Nephrology Dialysis Transplantation, Vol 12, Issue 10 2128-2132, Copyright © 1997 by Oxford University Press
K Aasarod, T Wideroe and S Flakne
Background: The most efficient way to perform
automated peritoneal dialysis (APD) has not yet been defined. Tidal
peritoneal dialysis (TPD) has been claimed to be more efficient than
traditional intermittent peritoneal dialysis (IPD), but few comparative
studies have been done keeping dialysate flow the same in the two treatment
techniques. Method: Six patients were treated with 10,
14 and 24 litres total dialysis fluid volume during 9 h (flow rate 18,5,
25.9 and 44.4 ml/min), receiving the treatments both as IPD and TPD.
Glucose concentration in the fluid was held constant during all treatments.
Transperitoneal clearances (ml/min) for urea, creatinine and uric acid and
ultrafiltration volume was calculated, and comparisons made between TPD and
IPD. The total intraperitoneal dwell time was calculated for each treatment
session. A peritoneal equilibration test was also done for each patient.
Results: The ratio of the creatinine concentration in
dialysate to the concentration in plasma at 4 h obtained with the
peritoneal equilibration test (PET) averaged 0.77 (range 0.69-0.82). Urea
clearance was higher for IPD than for TPD with 10 litres:
14.3±2.4 and 13.3±2.7 (P=0.0092). For 14 and 24
litres urea clearance for IPD and TPD was 17.9±2.3 and
15.9±3.5 (n.s.) and 20.9±3.6 and 19.9±5.6
(n.s) respectively. Creatinine clearance was higher for IPD than for TPD
with 10 litres: 9.6±1.3 and 8.9±1.3 (P=0.0002). For
14 and 24 litres creatinine clearance for IPD and TPD was
11.0±0.7 and 9.9±2.0 (n.s.) and 12.3±1.2
and 12.4±2.2 (n.s.) respectively. Uric acid clearance was higher
for IPD than for TPD with 10 litres: 8.4±1.3 and
7.7±1.0 (p=0.0054). For 14 and 24 litres uric acid clearance for
IPD and TPD was 9.4±1.7 and 8.9±2.2 (n.s.) and
11.3±2.9 and 10.6±2.6 (n.s.) respectively. IPD gave
significantly higher ultrafiltration volume (ml) than IPD for both 10 and
14 litres: 944±278 and 783±200 (P=0.0313) and
1147±202 and 937±211 (P=0.0478). For 24 litres there
was no significant difference between IPD and TPD: 1220±224 and
1253±256. Conclusion: With the lowest
dialysate flow rate (18.5 ml/min), solute clearance and ultrafiltration
volume was higher on IPD than on TPD. With the intermediate flow rate (25.9
ml/min) the ultrafiltration volume was higher on IPD, but no difference was
found for solute clearance. With the highest flow rate (44.4 ml/min) there
as no difference neither for ultrafiltration nor for solute clearance.
Keywords: automated peritoneal dialysis; dialysate
flow rate; solute clearance; tidal peritoneal dialysis; ultrafiltration
ORIGINAL ARTICLES
A comparison of solute clearance and ultrafiltration volume in peritoneal dialysis with total or fractional (50%) intraperitoneal volume exchange with the same dialysate flow rate
Department of Medicine, Division of Nephrology, University Hospital of Trondheim, N-7006 Trondheim, Norway; Corresponding author
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