Initial Feasibility Pilot Study of Interdialytic Peritoneal Ultrafiltration to Manage Volume Status in Patients on Hemodialysis (iPUF-HD)
Bibliographic record
Abstract
Background: Increased dietary sodium (Na) and reduced Na excretion drive interdialytic weight gain (IDWG). High ultrafiltration (UF) rates are associated with mortality in hemodialysis (HD) patients. Achieving complete removal of IDWG is often challenging with conventional HD. Combination therapy with peritoneal dialysis (PD) allows additional UF but significantly increases treatment burden. We report first use of short dwell PD, delivered passively, immediately after HD for 2/3 sessions per week. To maximize Na removal and address congestion we instilled low volume 0% sodium fluid with short dwell time. Methods: We studied 5 anephric HD patients with history of difficult to manage IDWG [(> 4% of dry weight) within conventional HD regimen. After catheter implantation/healing, patients underwent two short dwell (2 hours) peritoneal treatment sessions per week (immediately after HD), using 10% dextrose. Low volume (500ml) was used to limit glucose exposure (no more than conventional 2.5% dextrose/sodium containing PD fluid). Patients were treated for 3 weeks with additional one-washout. IDWG, hemodynamics, effluent composition, tolerability, serum sodium/osmolality and intradialytic serial echocardiography (HD-induced myocardial stunning) were assessed. Results: Low volume Na-free peritoneal solution effectively removed 4.83±1.37g of Na and 251±190ml UF per session. Na-free 10% dextrose PD solution was well tolerated without treatment interruption (pain score 0 -1/5). During intervention period, IDWG progressively decreased (from 1820 to 950ml), markedly greater than achieved peritoneal UF. Serum potassium, hs-troponin, calcium, and hemoglobin concentrations remained stable. Serum Na modestly decreased from 136.64±4.46 to 132.11±2.96mmol/L (p < 0.0001), with no adversity attributable to hyponatremia. Systolic blood pressure and continuous intradialytic hemodynamics remained unchanged throughout. Of those with viable echo images (for strain analysis), HD-induced myocardial stunning was reduced in 2/3 patients. Conclusion: This pilot study suggests that additional Na removal can be achieved with use Na-free peritoneal fluid delivered post-dialytic. Such a regimen appears to be capable of improving the congestive state (and its consequences) in patients otherwise unable to be adequately managed with conventional HD.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".