Quantification of peritoneal transport.

Kinetic models have been used in both hemodialysis (HD) and peritoneal dialysis (PD) therapies. Because many different theoretical models are available, users should choose a model that suits the purpose of their studies. In general, simple models are useful for clinical investigations and research; rigorous models may be available with the use of computers. Several commercial software packages with rigorous models specifically designed for PD are also useful for analyzing patient data and for constructing prescriptions. Although the overall mass transfer area coefficient (MTAC) is a parameter for diffusion transport, it may become a useful tool for predicting peritoneal ultrafiltration by defining a new "index for peritoneal diffusive selectivity" (IPDS), the ratio of the MTACs for urea and creatinine. Kinetic models are especially useful in treatments with relatively complex prescriptions such as combined PD and HD ("complementary") therapy, sample calculations of which are discussed.

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.