Development and Clinical Application of Recirculating Peritoneal Dialysis

To improve the efficacy of conventional peritoneal dialysis, the authors have successfully developed recirculating peritoneal dialysis (RPD). The system consists of a newly-designed dual lumen catheter through which peritoneal dialysate is extracorporeally recirculated, and a hollow fiber dialyzer which purifies the peritoneal dialysate. The system continuously purifies the peritoneal dialysate and achieves high-efficiency solute removal. In canine models as well as in clinical trials, PRD showed a higher efficiency than intermittent peritoneal dialysis (IPD). With canine models, the urea reduction rate was 14.6 ± 6.1% in RPD (n=6), and 3.3 ± 2.6% in IPD (n=6), showing that RPD increased the reduction rate significantly (p< 0.01). RPD has been applied to two renal failure patients with promising results. The patients tolerated the treatment well, and the system improved solute removal efficiency remarkably, giving an adequate flow of recirculating peritoneal dialysate with no anticoagulant. It is estimated that 8 h of RPD increases urea clearance by 47%, compared to 8 h of conventional peritoneal dialysis with 4 exchanges