A Prescription Model for Peritoneal Dialysis

Robertson, Bruce C.; Juhasz, Nikola M.; Walker, Phillip; K, Raymond; Taber, Tim E.; Adcock, Angela A.

doi:10.1097/00002480-199541010-00020

Cited by 5 publications

(5 citation statements)

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“…These enhancements include modifying the solute mass transport equations to better reflect the role of solute absorption and updating solute mass transfer area coefficients (MTACs) to reflect their dependence on both fill volumes and dwell times [22][23][24][25]. The clinical application of PD Adequest 2.0 was subsequently validated in a multinational study of 104 adult patients conducted by Vonesh et al [6].…”

Section: Discussionmentioning

confidence: 99%

Validation of PD Adequest 2.0 for pediatric dialysis patients

Warady

Watkins

Fivush

et al. 2001

Pediatric Nephrology

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Kinetic modeling has proven to be a valuable tool for peritoneal dialysis (PD) prescription in adult PD patients. The clinical application of this procedure has rarely been studied in children. We therefore evaluated the PD Adequest 2.0 for Windows program (Baxter Healthcare Co., Deerfield, IL) as a prescription aid for the management of pediatric PD patients by comparing the measured and predicted PD clearances, total drain volumes, and net ultrafiltration in 34 children (15 males) (mean age 10.9 +/- 6.0 years) receiving long-term PD. In each case, a 4-h peritoneal equilibration test was conducted with a standardized test exchange volume of 1,100 ml/m2 BSA. A total of 43 24-h dialysate (plus urine in 12) collections were analyzed. The levels of agreement between measured and predicted values for weekly peritoneal and total urea Kt/V, weekly peritoneal and total creatinine clearance, daily drain volume, net ultrafiltration and daily peritoneal urea and creatinine mass removal were assessed with correlation coefficients (re) and Bland-Altman limits of agreement. The study revealed that there is a basic level of agreement between measured and modeled values for solute removal and total drain volume, with correlation coefficients ranging from 0.75 to 0.98. In contrast, the rc for net ultrafiltration was only 0.34. The majority (75%) of patients had modeled urea and creatinine clearances that were within 20% of their measured values. These data suggest that the PD Adequest 2.0 for Windows program can predict urea and creatinine clearances with reasonable accuracy in pediatric PD patients, making it a valuable resource in prescription management.

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Section: Discussionmentioning

confidence: 99%

Validation of PD Adequest 2.0 for pediatric dialysis patients

Warady

Watkins

Fivush

et al. 2001

Pediatric Nephrology

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“…The literature does not always clearly indicate whether that volume is included. Residual volume is regularly included in studies with dilution markers for peritoneal volume (5,11,27,36,38,39), but it is lacking in calculations made by simplified logarithmic or other methods (2,25-27,40,43). The presence or absence of adjustment for residual volume could also have contributed to the varying MTAC results, although many other causes related to the programs may have been present.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Function and Adequacy Calculations: Current Programs versus PD Adequest 2.0

Teixidó-Planas

2002

Perit Dial Int

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Objective Our current programs (CPs) were compared to PD Adequest 2.0 (PD-A) for calculations of peritoneal membrane transport and dialysis adequacy. Design Thirty peritoneal equilibration tests (PETs) and 24-hour balances (24hBs) were conducted and calculated using our CPs and PD-A. Patients and Methods Thirty hospital-controlled peritoneal dialysis (PD) patients were studied. The inclusion of correction factors (for glucose or plasmatic water) and of residual volume, and the use of 3 or 6 peritoneal samples were analyzed to discover the differences between programs. The main outcome measures were peritoneal permeability and adequacy parameters, evaluated by Student t-test (mean and paired comparisons) and linear regression for correlation. Results No significant differences were found in D/P values for small solutes. At the first step, mass transfer area coefficient (MTAC) urea and MTAC creatinine were significantly higher in DP-A than in CP, but MTAC glucose did not differ. The causes of differences were: ( 1 ) inclusion of a correction factor for aqueous plasmatic concentration of small solutes in CP; ( 2 ) lack of inclusion of residual volume in peritoneal volumes in CP; and ( 3 ) use of 6 peritoneal samples in CP versus 3 in PD-A. At the second step, when the input data were made equivalent for both programs, the differences disappeared for MTAC urea, creatinine, and glucose (mean comparison), but creatinine and glucose remained different by paired comparison. Similar results were obtained when a correction for plasmatic aqueous concentration was applied to the data in both programs [MTAC urea: 22.60 ± 4.27 mL/min (CP) vs 22.43 ± 4.61 mL/min (PD-A), nonsignificant, r = 0.97; MTAC creatinine: 9.76 ± 3.83 mL/min (CP) vs 10.61 ± 3.07 mL/min (PD-A), nonsignificant, r = 0.98; MTAC glucose: 13.30 ± 3.12 mL/min (CP) vs 11.87 ± 3.41 mL/min (PD-A), nonsignificant, r = 0.92]. Creatinine and glucose were different by paired t-test. No significant differences were found in Kt/V and urea generation rate. Weekly creatinine clearance [WCCr: 70.71±16.71 L (CP) versus 79.33±18.73 L (PD-A), p < 0.001] and creatinine generation rate [CrGR: 0.56 ± 0.18 mg/min (CP) versus 0.61±0.19 mg/min (PD-A), p < 0.001) were significantly higher in PD-A than in CP owing to the lack of creatinine correction according to glucose concentration in the PD-A adequacy program. Finally, normalized protein nitrogen appearance according to Bergström [1.09 ± 0.20 g/kg/d (CP) versus 1.03 ± 0.21 g/kg/d (PD-A), p = 0.01] was different owing to the different algorithms and normalization method: standardized body weight in CP and actual body weight in PD-A. Conclusions Provided that equivalent data are used, PD-A and CP yield similar results. The PD-A program needs external correction of data input: ( 1 ) for plasmatic water concentration in MTAC calculations, and ( 2 ) for peritoneal glucose interference with creatinine analysis (Jaffé method) in WCCr and CrGR calculations; otherwise, it may give falsely optimistic results.

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“…In their original model, Pyle and Popovich express convective mass transport in terms of the net ultrafiltration (UF) rate, Q U (t). Robertson et al (24) and Waniewski et al (25) have noted the correct application of the model is obtained by replacing the net UF rate with the transcapillary UF rate, Q V (t), and by including a term in the model to describe solute absorption. This leads to what we call the modified Pyle-Popovich model in which mass transport is described by the following set of mass transfer equations: Modified Pyle-Popovich model of solute mass transport: body:…”

Section: Appendixmentioning

confidence: 99%

“…Several of these have been implemented in the newly released PD ADEQUEST 2.0 for Windows. These enhancements include modifying the solute mass transport equations to better reflect the role of solute absorption (24,25), and updating solute mass transfer area coefficients (MTACs) to reflect their dependence on both fill volumes (26) and dwell times (27).…”

mentioning

confidence: 99%

“…With respect to the first enhancement, Robertson et al (24) and Waniewski et al (25) have noted that the correct application of the Pyle-Popovich model of solute transport is obtained by modeling convective mass transport on the basis of the transcapillary UF rate rather than the net UF rate. Both authors also cite the need to include a term in the model that explicitly accounts for solute absorption via the lymphatic pathway and other fluid absorption pathways.…”

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confidence: 99%

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A Multinational Clinical Validation Study of Pd Adequest 2.0

1999

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Objective To clinically validate the use of the newly released kinetic modeling program, PD ADEQUEST 2.0 for Windows (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), by assessing the level of agreement between measured and modeled values of urea and creatinine clearances (CCr), glucose absorption, total drain volumes, and net ultrafiltration for all forms of peritoneal dialysis. Design A nonrandomized, multinational, prospective longitudinal study. Patients The study involved 104 adult patients [41 on continuous ambulatory peritoneal dialysis (CAPD), 63 on automated peritoneal dialysis (APD)] from 16 centers in 7 countries. All patients underwent a 4-hour peritoneal equilibration test (PET) but with varying percentage dextrose concentrations (1.5% or 2.5% dextrose) and varying fill volumes (range 1.5 – 2.5 L). Patients with a residual renal function greater than 10 mL/min were excluded, as were patients who had peritonitis within 6 weeks prior to baseline. Main Outcome Measures Correlation coefficients and Bland–Altman limits of agreement were used to assess the level of agreement between measured and modeled values of weekly peritoneal urea Kt/V (pKt/V) and total Kt/V, weekly peritoneal creatinine clearance (pCCr, L/week/ 1.73 m2) and total CCr (L/week/1.73 m2), daily drain volume (L/day), net ultrafiltration (UF, L/day), daily peritoneal urea and creatinine mass removal (g/day), and daily peritoneal glucose absorption (g/day). Measured values were obtained from three repeat 24-hour urine and dialysate collections per patient, while modeled values were calculated using the Baxter PD ADEQUEST 2.0 program in conjunction with kinetic parameters estimated from a 4-hour PET and long-dwell exchange independent of the 24-hour collections. Results The results show there is excellent agreement between measured and modeled urea Kt/V and CCr with concordance correlation coefficients ranging from 0.83 to 0.97 among CAPD and APD patients. There was also excellent agreement between measured and modeled values of glucose absorption and total drain volumes (concordance correlations of 0.90 and 0.98, respectively). This level of agreement was further supported by a Bland– Altman analysis of individual differences, including differences between measured and modeled net UF (coefficient of clinical agreement ranged from 0.66 to 0.92). Conclusions Data from a carefully performed PET and overnight exchange can, in combination with a scientifically and clinically validated kinetic model, provide clinicians with a powerful mathematical tool for use in CAPD and APD prescription management. Although not intended to replace actual measurements, kinetic modeling can prove useful as a means for quickly estimating approximate levels of clearance for a wide variety of alternative prescriptions. This, in turn, should speed up the process by which a physician can optimize the dose of dialysis suitable for a given patient and his/her lifestyle.

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A Prescription Model for Peritoneal Dialysis

Cited by 5 publications

References 0 publications

Validation of PD Adequest 2.0 for pediatric dialysis patients

Validation of PD Adequest 2.0 for pediatric dialysis patients

Peritoneal Function and Adequacy Calculations: Current Programs versus PD Adequest 2.0

A Multinational Clinical Validation Study of Pd Adequest 2.0

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