bergling, Karin E., Lund University, Lund, Sweden
  • Wieslander, Anders Per, Baxter, Lund, Sweden
  • Öberg, Carl Mikael, Lund University, Lund, Sweden

Group or Team Name

  • Renal Physiology & Peritoneal Dialysis Group

In a recent study we found that the treatment with APD could be improved in terms of shorter treatment times and markedly (> 20%) lower glucose absorption using optimized bi-modal treatment regimens, combining cycles with a high glucose concentration and cycles using low or no glucose.


We further explored this novel concept in silico by using a sparse linear regression model with constraints to find the shortest possible treatment time given a set of clinical treatment goals. We created optimal regimes giving the same Kt/V urea and/or weekly creatinine clearance and UF as a standard (6 × 2 L 1.36%) and an adapted (2 × 1.5L 1.36% + 3 × 3L 1.36%) regime.


Compared to the non-optimized (standard and adapted, see Figure A) regimes, optimized regimes for creatinine (35 L/week; see Figure B and C) and UF (0.5 L/day) demonstrated marked reductions (up to 40%) in glucose absorption (G abs), having a similar sodium and phosphate removal (see Table). Optimizing for urea Kt/V (1.40 /week; PD-only; see Figure A) and UF (0.5 L/day) leads to a slightly lower creatinine and phosphate removal but leads to a shorter treatment time. Larger fill volumes of 1200 mL/m2 (UF cycles) and 1400 mL/m2 (Clearance cycles) can be applied to shorten the total treatment time.


These simulations suggest that great reductions in treatment time and in glucose absorption are possible using a novel optimization technique for APD prescription. Further studies are needed to evaluate the feasibility of these novel regimens.

RegimeSodium Removal (mmol/d) †Urea Kt/V †Phosphate
(L/w) †
Standard 6 x 2 L 1.36%531.3829
Adapted APD541.4031
Optimized 12 L ‡511.4030
Optimized 23.6 L *591.5630
Optimized 32.8 L *551.6431

† PD only. ‡ optimized for urea Kt/V and UF, see text. * optimized for creatinine clearance and UF, see text.

Optimized APD


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