Kidney Week 2025 Early Program - Home Dialysis: Expanding Access to Home Therapies in 2025 and Beyond-Leveraging Peritoneal Physiology to Individualize Peritoneal Dialysis Prescribing

Video Transcription

Video Summary

Dr. Osama El-Shami reviews the physiology behind peritoneal dialysis (PD) to explain how prescriptions should be tailored to a patient’s peritoneal membrane. He describes the peritoneum as a low–blood-flow dialysis system (60–100 mL/min) with fill–dwell–drain cycles. Using the three-pore model, he explains that aquaporin-1 channels move water only, small pores move most solutes (urea/creatinine/glucose) plus water, and large pores move proteins. Early in a dwell, aquaporin water flow can dilute dialysate sodium (“sodium sieving”), then small-pore transport predominates.<br /><br />He discusses PET testing (6–12 weeks after start) to classify patients by “transfer” status (passive movement), guiding dwell length: faster transferers need shorter dwells for ultrafiltration, while slower transferers need longer dwells for clearance. Over time, transfer rates tend to increase; he highlights “pseudohypoxia” from high glucose/lactate solutions and mitochondrial dysfunction as a possible driver, reinforcing the need to minimize unnecessary high-dextrose exposure.<br /><br />He presents APD remote-monitoring data showing ultrafiltration often improves after the first cycle, suggesting adding cycles can increase volume removal. Intraperitoneal pressure rises with posture and coughing, relevant to leak risk and activity counseling. Finally, he reviews CAPD/APD options, the role of tidal PD for drain pain, emphasizes high-dose loop diuretics when residual urine exists, and positions icodextrin as ideal for long dwells to improve clearance with less glycemic impact.

Asset Subtitle

Osama El Shamy

Meta Tag

Module DIAL

Speaker Osama El Shamy

Keywords

peritoneal dialysis physiology

three-pore model

aquaporin-1 water transport

sodium sieving

peritoneal equilibration test (PET)

automated peritoneal dialysis (APD) remote monitoring

icodextrin for long dwells