CONTINUOUS REGENERATION OF PERITONEAL DIALYSATE BY A HYBRID ARTIFICIAL KIDNEY SYSTEM

为了提高传统腹膜透析（CPD）的溶质去除效率，本研究将开发一种利用新开发的人工肾小管再生腹膜透析液的系统。然而，由于肾小管细胞依赖于几种操作条件，并且没有显示出稳定的孵育，因此尚未开发出人工肾小管。另一方面，双向腹膜透析（BPD）作为一种新的腹膜透析系统已经发展起来，用于再生透析液。在BPD中，预先设定的腹膜透析液体积通过可逆泵在患者的腹膜腔和外部透析液储存库之间往复流动，使系统交替地形成引流期和输注期。在排液阶段，一部分停留的透析液以100 ml/min （QDR）的速度通过PD导管排出并进入储液池。在输注阶段，贮液池中的透析液以300 ml/min （QIN）的速度返回腹腔。在这两个阶段，附加的透析器持续净化腹膜透析液。本研究在尿毒症犬模型中检测BPD的溶质去除特性。BPD组和CPD组尿素还原率分别为20.0±7.2%（n=16）和3.5±3.6%（n=7）。肌酐也表现出类似的趋势。与传统的CAPD相比，BPD治疗的优势可以概括为：a)溶质去除效率高；b)无血管通道，无抗凝血；b)使用碳酸氢盐透析液的能力；b)通过减少交换减少蛋白质损失；b)通过体外循环输注药物的能力

In this study, a regeneration system for the spent dialysate of the peritoneal cavity using newly developed artificial renal tubules would be developed to improve the solute removal efficiency of the conventional peritoneal dialysis (CPD). Artificial renal tubules, however, have not been developed because the cells of renal tubules depended on several operating conditions and have showed no stable incubation. On the other hand, Bi-directional Peritoneal Dialysis (BPD) has been developed to regenerate the spent dialysate as a new peritoneal dialysis system. In the BPD, a preset volume of the peritoneal dialysate reciprocates between the patient's peritoneal cavity and a outside dialysate reservoir by a reversible pump, giving the system a drain phase and an infusion phase alternatively. In the drain phase, a part of the dwelt dialysate is drained through the PD catheter at 100 ml/min (QDR) and enters the reservoir. In the infusion phase, the dialysate in the reservoir is returned to the peritoneal cavity at 300 ml/min (QIN). In both phases, the add-on dialyzer purifies the peritoneal dialysate continually. In this study, solute removal characteristics of BPD were examined in uremic canine model. The urea reduction rate in BPD and CPD were 20.0 ± 7.2%(n=16) and 3.5 ± 3.6%(n=7), respectively. Creatinine showed a similar tendency. The advantages of BPD therapy in comparison with conventional CAPD can be summarized as follows :a) High efficiency for solute removalb) No vascular access and no anticoagulantc) Capability for bicarbonate dialysate usaged) Low protein loss by reducing the exchangese) Capability for drug infusion through the extracorporeal circuit