#2906 Ultrafiltration pattern in automated peritoneal dialysis

Abstract Background and Aims Prescriptions that can correct hypervolemia in automated peritoneal dialysis (APD) reduce patient complications. Using the Sharesource remote patient monitoring programme, it has been observed that some APD patients have no or low UF, especially in the early cycles. However, in continuous ambulatory peritoneal dialysis, ultrafiltration is higher when the patient is first connected to dialysis and during the first few hours when the patient is more hypervolemic. Determining which has the most UF from these cycles will show us the best UF time in the patient's treatment and help to reduce hypervolemia. In our study, we aimed to evaluate the UF amounts of the patients during the nocturnal cycles. Method The study included 32 patients (13 women, 19 men) who had been on APD for at least 3 months. The mean age of the patients was 58.4 ± 17.3 years (26–87). Patients were euvolemic and non-infection. Drainage volumes of each night cycle of the last month were averaged. The UF volume was calculated for each cycle. Patient UF profiles were calculated using descriptive analysis. UF profiles were compared between tidal therapy and standard therapy. In addition, both groups were evaluated for PET KTV. Results When all patients were evaluated, 1 patient had 4 cycles, 17 patients had 5 cycles, 11 patients had 6 cycles and 3 patients had 7 cycles. UF averages were calculated for each cycle in the patients. The mean UF levels of the patients are shown in the graphs (Figs 1 and 2). While 20 of the patients received conventional APD treatment, 11 received tidal treatment. When both treatment groups were evaluated, it was seen that the amount of UF decreased until the third filling in tidal treatment, that is, until complete drainage was achieved, and increased in subsequent cycle. In the standard treatment, it was seen that ultrafiltration gradually increased with each drainage. There was no difference in total UF between the two treatment methods. In 20 patients receiving standard treatment, positive UF was 67.9% in the first cycle, 85.7% in the second cycle, 90.5% in the third cycle, 95.2% in the fourth cycle, and 85.7% in the fifth cycle. The number of cases was low in the 6th and 7th cycles, but there were positive UF. When the patients receiving tidal and standard treatment were evaluated together, negative UF was also obtained in the 4th cycle due to the tidal treatment application procedure. There was no difference between PET and KTV between the two groups (P = 0.25, P = 0.62 respectively). Conclusion A pattern of increasing UF with increasing number of cycles has been observed with standard therapy. This may help to guide treatment options in APD. The pattern of increasing UF, usually in the first few hours with the expected first fill in CAPD, was found to be more pronounced with subsequent cycles in APD. This may represent a different kinetic pattern. The nightly sleeping position and the increase in peritoneal interstitial glucose may contribute to this situation. In addition, endogenous hormones (such as ADH, catecholamines, prolactin) whose levels change during the night may also play a role, but further studies are needed.