Business Mgt

In: Business and Management

Submitted By ppbl1973
Words 1016
Pages 5
Fluid Management in Peritoneal Dialysis
Ali K. Abu-Alfa, MD, FASN Associate Professor of Medicine Director, Peritoneal Dialysis Program Associate Director for outpatient Dialysis Director of Clinical Trials Yale School of Medicine New Haven, Connecticut http://kidney.yale.edu

Educational Objectives

Review physiology of ultrafiltration and impact of membrane transport characteristics. Discuss fluid balance in PD with focus on clinical needs, goals and effect on outcomes. Identify areas of interventions for optimization of fluid removal. Identify patients at risk for fluid retention. Review role of alternative osmotic agents: Icodextrin. Review ISPD guidelines and clinical algorithms for fluid management in PD.

Physiology of Ultrafiltration

Trans-capillary fluid movement:
Osmotic gradient (first and foremost). Hydrostatic pressure (much less so). Membrane function / surface area.

Lymphatic re-absorption.

Physiology of Ultrafiltration: Structure of the Peritoneal Membrane

Physiology of Ultrafiltration: Water, Glucose and Sodium Movements Na

H2O

Capillary

Peritoneal Space Glucose
Aquaporin mediated: 50% Intercellular: 50% Glucose transporter mediated: minimal Intercellular: >90%

Physiology of Ultrafiltration: Sodium Sieving with 3.86% Dextrose Dialysate

LaMilia et al, Nephrol Dial Transplant (2004) 19: 1849-1855

Physiology of Ultrafiltration: Effect of Sodium Sieving on Na Removal

250 200 150 100 50 0 Na removal CAPD APD Icodextrin

Rodriguez-Carmona, PDI 2003 (22): 705-713.

Physiology of Ultrafiltration: Crystalloid versus colloid osmosis

Blood in Peritoneal Capillaries urea creatinine
Endothelium

macromolecules

glucose
Mesothelium

crystalloid colloid osmosis osmosis

Dialysate filled Peritoneal Cavity

LaMilia et al, Nephrol Dial Transplant (2004) 19: 1849-1855

Physiology of…...

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