Streaming, mixing, and recirculation: role of the peritoneal access in continuous flow peritoneal dialysis (clinical considerations)

Abstract

Continuous flow peritoneal dialysis (CFPD) is a very promising modality of PD in terms of high rates of solute removal and ultrafiltration (UF). The published clinical data are characterized by marked variability in terms of clearances and UF. Analysis of those data suggest significant streaming and recirculation with the available double-lumen catheters. A new double lumen catheter is described. It has wide separation between the limbs to minimize streaming and recirculation, and a novel geometric configuration to maximize internal cross-sectional luminal area with the lowest external diameter. Preliminary in vitro studies have shown flow rates consistent with those required for CFPD, satisfactory mixing of the fluid, and minimal streaming and recirculation. Clinical validation with long-term studies are needed to assess the viability of CFPD as a chronic renal replacement therapy.