The occurrence of increased intraperitoneal volume events in automated peritoneal dialysis in the US: role of programming, patient/user actions and ultrafiltration

Borut Cižman, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Steve Lindo, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Brian Bilionis, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Ira Davis, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Aaron Brown, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Jennifer Miller, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Gerald Phillips, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Alex Kriukov, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
James A. Sloand, Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.

Document Type

Journal Article

Publication Date

6-1-2014

Journal

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

Volume

34

Issue

4

DOI

10.3747/pdi.2013.01157

Keywords

Automated peritoneal dialysis; increased intraperitoneal volume; tidal peritoneal dialysis; ultrafiltration

Abstract

UNLABELLED: BACKGROUND, OBJECTIVES AND METHODS: Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultrafiltration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively. RESULTS: Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed. CONCLUSIONS: IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient's UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.

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