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In vitro efficacy and safety of a system for sorbent-assisted peritoneal dialysis.

Authors
  • van Gelder, Maaike K1
  • Ligabue, Giulia2
  • Giovanella, Silvia2
  • Bianchini, Elena2
  • Simonis, Frank3
  • Hazenbrink, Diënty H M1
  • Joles, Jaap A1
  • Bajo Rubio, Maria A4
  • Selgas, Rafael4
  • Cappelli, Gianni2
  • Gerritsen, Karin G F1
  • 1 Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands. , (Netherlands)
  • 2 Division of Nephrology, Surgical, Medical, Dental, Morphology Sciences, Transplant, Oncology and Regenerative Medicine Department, University of Modena and Reggio Emilia, Modena, Italy. , (Italy)
  • 3 Nanodialysis BV, Oirschot, The Netherlands. , (Netherlands)
  • 4 Nephrology Service, Hospital Universitario La Paz, Institute for Health Research, Instituto Reina Sofía de Investigación en Nefrología, the Spanish Renal Research Network, Madrid, Spain. , (Spain)
Type
Published Article
Journal
AJP Renal Physiology
Publisher
American Physiological Society
Publication Date
Aug 01, 2020
Volume
319
Issue
2
Identifiers
DOI: 10.1152/ajprenal.00079.2020
PMID: 32475132
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

A system for sorbent-assisted peritoneal dialysis (SAPD) was designed to continuously recirculate dialysate via a tidal mode using a single lumen peritoneal catheter with regeneration of spent dialysate by means of sorbent technology. We hypothesize that SAPD treatment will maintain a high plasma-to-dialysate concentration gradient and increase the mass transfer area coefficient of solutes. Thereby, the SAPD system may enhance clearance while reducing the number of exchanges. Application is envisaged at night as a bedside device (12 kg, nighttime system). A wearable system (2.0 kg, daytime system) may further enhance clearance during the day. Urea, creatinine, and phosphate removal were studied with the daytime and nighttime system (n = 3 per system) by recirculating 2 liters of spent peritoneal dialysate via a tidal mode (mean flow rate: 50 and 100 mL/min, respectively) for 8 h in vitro. Time-averaged plasma clearance over 24 h was modeled assuming one 2 liter exchange/day, an increase in mass transfer area coefficient, and 0.9 liters ultrafiltration/day. Urea, creatinine, and phosphate removal was 33.2 ± 4.1, 5.3 ± 0.5, and 6.2 ± 1.8 mmol, respectively, with the daytime system and 204 ± 28, 10.3 ± 2.4, and 11.4 ± 2.1 mmol, respectively, with the nighttime system. Time-averaged plasma clearances of urea, creatinine and phosphate were 9.6 ± 1.1, 9.6 ± 1.7, and 7.0 ± 0.9 mL/min, respectively, with the nighttime system and 10.8 ± 1.1, 13.4 ± 1.8, and 9.7 ± 1.6 mL/min, respectively, with the daytime and nighttime system. SAPD treatment may improve removal of uremic toxins compared with conventional peritoneal dialysis, provided that peritoneal mass transport will increase.

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