Development of a High-efficiency Peritoneal Dialysis system

为了提高传统腹膜透析(CPD)中的溶质清除效率，新近推出的连续再循环腹膜透析(CRPD)是一种高效的家庭透析系统。在本研究中，我们开发了一套CRPD系统，该系统由双腔PD导管、体外透析器和透析机组成。在犬的体外研究和临床研究中，我们对CRPD中的溶质去除特性进行了研究。1.体外透析器的优化设计我们对一台试验透析器进行了透析实验，使用的是含有几种标志性溶质的水溶液。2.透析机的研制CRPD透析机有(A)葡萄糖输注器，(B)家用透析液冲洗设备和(C)几种监测器。(A)为了从患者体内排出水分，外层透析液需要1.0-1.5%的葡萄糖。葡萄糖输注器要求透析液中含有最少量的葡萄糖。(2)腹膜透析治疗中腹膜透析液混入不好。它降低了处理的溶质去除效率。为了改善混合，在CRPD中引入了冲洗机。(C)在该机器中配备了气泡检测器、血液渗漏监测仪和压力计。3.对CRPD中的溶质去除特性进行了60多只狗的再透析实验，以评价CRPD的溶质去除效率。在临床研究中，CRPD治疗5例肾衰患者。患者对CRPD治疗耐受性好，溶质效率高于常规PD治疗。CRPD治疗期间未见纤维蛋白生成。

In order to improve solute removal efficiency in conventional peritoneal dialysis (CPD) , Continuous Recirculating Peritoneal Dialysis (CRPD) was newly introduced as a high-efficiency home dialysis system. In this research, we developed a CRPD system which consists of a double-lumen PD catheter, an extracorporeal dialyzer and a dialysis machine. Solute removal characteristics in CRPD were examined during a canine ex vivo study and a clinical study.1.Optimum design of the extracorporeal dialyzerWe carried out dialysis experiments for a test dialyzer using an aqueous solution involving several marker solutes. By analytical calculations, an optimum shape of dialyzer can be determined as an optimum from these results.2.Development of the dialysis machineThe dialysis machine for CRPD has (a) a glucose infuser, (b) a flushing equipment for dwelled dialysate and (c) several kinds of monitors. (a) For water removal from the patient, a 1.0-1.5 % of glucose was needed for the outer dialysate. The glucose infuser requires minimum amount of glucose for the dialysate. (b) Dwelled dialysate in the peritoneal cavity is not mixed well in PD treatments. It reduces solute removal efficiency of the treatment. In order to improve the mixing, a flushing machine was introduced to CRPD.(c) A bobble detector, a blood leakage monitor and a pressure gauge were equipped in this machine.3.Solute Removal Characteristics in CRPDRecirculation-dialysis experiments using over 60 dogs were done for the evaluation of CRPD.CRPD has a higher solute removal efficiency than in CPD.In the clinical study, CRPD treatments were applied to five renal failure patients. The patients tolerated the CRPD treatments well and solute efficiency was higher than with Conventional PD treatments. No fibrin formation occurred during the CRPD treatments.