Division of Nephrology, University of Maryland School of Medicine, Baltimore, MD, USA.
VA Maryland Health Care System, Baltimore, MD, USA.
Ren Fail. 2024 Dec;46(2):2408432. doi: 10.1080/0886022X.2024.2408432. Epub 2024 Oct 1.
Dwell time is a critical component of automated peritoneal dialysis (APD) prescription, the stage at which transmembrane mass and fluid transfer occur. Loss of prescribed dwell time (LDT) can negatively influence the efficiency of APD. We investigated the incidence of LDT and related causes using APD in the acute care setting at a tertiary care center.
Retrospective analysis was conducted of all inpatients receiving APD treatments from 1 December 2021 to 1 June 2023. Patient demographics, comorbidities, laboratory, and treatment data were extracted from electronic medical records and a propriety database.
= 235 cycler treatments completed by 32 patients were included for analysis. The total LDT per treatment exceeding 30 minutes and 60 minutes occurred in 27% and 20% of all treatments. LDT of more than 10 minutes per each cycle exchange occurred in 26%. Session disruptions were caused by slow out-flow (55%), inadequate drain volumes (32%), patient line occlusions (20%), and priming errors (23%). The slow flow alarm requiring user intervention was reported to occur in about one-third of all treatments (31%).
There was significant LDT and inadequate drain volume seen in about one-quarter and one-third of all inpatient APD treatments respectively. This can impact solute clearance and ultrafiltration. Slow flow alarms were the most prevalent and the leading cause of LDT followed by inadequate drain volume. Future studies are required to investigate measures to reduce slow drain and improve drain volume in the hospital setting. .
驻留时间是自动化腹膜透析（APD）处方的一个关键组成部分，是跨膜质量和液体转移发生的阶段。失去规定的驻留时间（LDT）可能会对 APD 的效率产生负面影响。我们在一家三级护理中心的急性护理环境中使用 APD 调查了 LDT 的发生率和相关原因。
对 2021 年 12 月 1 日至 2023 年 6 月 1 日期间接受 APD 治疗的所有住院患者进行了回顾性分析。从电子病历和专有数据库中提取患者人口统计学、合并症、实验室和治疗数据。
共纳入 32 名患者的 235 个循环治疗进行分析。所有治疗中，超过 30 分钟和 60 分钟的总 LDT 分别占 27%和 20%。每个循环交换超过 10 分钟的 LDT 占 26%。治疗中断是由于流出缓慢（55%）、引流量不足（32%）、患者管路堵塞（20%）和预充错误（23%）引起的。需要用户干预的缓慢流动警报报告在所有治疗中约占三分之一（31%）。
约四分之一和三分之一的住院 APD 治疗分别出现明显的 LDT 和引流量不足。这会影响溶质清除率和超滤。缓慢流动警报是最常见的，也是导致 LDT 的主要原因，其次是引流量不足。需要进一步研究减少缓慢引流和提高医院环境中引流量的措施。
