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      The Vicenza Wearable Artificial Kidney for Peritoneal Dialysis (ViWAK PD)

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          Abstract

          Background: The study describes the structure and operational characteristics of a new wearable system for continuous ambulatory peritoneal dialysis (CAPD) for chronic kidney disease patients. Methods: We designed a wearable system consisting of: (1) a double lumen peritoneal catheter; (2) a dialysate outflow line; (3) a miniaturized rotary pump; (4) a circuit for dialysate regeneration featuring a waterproof container with 4 cartridges in parallel with a mixture of activated carbon and polystyrenic resins; (5) a filter for deaeration and microbiological safety; (6) a dialysate inflow line, and (7) a handheld computer as a remote control. The system has been tested circulating 12 liters of exhausted PD solution through the experimental adsorption unit at a rate of 20 ml/min. Creatinine, β<sub>2</sub>-microglobulin (β<sub>2</sub>-MG) and angiogenin were measured before and after the adsorption unit at baseline, and after 4 and 10 h of use. Results: The cartridges containing polystyrenic resin completely removed β<sub>2</sub>-MG and angiogenin from the fluid batch. Those with the activated carbon removed completely urea and creatinine. The final result was 11.2 liters of net solute clearance. The system is designed to be used as follows: The peritoneal cavity is loaded in the morning with 2 liters of fresh PD solution. After 2 h, when dialysate/plasma equilibration at approximately 50% has occurred, recirculation is activated for 10 h at a rate of 20 ml/min. After this period, recirculation stops and glucose is optionally added to the peritoneal cavity to achieve ultrafiltration if needed. After 2 h the fluid is drained and a 2-liter icodextrin exchange is performed overnight to achieve further ultrafiltration. The clearance provided by the minicycler is further increased by the 2-liter exchange and the overnight exchange. Therefore, the system operates 24 h/day and provides creatinine and β<sub>2</sub>-MG clearance in the range of 15–16 liters/day, corresponding to a weekly clearance of 100–110 liters. The patient reduces the number of exchanges compared to CAPD and uses less fluid than in automated peritoneal dialysis (APD). Furthermore, the handheld computer allows for prescription and assessment of the therapy providing information on cartridge saturation, flow and pressure conditions and offering the possibility of remote wireless control of operations. Some problems still remain to be solved in the present configuration including the addition of an injection system for glucose and bicarbonate when needed, a system to reduce fibrin delivery to the sorbent and finally a more complex mixture of sorbents to make sure a complete removal of small molecules including urea is achieved. Conclusion: The wearable PD system may become a possible alternative to APD or CAPD reducing the time dedicated to perform exchanges and improving peritoneal dialysis adequacy and patient’s rehabilitation.

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          Most cited references 6

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          The regenerative dialysis (REDY) sorbent system

           M. Roberts (1998)
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            Slow Continuous Intracorporeal Plasmapheresis for Acute Fluid Overload

            Intermittent dialysis is still the predominant treatment for acute or chronic renal insufficiency in the USA despite increasing evidence that slower and longer fluid management therapies are more beneficial to the patient. We have investigated the use of slow continuous intracorporeal plasmapheresis (SCIP) as a more efficient and hemodynamically stable alternative means of treating acute fluid overload. In this paper we discuss preliminary observations on the safety of SCIP catheter insertion, fluid removal, extraction and pathology in Yorkshire pigs. SCIP catheters removed plasma for extracorporeal plasma water removal without significant gross or histopathological changes. Blood chemistry and cell counts remained stable during therapy. Toxicological studies indicated no pyrogenicity, hemolysis, cytotoxicity, acute systemic toxicity, delayed-type hypersensitivity, or blood recalcification coagulation inhibition. Intracutaneous extracts caused only mild irritation. SCIP therapy appears to be safe for use in the removal of plasma and plasma water from experimental animals.
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              Clinical experience with continuous flow and flow‐through peritoneal dialysis

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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2007
                September 2007
                03 September 2007
                : 25
                : 4
                : 383-388
                Affiliations
                aDepartment of Nephrology, St. Bortolo Hospital, Vicenza, and bR&D Department, Medica Srl, Medolla, Italy
                Article
                107775 Blood Purif 2007;25:383–388
                10.1159/000107775
                17785968
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 6, References: 22, Pages: 6
                Categories
                Original Paper

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