SuO014PERITONEAL DIALYSIS WITH THE NEW PORTABLE CARRY LIFE® SYSTEM

Abstract

INTRODUCTION AND AIMS: Carry LifeVR System PD (CLS PD) is a new portable device intended to perform peritoneal dialysis (PD) by continuous removal of uremic toxins from the intraperitoneal dialysis fluid in order to maintain the blood to dialysate concentration gradient. The dialysis fluid is continuously recirculated through the device which contains an adsorbent unit (Purecart) designed to remove uremic toxins. Glucose is added to the recirculating fluid in order to maintain a stable intraperitoneal glucose concentration throughout the treatment. This version of the CLS PD system requires two catheters for access to the peritoneal cavity, as there is simultaneous inflow and outflow of the dialysis fluid. The aim was to perform a feasibility study of the CLS PD to study 1) removal of biomarkers of uremic toxins (urea, creatinine, phosphate, b2-microglobulin) 2) maintenance of intraperitoneal glucose concentration 3) efficacy of ultrafiltration (UF) and 4) safety and patient tolerability. METHODS: Four patients on stable PD therapy were treated with the CLS PD device for eight hours. Before the treatment a temporary pig-tail catheter for fluid inflow, was inserted into the abdomen at a distance from the standard PD catheter. After an initial fill of the peritoneal cavity with two litres of a standard PD solution with 1.36% glucose, the CLS PD was connected to the patient. The Purecart was exchanged after the first four hours of treatment. Biomarkers for uremic toxins, potassium and glucose were measured every hour in the recirculated dialysis fluid and in serum before and after the treatment session. Data is expressed as mean6STDEV. RESULTS: The concentration gradients for the biomarkers of uremic toxins were maintained after the eight hour treatment session with CLS PD (the dialysate:plasma concentration ratio of urea was 0.8360.02, of creatinine was 0.2860.03, and of phosphate was 0.2760.03). The serum concentrations of creatinine, phosphate and potassium were reduced by the treatment (creatinine: 7336184 to 6806168 mmol/L, p<0.05; phosphate: 2.060.2 to 1.760.05 mmol/L, p<0.05; potassium: 4.760.4 to 4.360.4, p<0.01), whereas the decrease in serum levels of urea and b2-microglobulin was not significant (21.568.2 to 19.6±6.8 mmol/L, and 28.167.8 to 26.366.7 mg/ L). The intraperitoneal glucose concentration was maintained and was in average 54.0 63.0 mmol/l which resulted in an UF volume of 366651 ml. The albumin concentration in the dialysis fluid was 1.6±0.9 g/L at the end of the session, which means a total removal of 2.060.6 grams of albumin during the eight hour treatment. All patients tolerated the treatment well and no discomfort was experienced. CONCLUSIONS: The new portable device CLS PD provides an efficient peritoneal dialysis therapy by maintaining the blood to dialysate concentration gradients of established biomarkers of uremic toxins. With the use of CLS PD the intraperitoneal glucose concentration can be maintained throughout the treatment to enable an efficient ultrafiltration. The CLS PD treatment was associated with relatively low removal of albumin and was well tolerated by the patients.