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

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.

Evaluation of a system for sorbent‐assisted peritoneal dialysis in a uremic pig model

“…In addition, slow equilibration between plasma and intraperitoneal compartment in the pig limited lactate release. In vitro, we have demonstrated that cumulative base release by the nighttime system is sufficient (≥70 mmol) in case of metabolic acidosis (van Gelder, Ligabue, et al, 2020). Importantly, the capacity of the sorbents to release bicarbonate is highly concentration-dependent, an important safety characteristic of the device.…”

“…Consequently, solute concentrations in peritoneal effluent entering the SAPD system were low, accounting for the low absolute removal by the system. Of note, in vitro studies showed that in case of higher toxin delivery to the system the capacity of the system was sufficient to remove the daily toxin production (van Gelder, Ligabue, et al, 2020). The increase of the MTAC during SAPD treatment (1.1-to 1.3-fold for urea and 1.2-to 2.3-fold for creatinine vs. a static dwell) was lower than previously reported in patients treated with CFPD (1.5-to 2.5-fold for urea and 1.4-to 2.5-fold for creatinine) (Amerling et al, 2001;Cruz et al, 2001;Freida & Issad, 2003;Raaijmakers et al, 2011).…”

Artificial Kidney Engineering: The Development of Dialysis Membranes for Blood Purification

“…Although peritoneal dialysis is associated with less life-style restriction for patients compared with hemodialysis, storage and transportation of dialysate are still an issue for patients and limit their daily activities. Several peritoneal dialysis-based wearable devices are under development currently including the AWAK project by AWAK Technologies (Singapore) [53], the WEAKID project by Nanodialysis Inc (Oirschot, The Netherlands) [52,99], and CarryLife project by Triomed (Lund, Sweden) [51].…”

“…Several human trials for peritoneal dialysis-based wearable devices are still under study. Current published research revealed sufficient dialysis clearance without severe adverse events [53,99]. Abdominal discomfort is the most common side effect [53].…”

Innovationen in der Peritonealdialyse

“…[30]. Andere Verfahren verwenden zusätzlich Austauscherharze oder versuchen, durch Dilution eine Harnstoffelimination zu erreichen [35]. Darüber hinaus werden photo-und elektrooxidative Verfahren für die Lösung des "Harnstoffproblems" getestet [14].…”