Feasibility of creating a homogenous PD Solution at Home with Point-of-care dialysate generation system

Background

Point-of-care dialysate generation allows for PD fluid production in the home. Ensuring that all solutes are evenly distributed (solution homogeneity) in the fill bag is vital to avoid concentration gradients that may impact ultrafiltration and electrolyte balance. Current dialysis bags are commercially manufactured in quantities up to 6L in volume. Viva Komfort (Komfort) produces one bag of 15L. This study evaluates the feasibility of creating a homogenous PD solution at home in reasonable amount of time.

Methods

A 15L fill bag containing concentrates equivalent to a 2.5% dextrose-based dialysis solution was placed on the tray. Water was pumped into the bag at 500ml/min, while Komfort‘s mixing tray was tilted back and forth for different durations (25, 30, 40 mins). As the bag was drained, samples were collected; at 0.2L, 1L,5L, 10L and end of drain (15L). Glucose and sodium concentrations were measured; sodium was used as the surrogate electrolyte as it is most abundant in dialysate. Delta of 2.5% was a chosen threshold to signify sufficient mixing. Sensors were placed to measure conductivity (target: 12mS/cm) and dialysate temperature (37°C).

Results

The test set-up’s inlet water ranged from 25.8–30.3°C. Final conductivity of the resultant fill bag ranged from 11.65 – 12.66 mS/cm. With 25-mins mixing (n=3), homogeneity was not achieved. Subsequently, 30-mins (n=13) and 40-mins (n=2) had good results. Resultant fluid temperature ranged from 34.2 – 37.8°C. Figure shows the △% of each sample point to the average glucose and sodium concentration from the 5 sample points. 25-mins mixing showed numerous points >2.5% thresholds. 30-minute and 40-minute group consistently produced concentrations within acceptable limits across 75 data points; with 1 outlier in the 30-mins group.

Conclusion

The findings show feasibility of producing reliable homogenous PD solution at home with Komfort. Further assessments will be conducted to examine the effects of the input water temperature as well as glucose tonicity in the fill bag on mixing durations.

Presented at ASN Kidney Week 2026, Denver, Colorado, United States, 21 – 25 October 2026.

Authors:

• Martin J. Schreiber, Cleveland Clinic, OH, United States; Vivance, CA, United States
• Prashanth Kumar, Desert Cities Dialysis, CA, United States
• Ricardo Aguilar Grajeda, Vivance, Singapore
• Marcin Pawlak, Vivance, Singapore
• Sheena Gow, Vivance, Singapore
• Jason Lim, Vivance, Singapore
• Alessandro Donadio, Vivance, Singapore
• Sridhar Chirumarry, Vivance, Singapore
• Mandar Gori, Vivance, CA, United States
• Arsh Jain, London Health Sciences Center, Ontario, Canada