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Abstract: TH-PO292

Peritoneal Sodium Removal Technique with Salt-Free Solution in Pigs

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Turner, Jeffrey M., Yale University, Hamden, Connecticut, United States
  • Finkelstein, Fredric O., Yale University, Hamden, Connecticut, United States
  • Mahoney, Devin, Yale University, Hamden, Connecticut, United States
  • Griffin, Matthew, Yale School of Medicine, New Haven, Connecticut, United States
  • Rao, Veena, Yale University, Hamden, Connecticut, United States
  • Testani, Jeffrey M., Yale University, Hamden, Connecticut, United States
Background

Over time, interest in the concept of sodium and fluid removal via non-renal routes in heart failure (HF) has grown significantly. One approach to removing sodium and fluid without diuretics is peritoneal dialysis (PD). Traditional PD, however, is ineffecient in that it requires large intraperitoneal volumes with long dwell times while only offering limited sodium and fluid removal. Utilization of salt free peritoneal solution will result in removal of a clinically significant amount of sodium and fluid.

Methods

Eighty kg anesthetized pigs (N=15) underwent surgical implantation of PD catheters. In 5 pigs, we allowed a 6 hour dwell and the intraperitoneal volume was determined serially using indicator dilution technique with I-131 radiolabeled albumin. 10 pigs underwent a 2 hour dwell with fluid volume measured by manual removal. To understand the effects of higher peritoneal solution volumes, 4 of these pigs then underwent 4 cycles of 2.5 L of 10% dextrose with 90 minute dwell times, for a total of 11 L cycled. These 4 animals had plasma volume measured with I-131 radiolabeled albumin prior to and after cycling was complete. Serial plasma and peritoneal fluid samples were obtained and glucose and electrolyte concentrations were determined.

Results

In the 5 animals with a 6 hour dwell, ultrafiltration approached 1.5 L and 5.1 +/- 0.4 grams of sodium was removed. In the 10 pigs that underwent a 2 hour dwell, an average of 0.9 +/- 0.2 L of ultrafiltration occurred with a corresponding 3.9 +/- 0.5 g of sodium removed. Despite a large sodium removal, the average decrease in serum sodium concentration following the 2-hour dwell was only 2.2 +/- 0.3 mmol/L (P < 0.0001). In the pigs that underwent fluid cycling, an average of 22.5 +/- 3.5 g of sodium was removed and plasma volume decreased dramatically in these animals.

Conclusion

Peritoneal sodium removal with salt free solution is capable of removing large quantities of fluid and sodium with relatively small intraperitoneal volumes. Additional research is required to understand the safety/tolerability of this approach in humans, development of optimal solutions and protocols for fluid instillation and removal from the peritoneum.

Funding

  • Commercial Support