Relationship between Drain Volume/Fill Volume Ratio and Clinical Outcomes Associated with Overfill Complaints in Peritoneal Dialysis Patients

Davis, Ira D.; Čižman, Borut; Mundt, Kelly; Wu, LieLing; Childers, Robert; Mell, Rod; Prichard, Sarah

doi:10.3747/pdi.2010.00012

Cited by 15 publications

(16 citation statements)

References 32 publications

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“…As with all other considerations with regard to PD prescription, clinicians must consider individual patient tolerance to a specific fill volume. While abdominal compliance and tolerance to larger fill volumes is greater when patients are in the supine position, individual body size, habitus, and comorbidities may increase intraperitoneal pressures to undesirable levels, potentially compromising patient safety, particularly after ultrafiltrate is added to the dwell volume (40,41). If nothing else, demonstration of extremes of PD prescription, such as 3-L fill volumes that would be needed to achieve adequacy for patients with < 2mL/min of residual renal urea clearance, higher V urea , and slower membrane transport function, should help highlight for prescribers when it might be appropriate to consider transfer to another dialysis modality, particularly if APD is not an option.…”

Section: Resultsmentioning

confidence: 99%

Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

et al. 2015

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♦ Background: The use of automated and continuous ambulatory peritoneal dialysis (APD and CAPD) prescriptions (Rxs) to achieve adequate uremic toxin and fluid removal targets is important for attaining optimal patient outcomes. One approach for predicting such Rxs is the use of kinetic modeling. ♦ Methods: Demographic data and peritoneal membrane characteristics derived from a peritoneal equilibration test (PET) were available from 1,005 patients in North American centers who participated in a national adequacy initiative in 1999. Twelve patient subgroups were identified according to peritoneal membrane transport type and tertiles of total body water, assumed equal to urea distribution volume (V urea ). Each patient was then modeled using PD Adequest 2.0 to be treated by 12 CAPD and 34 APD Rxs using both glucose and icodextrin solutions to achieve adequacy targets of weekly urea Kt/V of 1.7 and 1 L of daily ultrafiltration (UF). Residual kidney function (RKF) was assumed to be 0, 2, 4, and 6 mL/min. Feasible peritoneal dialysis (PD) Rxs were identified where: 1) the 95% confidence limit achieved the goal of meeting the targets for urea Kt/V, daily UF, and both in 85%, 75%, and 70% of patients, respectively; 2) average PD solution dextrose concentration was < 2.5%; and 3) the number of daytime exchanges was minimized. ♦ Results: Feasible PD Rxs were similar when RKF was ≥ 2 mL/min, allowing condensed recommendations based on RKF ≥ 2 mL/min or < 2 mL/min. Individuals with lower or slower membrane transport required relatively greater 24-h solution volumes to achieve adequacy targets when RKF fell below 2 mL/min. With increasing V urea , there was disproportionately greater dependence on RKF to achieve targets. While multiple Rxs achieving urea Kt/V and daily UF goals were identified for all membrane transport types, use of icodextrin in the long dwell reduced the need for a midday exchange in APD, glucose exposure, required fill and 24-h dwell volumes, irrespective of RKF and V urea . While these benefits were most notable in high and high-average transporters, similar results were also seen in low and low-average transporters.

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Section: Resultsmentioning

confidence: 99%

Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

et al. 2015

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“…In a recent study, Davis et al (30) reported that insufficient drain was associated with 88% of the increased intraperitoneal volume cases they analyzed. Their finding suggests that potential causes of increased V R should be explored by the attending clinical team in situations in which UF with icodextrin is considerably less than predicted.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal Residual Volume Induces Variability of Ultrafiltration with Icodextrin

2014

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♦ Background: Icodextrin induces ultrafiltration (UF) during long-dwell exchanges by creating a difference in oncotic pressure between the peritoneal cavity and plasma; however, the mechanisms governing intra-patient and inter-patient variability in UF when icodextrin is used remain largely unexplained. In the present study, we show theoretically that differences in peritoneal residual volume (V R ) have a more profound effect on UF with icodextrin use than with glucose use. This phenomenon is attributed to a differential effect of V R on oncotic, rather than osmotic, pressure between the peritoneal cavity and plasma. ♦ Methods: The three-pore model was used to calculate the effect on UF of V R between 150 mL and 1200 mL when 7.5% icodextrin (ICO) or 3.86% glucose solution is used at the end of a 12-hour dwell in the four patient transport groups (that is, fast to slow). Oncotic (with ICO) and osmotic (with glucose) pressure differences averaged over the entire dwell were also calculated. ♦ Results: As expected, at a nominal V R of 300 mL, UF with glucose differed substantially between the four patient transport groups (2 -804 mL), whereas UF with ICO did not (556 -573 mL). When V R was increased to 1200 mL from 150 mL, the concentrations of the oncotic and osmotic agents at the start of the dwell with an infusion volume of 2 L decreased to 4.9% from 7.0% with ICO and to 2.5% from 3.6% with glucose. The decrease in UF on average was greater with ICO [to 252 mL from 624 mL: that is, a reduction of 372 mL (60%)] than with glucose [to 292 mL from 398 mL: that is, a reduction of 106 mL (

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“…However, many events where the DV/FV was high caused very minor symptoms and the variability of the relationship of DV/FV with symptoms was noted. Over 80% of suspected significant overfill events were related to insufficient drains while much smaller numbers were due to excess infusion, device malfunction or excess ultrafiltration (1).…”

mentioning

confidence: 99%

“…A "PubMed" search reveals no articles about PD with 'drain pain' in the title and only one addressing 'overfill' in the sense of an excessive intraperitoneal dialysate volume (1). Are these complications both rare?…”

mentioning

confidence: 99%