Ultrafiltration in Peritoneal Dialysis

(Download PDF) (Go to Poster ISPD 2014) (Back to Menu)

We summarize here what SCPD (Steady Concentration Peritoneal Dialysis) consists of, present the original publication and its preliminary outlines, and direct to other pages of the site on new research derived from this technique and other experiences and research that have made it possible to update a new and more refined method.

SCPD, stable concentration peritoneal dialysis, is a method that manages to increase UF in PD above 3.86% glucose. Derived from our Peritoneal Nutrition.

Abstract: Peritoneal dialysis (PD) has a very limited ultrafiltration capacity and this makes it difficult to treat water overload situations. However, the most innocuous solution used in PD, 1.36%, has in the first minutes a very high ultrafiltration power (7 ml/mn), which disappears as quickly as glucose is absorbed. Continuous Peritoneal Nutrition maintains the initial concentration of 1.36% during the entire exchange, achieving, with this innocuous peritoneal concentration, a higher ultrafiltration than that achieved with an exchange of 3.86%. This is due to the effect of the slow and continuous infusion of hyperconcentrated nutrient solutions in the peritoneal cavity previously filled with the 2L of a 1.36% exchange. With this principle, we perform in patients with severe fluid overload one or several consecutive 4-hour exchanges with 2 liters of 1.36% glucose, infusing 50% glucose at 40 mL/h and we manage to revert in a few hours their severe overload with perfect tolerance and without collateral effects, as was the case in Peritoneal Nutrition from which the method was derived.

MAIN PUBLICATION

After several presentations of preliminary aspects (see below), in 2016 the final article was published in Peritoneal Dialysis International. In addition to confirming the usefulness and safety of the technique to increase UF, it uncovered the possible influence of intraperitoneal pressure (IPP) and overhydration, which guided further investigations.

NEW PAUTA

Everything published since then on SCPD has allowed us to update the technique by designing a new performance protocol to make it more effective and safer.

SCDP, SODIUM REMOVAL AND GLUCOSE ABSORPTION.

The price of UF in PD. Cost-effectiveness of SCPD, steady concentration peritoneal dialysis (LVIII Meeting of the Sociedad Castellano-Astur-Leonesa de Nefrología, SCALN. La Granja de San Ildefonso, Segovia, Spain, 23-24 September 2022). Abstract Presentation

PRELIMINARY PRESENTATIONS OF PARTIAL ASPECTS ON SCPD

1.- Maintenance in PD technique to high transporter patients (LI Meeting of the Sociedad Castellano Astur Leonesa de Nefrología SCALN, Burgos, Spain, 24-25 October 2014) . Abstract Presentation

2.- UF2 How ultrafiltration in peritoneal dialysis is squared (Grupo Centro de diálisis peritoneal GCDP, Madrid, Spain, 29 October 2014). Presentation

Treatment of fluid overload in PD by the method of Continuous Peritoneal Nutrition. (15th Congress of the International Society for Peritoneal Dialysis 7th-10th september 2014. Madrid, Spain) Abstract Poster

A new method to increase ultrafiltration in peritoneal dialysis (Research Session of the Hospital Clínico Universitario de Valladolid, Spain, 27th March 2015). Presentation

5.- The degree of fluid overload influences UF response to steady concentration peritoneal dialysis (SCPD). (XLV Congress of the Spanish Society of Nephrology SEN. Valencia, Spain, 3-6 Oct 2015). Abstract Presentation

Inverse relationship between ultrafiltration and osmotic gradient in steady concentration peritoneal dialysis (SCPD). Implications of intraperitoneal pressure. (IX National Meeting of Peritoneal Dialysis. Cáceres, Spain, 28-30 January 2016). Abstract Presentation

OTHER RELATED RESEARCH

Influence on UF in PD of Intraabdominal Pressure, overhydration, hypoalbuminemia, gender-linked characteristics.

TREATMENT OF FLUID OVERLOAD IN PERITONEAL DIALYSIS BY THE METHOD OF CONTINUOUS PERITONEAL NUTRITION.

G. Rodriguez-Portela¹, S. Valenciano-Martinez¹, S. Palomo-Aparicio¹, D.E. Vasquez-Blandino¹, S. Sanz-Ballesteros¹, R. Gordillo-Martin, E. Hernandez-Garcia², L. Sanchez-Garcia³, V.Perez-Diaz¹,

¹Hospital Clínico Universitario de Valladolid, ²Hospital Rio Carrion de Palencia, ³Hospital Universitario Rio Hortega de Valladolid. Spain.

Objectives: The limited ultrafiltration capacity of peritoneal dialysis (PD) hinders the treatment of fluid overload situations. The most innocuous PD solution (1.36%) has in the first few minutes a high power of ultrafiltration (7ml/min), but this power decreases quickly as glucose is absorbed. Continuous Peritoneal Nutrition¹ maintains the initial concentration of 1.36% during all the dwell time, achieving an ultrafiltration higher than that of 3.86% PD solutions with a much safer solution. This is achieved by slow infusion of hyperconcentrated solutions of nutrients on the intraperitoneal 2L volume of 1.36% PD solution. Here we evaluate this method for the treatment of fluid overload in PD.

Methods: We tested this procedure on PD patients with symptomatic fluid overload superior to 3 liters, not reversible through its PD regimen. We applied a single session of automated PD with 3 dwells of 4 hours of 2 liter 1.36% solution, infusing during dwell periods 40 ml/h solution glucose 50%.

Results: As in Continuous Peritoneal Nutrition, concentration of intraperitoneal glucose remained close to 1500 mg/dl and serum glucose urea, creatinine and K remained stable. We achieve a high ultrafiltration of 433 to 928 ml per 4 hours dwell and 1850 to 2445 ml for the whole session of 3 dwells. The patients restored their water balance and recovered from heart failure. After this single session of continuous peritoneal nutrition, in the following months the balance was maintained with less difficulty through diet and PD.

Conclusions: We demonstrate the usefulness and safety of occasional use of this technique in PD patients with fluid overload, achieving high ultrafiltration without interfering with the PD, causing harmful hyperglycemia nor exposing the peritoneum to high concentrations of glucose.

1.- Nutrición peritoneal continua en pacientes en DPAC. de Alvaro, et al. Nefrología.1988.8:supl3.75-80. (PDF)

(Download PDF) (Go to Poster ISPD 2014) (Back to Menu)