Continuous Flow Peritoneal Dialysis: Is There a Need for it?

Abstract

Automated peritoneal dialysis (APD) is the fastest growing technique of peritoneal dialysis. However, recently APD has displayed some limitations imposed by the characteristics of the technique and by the characteristics of the peritoneal membrane of some patients. In general, the advent of a new technique such as continuous flow peritoneal dialysis (CFPD) should be seen as a benefit for several patients based on different considerations: CFPD is a high-efficiency technique which could overcome some of the limitations imposed by other techniques in terms of adequacy targets and performance. CFPD may become a useful tool to keep patients on PD who would otherwise be transferred to hemodialysis. CFPD may present advantages in terms of biocompatibility and also in terms of the possible modulation of the peritoneal solution to patient needs. Recent developments in technology seem to have made CFPD easily feasible and well tolerated. A new era of PD is probably beginning and CFPD will definitely represent one of the key issues in the future of PD.

Continuous Flow Peritoneal Dialysis

“…In general, CFPD done with two catheters has been shown to be more effective in terms of clearances achieved than when one double lumen catheter is used. This is thought to be because of streaming of dialysate directly from inflow to outflow port of the double lumen catheter, resulting in poor mixing and recirculation of dialysate, which in turn results in lower effective dialysate flow rate (30,31). With two catheters, average urea clearances of 44 to 58 ml/min have been achieved (14,22,29) versus 14 to 20 ml/min with double lumen catheters (17,32).…”

“…Abdominal pressure was carefully monitored in our study, with frequent measurements of inflow and outflow pressure at the transducers. Direct measurement of intra-abdominal pressure, however, remains a technical challenge (18,31).…”

Infections related to prosthetic materials in patients on chronic dialysis

“…In some countries ∼30% of peritoneal dialysis patients are on APD. As a consequence of trying to achieve more efficient dialysis, continuous flow peritoneal dialysis (CFPD) was introduced [24,25]. However, a final judgment about this method has not yet been made.…”