Development of a computer-aided diagnosis system for a new modality of renal replacement therapy: an integrated approach combining both peritoneal dialysis and hemodialysis

Clinical Effects of Combined Therapy with Peritoneal Dialysis and Hemodialysis

The fundamental objective of dialysis is to maintain the dose of solute clearance and ultrafiltration (UF). When peritoneal dialysis (PD) patients cannot maintain target clearances, the dialysis dose needs to be increased. The means of increasing dose by PD alone are limited, especially in patients with UF failure. Combination therapy with PD and hemodialysis (PD+HD) is the simplest way to solve this problem. The general prescription for PD+HD should be 5 – 6 days of PD and 1 session of HD weekly. To determine the adequacy of PD+HD, we adopted the equivalent renal clearance (EKR), transforming the weekly Kt/V from PD and then evaluating the total clearance from both modalities.

The weekly PD+HD regimen improves clinical status in patients in whom PD alone does not result in dialysis adequacy, and it permits a substantial prolongation of PD. The complementary effects of PD and HD improve clinical status and prognosis in patients undergoing dialysis; we therefore propose to use the term “complementary dialysis” for this technique.

The impact of a remote monitoring system of healthcare resource consumption in patients on automated peritoneal dialysis (APD): A simulation study

Aims: Remote monitoring (RM) can improve management of chronic diseases. We evaluated the impact of RM in automated peritoneal dialysis (APD) in a simulation study. Materials and methods: We simulated 12 patient scenarios with common clinical problems and estimated the likely healthcare resource consumption with and without the availability of RM (RM+ and RM– groups, respectively). Scenarios were evaluated 4 times by randomly allocated nephrologist-nurse teams or nephrologist-alone assessors. Results: The RM+ group was assessed as having significantly lower total healthcare resource consumption compared with the RM– group (36.8 vs. 107.5 total episodes of resource consumption, p = 0.002). The RM+ group showed significantly lower “unplanned hospital visits” (2.3 vs. 11.3, p = 0.005), “emergency room visits” (0.5 vs. 5.3, p = 0.003), “home visits” (0.5 vs. 5.8, p = 0.016), “exchanges over the telephone” (18.5 vs. 57.8, p = 0.002), and “change to hemodialysis” (0.5 vs. 2.5, p = 0.003). Evaluations did not differ between nephrologist-nurse teams vs. nephrologist-alone assessors. Conclusion: RM can be expected to reduce healthcare resource consumption in APD patients.

Clinical application of computer-aided diagnostic system for harmonious introduction of complementary dialysis therapy

In chronic peritoneal dialysis (PD) therapy, peritoneal permeability is gradually enhanced over the duration of the therapeutic course, leading to a grave decline in the therapeutic efficiency. In recent years, a novel therapy (CD therapy), which integrates PD therapy with hemodialysis therapy, is being applied to end-stage PD patients to complement the decline of therapeutic efficiency caused by the grave degeneration of the peritoneal tissue. To realize a harmonious introduction of the CD therapy, this study developed a useful index (KAu/c), which evaluates both therapeutic efficiency and degeneration of peritoneal tissue. Using a mathematical model and KAu/c, we were able to validate the therapeutic efficiency in the PD patients, and, in one case, propose a better prescription for the patient by employing the CD therapy. The clinical implementation of this methodology is indispensable with regard to expanding the therapeutic monitoring system for renal replacement therapy.

Development of a computer-aided diagnosis system for continuous peritoneal dialysis: an availability of the simultaneous numerical optimization technique for kinetic parameters in the peritoneal dialysis model

We developed a novel diagnostic system for continuous peritoneal dialysis, which evaluates the peritoneal permeability and hydraulic conductance (peritoneal function) by applying the kinetic model and a clinical test with minimum nursing time. Kinetic parameters for the peritoneal function were determined by the simultaneous numerical optimization techniques (SNOT). Furthermore dialysis outcome and ultrafiltration volume were estimated and predicted by using the kinetic model with a set of optimal kinetic parameters, which were in agreement with measured data (r(2)>0.82). The clinical implementation of the SNOT is very useful to explore the better prescriptions for each patient's clinical condition.