Continuous ambulatory peritoneal dialysis. 1978.
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History, 20th Century↗
Biomedical subjects
W K Pyle
Publications and source records attributed to W K Pyle.
An hypothesis to explain the ultrafiltration characteristics of peritoneal dialysis.
We present an hypothesis that could account for many characteristics of ultrafiltration and solute movement during peritoneal dialysis. The hypothesis describes transcapillary ultrafiltration and can account for (1) the osmotic effectiveness of rapidly absorbed glucose, (2) small solute sieving in a system permitting protein loss, (3) functional estimates of effective pore sizes as low as 11 A for urea and as high as 62 A for proteins from hydrodynamic analyses, (4) isolated loss of ultrafiltration without loss of clearance, (5) decreased ultrafiltration with decreased clearances, and (6) increased ultrafiltration with decreased clearances. Mechanisms for fluid movement from the peritoneal interstitium into the peritoneal cavity may involve both hydrostatic and osmotic pressure. Interstitial water pathway dimensions, interstitial gel surface charges, mesothelial cell surface charges, and transmesothelial-cell water movement might also account for sieving effects during peritoneal ultrafiltration.
Animals↗
A comparison of the relative efficacy of CAPD and hemodialysis in the control of solute concentration.
Metabolite concentrations found in patients on both continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis are predicted by means of a theoretical transport model. Effects of variation in parameters such as generation rate, mass transfer, coefficients and residual renal clearance are studied. The information obtained indicates that CAPD is as effective as hemodialysis in reducing the concentrations of low molecular weight metabolites occurring in the "average" ESRD patient. CAPD becomes increasingly more effective than hemodialysis as molecular weight increases.
Ambulatory Care↗
Continuous ambulatory peritoneal dialysis.
The technique of continuous ambulatory peritoneal dialysis was evaluated in nine patients during 136 patient weeks. The major objectives were to see if continuous ambulatory peritoneal dialysis would provide [1] acceptable control of serum chemistries by usual criteria, [2] adequate removal of sodium and water, [3] tolerable protein losses, and [4] a low prevalence of peritonitis with episodes responsive to therapy with continuing continuous ambulatory peritoneal dialysis. Preliminary findings suggest continuous ambulatory peritoneal dialysis represents an effective ambulatory, portable, internal dialysis technique. Larger-solute clearances per week may approach values six times greater than with most hemodialysis techniques. Small-solute clearances approach dialysate flow rate (8.3 ml/min) and are comparable to other dialysis techniques on a weekly basis. Edema is readily controlled and protein losses should be tolerable with adequate protein intake. Peritonitus occurs on the average every 10 weeks but responds to therapy promptly with continuing continuous ambulatory peritoneal dialysis. If the prevalence of peritonitis can be reduced, continuous ambulatory peritoneal dialysis appears to represent a very attractive dialysis technique.
Adult↗