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Optimizing Automate...
Optimizing Automated Peritoneal Dialysis Using an Extended 3-Pore Model
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- Öberg, Carl M. (author)
- Lund University,Lunds universitet,Njurfysiologi och peritonealdialys,Forskargrupper vid Lunds universitet,Renal physiology and peritoneal dialysis,Lund University Research Groups,Skåne University Hospital
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- Rippe, Bengt (author)
- Skåne University Hospital
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(creator_code:org_t)
- Elsevier BV, 2017
- 2017
- English 9 s.
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In: Kidney International Reports. - : Elsevier BV. - 2468-0249. ; 2:5, s. 943-951
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http://dx.doi.org/10... (free)
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http://www.kireports...
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Abstract
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- Introduction In the current study, an extended 3-pore model (TPM) is presented and applied to the problem of optimizing automated peritoneal dialysis (APD) with regard to osmotic water transport (UF), small/middle-molecule clearance, and glucose absorption. Methods Simulations were performed for either intermittent APD (IPD) or tidal APD (TPD). IPD was simulated for fill and drain volumes of 2 L, whereas TPD was simulated using a tidal volume of 0.5 L, 1 L, or 1.5 L with full drains and subsequent fills (2 L) occurring after every fifth dwell. A total of 25 cycles for a large number of different dialysate flow rates (DFR) were simulated using 3 different glucose concentrations (1.36%, 2.27%, and 3.86%) and 3 different peritoneal transport types: slow (peritoneal equilibrium test D/Pcrea < 0.6), fast (peritoneal equilibrium test D/Pcrea > 0.8), and average. Solute clearance and UF were simulated to occur during the entire dwell, including both fill and drain periods. Results It is demonstrated that DFRs exceeding ∼ 3 L/h are of little benefit both for UF and small-solute transport, whereas middle-molecule clearance is enhanced at higher DFRs. The simulations predict that large reductions (> 20%) in glucose absorption are possible by using moderately higher DFRs than a standard 6 × 2 L prescription and by using shorter optimized “bi-modal” APD regimens that alternate between a glucose-free solution and a glucose-containing solution. Discussion Reductions in glucose absorption appear to be significant with the proposed regimens for APD; however, further research is needed to assess the feasibility and safety of these regimens.
Subject headings
- TEKNIK OCH TEKNOLOGIER -- Medicinteknik -- Annan medicinteknik (hsv//swe)
- ENGINEERING AND TECHNOLOGY -- Medical Engineering -- Other Medical Engineering (hsv//eng)
Keyword
- 3-pore model
- automated peritoneal dialysis
- dialysis efficiency
- PD prescription
- urea kinetics
Publication and Content Type
- art (subject category)
- ref (subject category)
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