Influence of local inflammation of the peritoneal membrane on diuresis and residual renal function in patients treated with peritoneal dialysis

2011 ◽  
Vol 15 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Ivo Jelicic ◽  
Dragan Ljutic ◽  
Milenka Sain ◽  
Vedran Kovacic ◽  
Josipa Radic
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Local Inflammation ◽  
Peritoneal Membrane

scholarly journals Incremental peritoneal dialysis

2020 ◽  
Vol 40 (3) ◽  
pp. 320-326 ◽  
Author(s):  
Peter G Blake ◽  
Jie Dong ◽  
Simon J Davies
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Renal Clearance ◽  
Observational Studies ◽  
Controlled Trial ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Full Dose ◽  
Randomized Controlled ◽  
Initiation Of Dialysis

Incremental peritoneal dialysis (PD) has been variably defined. It involves taking advantage of the residual renal function that is usually present at initiation of dialysis to initially prescribe less onerous lower doses of PD while still achieving individualized clearance goals. We propose that incremental PD be defined as a strategy, rather than a particular regime, in which: (1) less than standard “full-dose” PD is initially prescribed in recognition of the value of residual renal function; (2) peritoneal clearance is initially less than the individualized clearance goal but the combination of peritoneal plus renal clearance achieves or exceeds that goal clearance; and (3) there is a clear intention to increase dose of PD as renal clearance declines and/or symptoms appear. Incremental PD by its nature lessens the workload of dialysis for those doing PD, reduces cost and exposure of the peritoneal membrane to glucose, and may lessen mechanical symptoms. Evidence that incremental PD improves clinical outcomes compared to the use of full-dose PD is lacking but one randomized controlled trial, multiple observational studies, and a systematic review all suggest that outcomes are at least as good. Given that incremental PD costs less and is inherently less onerous, it is reasonable, pending larger randomized trials, to adopt this strategy.

scholarly journals Effects of Roxadustat on the Anemia and Iron Metabolism of Patients Undergoing Peritoneal Dialysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Keiji Hirai ◽  
Hiroaki Nonaka ◽  
Moeka Ueda ◽  
Junki Morino ◽  
Shohei Kaneko ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Ferritin ◽  
Iron Metabolism ◽  
Residual Renal Function ◽  
Plasma Creatinine ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Urea Clearance ◽  
Membrane Function

Background: We investigated the effects of roxadustat on the anemia, iron metabolism, peritoneal membrane function, and residual renal function; and determined the factors associated with the administration of roxadustat in patients who were undergoing peritoneal dialysis.Methods: We retrospectively analyzed the changes in hemoglobin, serum ferritin, transferrin saturation (TSAT), 4-h dialysate/plasma creatinine, and renal weekly urea clearance over the 24 weeks following the change from an erythropoiesis-stimulating agent (ESA) to roxadustat in 16 patients who were undergoing peritoneal dialysis and had anemia (Roxadustat group). Twenty-three peritoneal dialysis patients who had anemia and continued ESA served as a control group (ESA group).Results: There were no significant differences in hemoglobin, serum ferritin, TSAT, 4-h dialysate/plasma creatinine, or renal weekly urea clearance between the two groups at baseline. The hemoglobin concentration was significantly higher in the Roxadustat group than in the ESA group after 24 weeks (11.6 ± 1.0 g/dL vs. 10.3 ± 1.1 g/dL, p < 0.05), whereas the ferritin concentration and TSAT were significantly lower (139.5 ± 102.0 ng/mL vs. 209.2 ± 113.1 ng/mL, p < 0.05; and 28.1 ± 11.5% vs. 44.8 ± 10.4%, p < 0.05, respectively). The changes in 4-h dialysate/plasma creatinine and renal weekly urea clearance did not differ between the two groups. Linear regression analysis revealed that the serum potassium concentration correlated with the dose of roxadustat at 24 weeks (standard coefficient = 0.580, p = 0.019).Conclusion: Roxadustat may improve the anemia and reduce the serum ferritin and TSAT of the peritoneal dialysis patients after they were switched from an ESA, without association with peritoneal membrane function or residual renal function.

N-Acetylcysteine Improves Residual Renal Function in Peritoneal Dialysis Patients: A Pilot Study

2011 ◽  
Vol 31 (5) ◽  
pp. 545-550 ◽  
Author(s):  
Leonid Feldman ◽  
Michal Shani ◽  
Shai Efrati ◽  
Ilia Beberashvili ◽  
Iris Yakov–Hai ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Optimal Care ◽  
Membrane Function ◽  
End Of Treatment ◽  
Sodium Sieving

BackgroundPreservation of peritoneal membrane function and residual renal function is important for the optimal care of peritoneal dialysis patients. N-Acetylcysteine may ameliorate oxidative stress, which is thought to be involved in peritoneal membrane dysfunction. In addition, N-acetylcysteine may have a positive effect on renal function in the setting of nephrotoxic contrast media administration. The aim of this study was to investigate the effect of N-acetylcysteine on peritoneal and residual renal function in peritoneal dialysis patients.MethodsTen prevalent peritoneal dialysis patients were administered oral N-acetylcysteine 1200 mg twice daily for 4 weeks. At baseline and at the end of treatment, peritoneal membrane function and residual renal function were assessed using a 4.25% dextrose peritoneal equilibration test and 24-hour dialysate and urine collection for calculation of peritoneal and residual renal Kt/V and mean urea and creatinine residual renal clearance.ResultsNo significant changes were demonstrated in peritoneal membrane function, including dialysate-to-plasma creatinine ratio, sodium sieving, and net ultrafiltration. Residual renal function improved significantly: urine volume increased from 633 ± 426 to 925 ± 552 mL/24 hours ( p = 0.022), residual renal Kt/V increased from 0.56 ± 0.41 to 0.75 ± 0.47 ( p = 0.037), and mean residual urea and creatinine clearance increased from 4.96 ± 3.96 to 5.95 ± 4.08 mL/min/1.73 m2( p = 0.059).ConclusionsN-acetylcysteine may improve residual renal function in patients treated with peritoneal dialysis.

Treatment Targets for Diabetic Patients on Peritoneal Dialysis: Any Evidence?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 176-179 ◽  
Author(s):  
Chiu-Ching Huang
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Clinical Outcome ◽  
Small Molecules ◽  
Residual Renal Function ◽  
Diabetic Patients ◽  
Peritoneal Membrane ◽  
Comorbid Conditions ◽  
Dialysis Solutions

Diabetic patients are often affected by comorbid conditions that influence clinical outcome. Taking care of diabetic peritoneal dialysis (PD) patients is a challenge for nephrologists, not only because these patients have more complications and comorbidities, but also because of their difficulties in maintaining glycemic control with the use of current glucose-containing dialysis solutions. In addition, the increased transport of small molecules and proteins by the peritoneal membrane in diabetic patients adds the further problems of ultrafiltration deficit and malnutrition. The present article reviews pertinent evidence toward establishing the best strategy for the care of diabetic PD patients. With better glycemic control, improved nutrition, improved fluid balance, and optimal preservation of residual renal function, there is hope for improving the survival of diabetic PD patients.

The Clinical Usefulness of Peritoneal Dialysis Fluids with Neutral pH and Low Glucose Degradation Product Concentration: An Open Randomized Prospective Trial

2008 ◽  
Vol 28 (2) ◽  
pp. 174-182 ◽  
Author(s):  
Hoon Young Choi ◽  
Dong Ki Kim ◽  
Tae Hee Lee ◽  
Sung Jin Moon ◽  
Seung Hyeok Han ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Prospective Trial ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Low Concentration ◽  
Neutral Ph ◽  
Randomized Prospective Trial ◽  
Dialysis Fluids

Background Long-term peritoneal dialysis (PD) is associated with the development of various structural and functional changes to the peritoneal membrane when bioincompatible conventional peritoneal dialysis fluids (PDFs) are used. In this study, we looked at patients that were treated with conventional PDFs and then changed to novel biocompatible PDFs with a neutral pH and a low concentration of glucose degradation products (GDPs) to investigate whether this change could result in the arrest or reversal of peritoneal membrane deterioration. Methods In an open label, randomized prospective trial, the clinical effects of conventional PDFs and biocompatible PDFs with neutral pH and very low concentration of GDPs were compared in 104 patients equally divided between both study PDFs. Blood and effluent dialysate samples, peritoneal equilibration tests, and adequacy evaluation were undertaken at baseline, 4, 8, and 12 months. The target variables were the ratio of dialysate-to-plasma (D/P) creatinine, peritoneal ultrafiltration, residual renal function, dialysis adequacy indices, and effluent cancer antigen 125 (CA125). Results D/P creatinine values were not different in the two groups. Peritoneal ultrafiltration was significantly higher in the low-GDP PDF group than in the conventional PDF group at all follow-up times (4 months: 9.1 ± 4.3 vs 6.0 ± 3.0; 8 months: 8.3 ± 3.4 vs 6.0 ± 3.0; 12 months: 8.9 ± 3.3 vs 6.1 ± 3.3 mL/g dextrose/day; p < 0.05). Peritoneal Kt/V urea values and total weekly Kt/V urea values at 4 months were significantly higher in the low-GDP PDF group than in the conventional PDF group. Residual renal function was not statistically significant. Effluent CA125 levels were significantly higher in the low-GDP PDF group at all follow-up visits (4 months: 37.8 ± 20.8 vs 22.0 ± 9.5; 8 months: 41.2 ± 20.3 vs 25.9 ± 11.3; 12 months: 40.4 ± 21.4 vs 28.6 ± 13.0 U/mL; p < 0.05). Among anuric patients, peritoneal ultrafiltration at 4, 8, and 12 months, total weekly Kt/V at 4 and 8 months, and CA125 levels at all follow-up visits were significantly higher in patients treated with low-GDP PDF than those treated with conventional PDF. However, among anuric patients, D/P creatinine showed no significant differences between the low-GDP PDF group and the conventional PDF group. Conclusion The use of biocompatible PDFs with neutral pH and low GDP concentration can contribute to improvement of peritoneal ultrafiltration and peritoneal effluent CA125 level, an indicator of peritoneal membrane integrity in PD patients.

scholarly journals Increase in Extracellular Hydration Status after Initiating Peritoneal Dialysis Electively

2017 ◽  
Vol 37 (3) ◽  
pp. 338-340 ◽  
Author(s):  
Kwanpeemai Panorchan ◽  
Andrew Davenport
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Protein Transport ◽  
Residual Renal Function ◽  
Hydration Status ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Reactive Protein ◽  
Total Body ◽  
Inflammatory Milieu

Renal replacement therapy is designed to treat uremic symptoms and correct hypervolemia. We hypothesized that starting peritoneal dialysis (PD) should reduce overhydration, and we measured body composition and hydration status using bio-impedance in PD patients prior to training and then at the first assessment of peritoneal membrane function. We studied 100 consecutive patients with a planned start to PD, without peritoneal infections or mechanical catheter problems, mean age 54.7 ± 17.1 years, 57% male and 25% diabetic. Extracellular water (ECW) overhydration increased from -0.06 (-1.21 to 0.97) L to 0.96 (0.50 to 3.01) L, p < 0.001. Fat mass increased from 22.7 ± 11.1 to 23.7 ± 11.3 kg, p = 0.007). The change in ECW/ total body water (TBW) was associated with age (β 0.065, p < 0.001), increasing comorbidity (β 1.107, p = 0.005), faster peritoneal protein transport (β 1.84, p < 0.04), and negatively with serum albumin (β -0.208, p < 0.001), and residual renal function (β -0.725, p = 0.026). Patients who had an increase in ECW/TBW had higher C-reactive protein (CRP) both before starting (16.8 ± 24.1 vs 7.7 ± 18.9 mg/L), and when established on PD (15.0 ± 31.8 vs 4.6 ± 5.1 mg/L), p < 0.05. Rather than a reduction in ECW hydration status, overhydration increased after starting PD. This was greater for older more comorbid patients and those with an inflammatory milieu and lower residual renal function. These factors should be considered when deciding upon initial PD prescriptions to limit ECW over-hydration before information on peritoneal membrane function becomes available.

scholarly journals Soluble CD59 in peritoneal dialysis: a potential biomarker for peritoneal membrane function

2020 ◽  
Author(s):  
Bernardo Faria ◽  
Mariana Gaya da Costa ◽  
Carla Lima ◽  
Loek Willems ◽  
Ricardo Brandwijk ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Residual Renal Function ◽  
Hemodialysis Patients ◽  
Healthy Controls ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Peritoneal Dialysate

Abstract Introduction Various studies have reported the importance of complement regulators in preventing mesothelial damage during peritoneal dialysis (PD). Its assessment, however, is limited in clinical practice due to the lack of easy access to the peritoneal membrane. Recently, a soluble form of the complement regulatory protein CD59 (sCD59) has been described. We therefore aimed to investigate the role of sCD59 in PD. Methods Plasma sCD59 was measured in 48 PD patients, 41 hemodialysis patients, 15 non-dialysis patients with chronic kidney disease and 14 healthy controls by ELISA (Hycult; HK374-02). Additionally, sCD59 and sC5b-9 were assessed in the peritoneal dialysate. Results sCD59 and sC5b-9 were detectable in the peritoneal dialysate of all patients, and marginally correlated (r = 0.27, P = 0.06). Plasma sCD59 levels were significantly higher in PD patients than in patients with chronic kidney disease and healthy controls, but did not differ from hemodialysis patients. During follow-up, 19% of PD patients developed peritoneal membrane failure and 27% of PD patients developed loss of residual renal function. In adjusted models, increased sCD59 levels in the dialysate (HR 3.44, 95% CI 1.04–11.40, P = 0.04) and in plasma (HR 1.08, 95% CI 1.01–1.17, P = 0.04) were independently associated with the occurrence of peritoneal membrane failure. Higher plasma levels of sCD59 were also associated with loss of residual renal function (HR 1.10, 95% CI 1.04–1.17, P < 0.001). Conclusions Our study suggests that sCD59 has potential as a biomarker to predict peritoneal membrane function and loss of residual renal function in PD, thereby offering a tool to improve patient management. Graphic abstract

RESIDUAL RENAL FUNCTION IN PERITONEAL DIALYSIS PATIENTS

2011 ◽  
pp. 30-34
Author(s):  
Hoang Bui Bao Hoang ◽  
Huu Loi Le ◽  
Tam Vo ◽  
Thi Anh Thu Tran
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Close Correlation ◽  
Residual Renal Function ◽  
Central Hospital ◽  
Dialysis Patients

Background: Peritoneal dialysis is used regularlly in treatment of ESRDs. Residual renal function (RRF) in these patients helps the adequacy of PD therapy very much. Objectives: 1. Study RRF of PD patients at Department of Nephro – Rheumatology, Hue Central Hospital. 2. Search the correlation between RRF and Kt/V. Patients and methods: 35 PD patients at Department of Nephro – Rheumatology, Hue Central Hospital. Measure RRF and Kt/V by formulars that depend on blood, urine and PD fluid samples. Results: Mean RRF of PD patients is 4.36 ± 13.8 ml/minute. There is a close correlation between RRF and Kt/V (r=0.79, p<0.01). Conclusion: RRF in PD patients correlates with Kt/V.

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