Innovative peritoneal dialysis: Flow-thru and dialysate regeneration

As the peritoneal dialysis (PD) patient's residual renal function declines, the dialysis dose must be increased. However, the options for increasing t he dose are limited to increasing the number of exchanges and/or the volume of each exchange. A review of the literature indicates that the dialysis d ose can be significantly increased by flow-through PD, wherein the dialysat e flows continuously into the peritoneal cavity through one catheter and ou t another and/or by regenerating the spent dialysate, thereby, significantl y increasing the dialysate flow rate. Flow-thru PD has been used with and w ithout dialysate regeneration. Regeneration has been used with standard inf low/outflow PD, In nearly all cases, substantially increased clearances ove r standard PD were obtained with reported urea and creatinine clearances as high as 58 and 48 ml/min, respectively. Applying flow-thru to the PD patie nt would require two catheters or a dual lumen catheter, and to obtain opti mum clearances, the dialysate should be pumped through the peritoneal cavit y at a high flow rate. Regenerating the dialysate allows high dialysate flo w rates while reducing the total amount of dialysate required. For the cont inuous ambulatory peritoneal dialysis (CAPD) patient, the unit would have t o be wearable; whereas for the patient on automated PD, flow-thru and/or re generation PD could be incorporated into the equipment, With sorbent regene ration, the protein in the spent PD could be purified and returned to the p atient thereby minimizing protein loss, increasing ultrafiltration, and enh ancing the removal of protein-bound metabolic toxins.