194 Increased Sodium Removal with Steady Concentration Peritoneal Dialysis

2020 ◽  
Vol 75 (4) ◽  
pp. 592
Keyword(s):  
Peritoneal Dialysis ◽  
Sodium Removal

scholarly journals Sodium removal in peritoneal dialysis: is there room for a new parameter in dialysis adequacy?

2019 ◽  
Vol 2 (3) ◽  
pp. 151-157
Author(s):  
Anna Lima ◽  
Joana Tavares ◽  
Nicole Pestana ◽  
Maria João Carvalho ◽  
António Cabrita ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Volume Overload ◽  
Residual Renal Function ◽  
Dialysis Adequacy ◽  
Sodium Removal ◽  
Low Sodium ◽  
Major Attention ◽  
New Strategies ◽  
Small Solute ◽  
Solute Clearance

In peritoneal dialysis (PD) (as well as in hemodialysis) small solute clearance measured as Kt/v urea has long been used as a surrogate of dialysis adequacy. A better urea clearance was initially thought to increase survival in dialysis patients (as shown in the CANUSA trial)(1), but  reanalysis of the data showed a superior contribution of residual renal function as a predictor of patient survival. Two randomized controlled trials (RCT)(2, 3)  supported this observation, demonstrating no survival benefit in patients with higher achieved Kt/v. Then guidelines were revised and a minimum Kt/v of 1,7/week was recommended but little emphasis was given to additional parameters of dialysis adequacy. As such, volume overload and sodium removal have gained major attention, since their optimization has been associated with decreased mortality in PD patients(4, 5). Inadequate sodium removal is associated with fluid overload which leads to ventricular hypertrophy and increased cardiovascular mortality(6). Individualized prescription is key for optimal sodium removal as there are differences between PD techniques (CAPD versus APD) and new strategies for sodium removal have emerged (low sodium solutions and adapted PD). In conclusion, future guidelines should address parameters associated with increased survival outcomes (sodium removal playing an important role) and abandon the current one fit all prescription model.

scholarly journals Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

2019 ◽  
Vol 9 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Amir Kazory ◽  
Abhilash Koratala ◽  
Claudio Ronco
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Population ◽  
Therapeutic Option ◽  
Free Water ◽  
Volume Overload ◽  
Cardiorenal Syndrome ◽  
Waste Products ◽  
Specific Patient ◽  
Fluid Removal ◽  
Sodium Removal

Background: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. Methods: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. Results: Herein, we provide an overview of approaches that can tailor PD treatment to the patients’ characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. Conclusion: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.

Use of Icodextrin during Nocturnal Automated Peritoneal Dialysis Allows Sustained Ultrafiltration While Reducing the Peritoneal Glucose Load: A Randomized Crossover Study

2007 ◽  
Vol 27 (3) ◽  
pp. 260-266 ◽  
Author(s):  
Ana Rodríguez-Carmona ◽  
Miguel Pérez Fontán ◽  
Elvia García López ◽  
Teresa García Falcón ◽  
Helena Díaz Cambre
Keyword(s):  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Serum Levels ◽  
Residual Renal Function ◽  
Similar Amount ◽  
Glucose Load ◽  
Sodium Removal ◽  
Dependent Variables ◽  
Ultra Filtration ◽  
Randomized Crossover Study

Background Optimization of ultrafiltration and preservation of the peritoneal membrane are desirable objectives in peritoneal dialysis (PD) patients. Mixtures of glucose-and non-glucose-based solutions may help to meet both targets simultaneously. Aim To analyze the effects, in terms of ultrafiltration and peritoneal glucose load, of including icodextrin-based dialysate in the nocturnal schedule of patients undergoing automated PD (APD). Method Following a randomized crossover design, 17 APD patients underwent two 10-day study periods under identical prescription (including amino acid-based solution for the night schedule), except for the substitution of 2 L glucose-based dialysate in the nocturnal mixture (control) by a similar amount of icodextrin-based dialysate (icodextrin phase) in one period. Dependent variables included ultra-filtration, sodium removal, peritoneal glucose load, and residual renal function. We measured serum and urine levels of icodextrin metabolites at the end of each phase. Results Ultrafiltration was marginally higher during the icodextrin phase (median 815 vs 763 mL/day, p = 0.07), while peritoneal sodium removal was similar in both phases (74 vs 71 mmol/L/day). Peritoneal glucose load (median 67.5 vs 104.0 g/day, p < 0.005) and absorption (14.0 vs 35.6 g/day, p < 0.005) were lower during the icodextrin phase. Diuresis was also modestly lower during the icodextrin phase (500 vs 600 mL/day, p < 0.05). Serum levels of icodextrin metabolites were moderately higher in the icodextrin phase ( p < 0.005) in patients both on and off diurnal icodextrin. Conclusion Inclusion of amino acid- and icodextrin-based solutions in the nocturnal schedule of APD patients may allow sustained ultrafiltration and sodium removal while significantly reducing the peritoneal glucose load in these patients.

Individualized pd Prescription: Apd versus Capd

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 92-94 ◽  
Author(s):  
Reinhard R. Brunkhorst
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Situation ◽  
Private Life ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Bicarbonate Buffer ◽  
Sodium Removal ◽  
Dialysis Solution ◽  
The Individual

The proportion of patients performing automated peritoneal dialysis (APD) is increasing worldwide, a development probably caused by the better possibilities of adapting APD to the patients’ individual needs with respect to private life as well as dialysis adequacy. Patients prefer the independence from dialysis during the day and report a higher quality of life compared to patients on continuous ambulatory peritoneal dialysis (CAPD). In case of declining clearance rates, Kt/V, or sodium removal rates, a change in the APD regimen, together with higher fill volumes and, for example, combination with daytime CAPD, offers the tools to increase the dialysis dose as required by the individual clinical situation. The development of an online dialysis solution production system for APD could even improve the possibilities of individualizing peritoneal dialysis by providing variable concentrations of glucose, sodium, and bicarbonate buffer.

scholarly journals Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

2017 ◽  
Vol 46 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Ana Fernandes ◽  
Roi Ribera-Sanchez ◽  
Ana Rodríguez-Carmona ◽  
Antía López-Iglesias ◽  
Natacha Leite-Costa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water ◽  
Volume Overload ◽  
Diabetic Patients ◽  
Longitudinal Analyses ◽  
Cross Sectional ◽  
Sodium Removal ◽  
Essential Stability ◽  
Stability Of Water

Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently. Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes. Main Results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics. Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.

Sodium Removal and Peritoneal Dialysis Modalities: No Differences With Optimal Prescription of Icodextrin

2013 ◽  
Vol 37 (7) ◽  
pp. E107-E113 ◽  
Author(s):  
Costas Fourtounas ◽  
Periklis Dousdampanis ◽  
Andreas Hardalias ◽  
Jannis G. Vlachojannis
Keyword(s):  
Peritoneal Dialysis ◽  
Sodium Removal

scholarly journals Influence of Different Payment Schemes on the Clinical Outcome in Peritoneal Dialysis Patients

2015 ◽  
Vol 36 (2) ◽  
pp. 205-212
Author(s):  
Chun-yan Su ◽  
Xin-hong Lu ◽  
Tao Wang
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcome ◽  
Dietary Intake ◽  
Nutrition Status ◽  
Volume Status ◽  
Dialysis Patients ◽  
Dialysis Adequacy ◽  
Sodium Removal ◽  
Significant Difference ◽  
Payment Schemes

Background Cost is always a big issue for dialysis patients. In the present study, we analyzed the effect of different payment schemes on dialysis adequacy and clinical outcome in our peritoneal dialysis program. Methods This is a single-center cohort study. A total of 175 patients who began dialysis from January 2006 to December 2007 were included. Baseline data, including volume status, dietary intake and nutrition status, dialysis adequacy, and sodium removal were collected at 6 months after peritoneal dialysis. Based on the different payment schemes, the patients were divided into 2 groups, higher payment group (GHP, 130 cases, with more than 85% reimbursement), and lower payment group (GLP, 45 cases, with less than 50% payment or totally self-paid). Patients were followed up until dropout or until December 31, 2013. Results At baseline, patients in the 2 groups had nearly the same residual renal function. But the GLP group patients dialyzed at a lower dose (4,516.91 ± 1,768.20 mL vs 6,058.17 ± 2,013.43 mL, p < 0.001). They had lower creatinine clearance (51.64 ± 24.23 L/w vs 70.54 ± 30.27 L/w, p < 0.001), sodium removal (2.23 ± 1.29 g vs 2.77 ± 1.29 g, p = 0.027), and fluid removal (970.33 ± 545.97 mL vs 1,146.66 ± 460.93 mL, p = 0.038). Normalized by height (in meters), the GLP group patients still had a lower normalized dialysis dose (2,890.61 ± 1084.44 mL/m vs 3,761.34 ± 1,237.10 mL/m, p < 0.001). Baseline nutritional and dietary parameters were comparable except that a lower daily protein intake (42.73 ± 10.99 g vs 47.26 ± 14.30 g, p = 0.032) and higher serum urea level (23.43 ± 6.88 mmol/L vs 19.84 ± 5.92 mmol/L, p < 0.001) were presented in the GLP group. There was no difference in volume status. During the follow-up, Kaplan-Meier analysis showed that there was no significant difference in patient survival and technique survival. In multivariate Cox regression analysis, after adjusting for related factors, payment was again not a strong predictor of survival in the study population. Conclusion Our study found that GLP group patients were adherent to lifestyle modification with lower dialysis doses, and they also had nearly the same long-term clinical outcome as the GHP group patients. Thus, lower dialysis doses combined with controlled dietary intake may be an effective approach to solve the dialysis problem for the low socio-economic status (SES) population.

CONTROLLED SODIUM REMOVAL WITH PERITONEAL DIALYSIS

ASAIO Journal ◽  
1972 ◽  
Vol 18 (1) ◽  
pp. 423-428 ◽  
Author(s):  
Daniel J. Ahearn ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Sodium Removal

Patient Selection for Automated Peritoneal Dialysis: For Whom, When?

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 102-107 ◽  
Author(s):  
Vassilios Liakopoulos ◽  
Nicholas Dombros
Keyword(s):  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Patient Choice ◽  
Rapid Decline ◽  
Automated Peritoneal Dialysis ◽  
Contributing Factors ◽  
Dialysis Dose ◽  
Intraperitoneal Pressure ◽  
Sodium Removal ◽  
Disturbed Sleep

The use of the various forms of automated peritoneal dialysis (APD) has increased considerably in the past few years. This increase has in part been driven by technology, through improved cycler design. Other contributing factors include better adjustment of APD to patient lifestyle, the flexibility that APD offers to patients, and the increased ability of APD to achieve adequacy and ultrafiltration targets. For high transporters and for patients unable to perform peritoneal dialysis (PD) on their own (for example, pediatric and elderly patients), APD is considered the most suitable PD modality. Furthermore, APD has been associated with improved compliance, lower intraperitoneal pressure, and lower incidences of peritonitis. On the other hand, concerns have been raised regarding increased complexity and cost, a more rapid decline in residual renal function, inadequate sodium removal, and disturbed sleep. Automated PD is an alternative to continuous ambulatory PD when a higher dialysis dose is needed, and it could be a reliable alternative for unplanned or urgent dialysis start. Other than beneficial results in high transporters, the medical advantages of APD remain controversial. Individual patient choice therefore remains the main indication for the application of APD, which should be made available to all patients starting PD.

Ultrafiltrazione peritoneale e sindrome cardiorenale: gestione del sovraccarico di fluidi e ruolo del sodio

2019 ◽  
Vol 31 (2) ◽  
pp. 100-105
Author(s):  
Luca Di Lullo ◽  
Claudio Ronco ◽  
Fulvio Floccari ◽  
Antonio De Pascalis ◽  
Rodolfo Rivera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Peritoneal Dialysis ◽  
Diuretic Therapy ◽  
Decompensated Heart Failure ◽  
Cardiorenal Syndrome ◽  
Therapeutic Modality ◽  
Heart Failure Patients ◽  
Sodium Removal ◽  
Refractory Heart Failure ◽  
Home Based

Congestion represents a crucial clinical component of both heart failure and cardiorenal syndrome and it has been postulated to modulate heart and kidney cross-link. Diuretic therapy is a corner stone in the treatment patients with heart failure, and renal replacement therapies are mainly used for patients with refractory heart failure who have not reached the worst stages of renal disfunction. Peritoneal dialysis is a home-based therapeutic modality providing both solute clearance and ultrafiltration, together with relief from congestion in decompensated heart failure patients. The following review will focus on sodium removal in refractory decompensated heart failure patients undergoing peritoneal dialysis. (Cardionephrology)

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