| [ Summary ] |
A combined treatment of hemodialysis (HD) and continuous peritoneal dialysis (PD), termed complementary dialysis, is expected to provide stable homeostasis with PD, and to increase the relatively low removal rates of PD with HD. Since the term complementary dialysis applies to two different therapies with different schedules, it may be difficult to prescribe a better therapeutic pattern without the aid of theoretical calculations. In this article, we discussed therapeutic schedules and solute removal efficiencies of the complementary dialysis from the viewpoint of kinetics. We constructed a kinetic model for the complementary dialysis that includes three compartments, i.e. the intracellular, extracellular and intraperitoneal spaces. Several patterns of the complementary dialysis were numerically simulated and were evaluated by employing the concept of Cleared-Volume. Additionally, we calculated the time courses of metabolite concentrations in plasma, and analyzed differences in therapeutic schedules. Patients with no residual renal function may require higher dialysis dose, if treated by one HD, one no dialysis day and five-day PD. Further more, the complementary dialysis with one HD and a five-day or six-day PD may not decrease the concentration of Β2-microglobulin if the patient is originally treated with seven-day PD. A better treatment schedule for complementary dialysis to improve solute removal capacity may be carefully prescribed using kinetic analysis. |