The influence of increased peritoneal membrane surface area on dialysis adequacy.

The adequacy of peritoneal dialysis is generally dependant on the choice of peritoneal fluid, the intraperitoneal fill volume and the contact time. Moreover, the peritoneal surface area acts as a major factor in the exchange dynamics of a peritoneal membrane. We designed a mechanism to increase the membrane surface contact area by using an abdominal belt in order to exert enough pressure on the fill volume, to effectively recruit more area in contact for exchange. We studied 12 patients on regular continuous ambulatory peritoneal dialysis (CAPD) at our center from January to October 2008. The age of patients ranged from 44 to 75 years, with a median of 55 years. All the patients were maintained on the same prescription four months before and during the study. Dialysis solutions were 1.36% Deaneal® , two liters, three exchanges and the last fill volume was two liters 7.5% Extraneal® . The belt was applied to all the patients most of the day and all night. We then observed its effect on dialysis adequacy, reflected by various parameters over a period of eight months. The average Kt/V before wearing the belt was 1.89 and improved after applying the belt to 2.3 (P <0.05). Our study suggests that increasing the abdominal pressure by wearing an abdominal belt rendered the filling volume of the PD dialysate to have a better contact with the peritoneal membrane and improved the dialysis adequacy. Studies with larger sample size are required to confirm the results.