Abstract: FR-PO669
Simultaneous Optimization of Ultrafiltration and Solute Transport in Automated Peritoneal Dialysis (APD)
Session Information
- Dialysis: Peritoneal Dialysis - II
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- 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
Background
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.
Methods
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.
Results
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.
Conclusion
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.
| Regime | Sodium Removal (mmol/d) † | Urea Kt/V † | Phosphate Clearance (L/w) † |
| Standard 6 x 2 L 1.36% | 53 | 1.38 | 29 |
| Adapted APD | 54 | 1.40 | 31 |
| Optimized 12 L ‡ | 51 | 1.40 | 30 |
| Optimized 23.6 L * | 59 | 1.56 | 30 |
| Optimized 32.8 L * | 55 | 1.64 | 31 |
† PD only. ‡ optimized for urea Kt/V and UF, see text. * optimized for creatinine clearance and UF, see text.
Optimized APD
Funding
- Private Foundation Support