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. 2022 Jan;17(1):107-110.
doi: 10.2215/CJN.08180621. Epub 2021 Dec 10.

Monitoring Daily Ultrafiltration in Automated Peritoneal Dialysis

Fabian Eibensteiner  1 , Krystell Oviedo Flores  2 , Markus Unterwurzacher  1   3 , Rebecca Herzog  1   3 , Klaus Kratochwill  1   3 , Seth L Alper  4   5 , Christoph Aufricht  1 , Franz König  6 , Andreas Vychytil  2
Affiliations

Monitoring Daily Ultrafiltration in Automated Peritoneal Dialysis

Fabian Eibensteiner et al. Clin J Am Soc Nephrol. 2022 Jan.
No abstract available

Keywords: chronic dialysis; peritoneal dialysis; peritoneal membrane; ultrafiltration.

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Figures

Figure 1.
Figure 1.
Daily ultrafiltration in automated peritoneal dialysis. (A) Reconstruction of automated peritoneal dialysis cycler readouts with accompanying peritoneal dialysis prescriptions for one representative patient. The green line displays daily cycler ultrafiltration (UF) measurements (ml/day), the blue line displays daily cycler glucose loads (g/day), and the red vertical line marks a peritonitis episode. (B) Ultrafiltration trends (ml/day) were modeled over time on peritoneal dialysis (PD) with mixed models for repeated measurements for all patients represented by the black line and density of measurement points by color ranging from purple (low) to yellow (high density). UF (ml/day) and glucose-corrected UF (ml/g/day) significantly increased over time, with respective slopes of 0.25 (95% confidence interval [95% CI], 0.07 to 0.43) and 0.0007 (95% CI, 0.00005 to 0.0014). Upon adjustment for residual kidney function, UF and glucose-corrected UF increments over time decreased and were no longer significant (0.09 [95% CI, −0.07 to 0.26], −0.0003 [95% CI, −0.0009 to 0.0003]). (C) Glucose-corrected UF (ml/g/day) is represented by the purple dashed line for low–glucose degradation products (GDP) dialysate and by the solid orange line for high-GDP dialysate (regression lines truncated at 3 years). In the low-GDP group, UF (ml/day) and glucose-corrected UF (ml/g/day) significantly increased over time with respective slopes of 0.45 (95% CI, 0.17 to 0.73) and 0.002 (0.001 to 0.003). In contrast, in the high-GDP group, UF (ml/day) and glucose-corrected UF (ml/g/day) did not significantly change over time, with respective slopes of 0.14 (95% CI, −0.08 to 0.37) and 0.00008 (−0.0009 to 0.001). The interaction estimates of the joint model, implicating a difference between the two groups, was significant for glucose-corrected UF with an estimate of 0.002 (95% CI, 0.0005 to 0.004) in contrast to UF with an estimate of 0.31 (95% CI, −0.05 to 0.66). (D) Glucose-corrected UF before (median [interquartile range] 2.03 [95% CI, 0.93 to 3.3]) and after each peritonitis episode (median [interquartile range] 1.95 [95% CI, 0.82 to 3.06]). Median 30-day UF and glucose-corrected UF significantly decreased after peritonitis (black dashed line) by −20% (95% CI, −51% to +3%). Differences in distributions of patients destined for kidney transplantation (green, left panel) and those destined for transfer to hemodialysis (red, right panel) below and above the median decrement (= black dashed line) were significant (P<0.05). (E) Changes of glucose-corrected UF during the final 6 months of automated peritoneal dialysis. Glucose-corrected UF significantly decreased in patients later transferred to hemodialysis (red lines and symbols, right panel, slope −0.007 [95% CI −0.01 to −0.002]) in contrast to glucose-corrected UF in patients eventually transplanted (green lines and symbols, left panel, slope −0.003 [95% CI, −0.008 to 0.001]).
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