A high performance liquid chromatography (HPLC) assay for linezolid in continuous ambulatory peritoneal dialysis fluid (CAPDF)

BackgroundCurrent guidelines suggest that intraperitoneal (IP) antibiotics should be administered only in a long peritoneal dialysis (PD) dwell (≥ 6 hours). The long dwell might result in low ultrafiltration and volume overload. We aim to examine plasma and dialysate concentration of cefazolin and ceftazidime after IP administration in a short-dwell (≤ 2 hours) automated cycling exchange.MethodsStable PD patients without peritonitis were invited to participate in the present study. Patients underwent 5 2-liter exchanges of PD fluid over 10 hours by the PD cycling machine without last fill or additional dwell. Cefazolin and ceftazidime (20 mg/kg each) were added to the first 5-liter bag of 2.5% dextrose PD fluid that was placed on the warmer of the PD cycling machine. Plasma samples were collected at 12 time-points over 24 hours. Dialysate samples from each exchange were also collected. Antibiotic concentrations in plasma and dialysate were then determined by high-performance liquid chromatography (HPLC).ResultsSix stable PD patients without peritonitis participated in the study. Dialysate cefazolin and ceftazidime were consistently high throughout the PD session in all patients (26 - 360 mg/L). Plasma cefazolin and ceftazidime exceeded the minimal inhibitory concentration (MIC) for susceptible organisms (≤ 8 mg/L) within 2 hours (cefazolin 28.5 ± 8.0 and ceftazidime 12.5 ± 3.4 mg/L), peak at 10 hours (51.1 ± 14.1 and 23.0 ± 5.2 mg/L) and sustained well above the MIC at 24 hours (42.0 ± 9.6 and 17.1 ± 3.1 mg/L).ConclusionsThe short-dwell cycling IP cefazolin and ceftazidime could provide adequate plasma concentration for up to 24 hours. Daily short-dwell cycling IP cefazolin and ceftazidime might be used to treat peritonitis in PD patients already using a PD cycling machine as well as selected continuous ambulatory PD (CAPD) patients who need shorter dwells during peritonitis due to increasing peritoneal solute transport.

Download Full-text

Take Care in how you Store Your PD Fluids: Actual Temperature Determines the Balance between Reactive and Non-Reactive GDPs

Peritoneal Dialysis International ◽

10.1177/089686080502500615 ◽

2005 ◽

Vol 25 (6) ◽

pp. 583-590 ◽

Cited By ~ 15

Author(s):

Martin Erixon ◽

Anders Wieslander ◽

Torbjörn Lindén ◽

Ola Carlsson ◽

Gunita Forsbäck ◽

...

Keyword(s):

High Performance Liquid Chromatography ◽

Liquid Chromatography ◽

Peritoneal Dialysis ◽

Aqueous Solutions ◽

Carbonyl Compounds ◽

High Performance ◽

Room Temperature ◽

Degradation Products ◽

Prolonged Storage ◽

Dialysis Fluids

Objective During heat sterilization and during prolonged storage, glucose in peritoneal dialysis fluids (PDF) degrades to carbonyl compounds commonly known as glucose degradation products (GDPs). Of these, 3,4-dideoxyglucosone-3-ene (3,4-DGE) is the most cytotoxic. It is an intermediate in degradation between 3-deoxyglucosone (3-DG) and 5-hydroxymethyl-2-furaldehyde (5-HMF). We have earlier reported that there seems to be equilibrium between these GDPs in PDF. The aim of the present study was to investigate details of this equilibrium. Methods Aqueous solutions of pure 3-DG, 3,4-DGE, and 5-HMF were incubated at 40°C for 40 days. Conventional and low-GDP fluids were incubated at various temperatures for up to 3 weeks. Formaldehyde, acetaldehyde, glyoxal, methylglyoxal, 3-DG, 3,4-DGE, and 5-HMF were analyzed using high performance liquid chromatography. Results Incubation of 100 μmol/L 3,4-DGE resulted in the production of 36 μmol/L 3-DG, 4 μmol/L 5-HMF, and 40 μmol/L unidentified substances. With the same incubation, 200 μmol/L 3-DG was converted to 9 μmol/L 3,4-DGE, 6 μmol/L 5-HMF, and 14 μmol/L unidentified substances. By contrast, 100 μmol/L 5-HMF was uninfluenced by incubation. In a conventional PDF incubated at 60°C for 1 day, the 3,4-DGE concentration increased from 14 to a maximum of 49 μmol/L. When the fluids were returned to room temperature, the concentration decreased but did not reach original values until after 40 days. In a low GDP fluid, 3,4-DGE increased and decreased in the same manner as in the conventional fluid but reached a maximum of only 0.8 μmol/L. Conclusions Considerable amounts of 3,4-DGE may be recruited by increases in temperature in conventional PDFs. Lowering the temperature will again reduce the concentration but much more time will be needed. Precursors for 3,4-DGE recruitment are most probably 3-DG and the enol 3-deoxyaldose-2-ene, but not 5-HMF. Considering the ease at which 3,4-DGE is recruited from its pool of precursors and the difficulty of getting rid of it again, one should be extremely careful with the temperatures conventional PDFs are exposed to.

Download Full-text

Growth of Bacterial Clinical Isolates in Continuous Ambulatory Peritoneal Dialysis Fluid

Peritoneal Dialysis International ◽

10.1177/089686088300300311 ◽

1983 ◽

Vol 3 (3) ◽

pp. 144-145 ◽

Cited By ~ 4

Author(s):

Dayl J. Flournoy ◽

Fred A. Perryman ◽

Syed M.H. Qadri

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Chemical Constituent ◽

Pseudomonas Sp ◽

Bacterial Isolates ◽

Proteus Vulgaris ◽

Dialysis Fluid ◽

Colony Forming Units ◽

Peritoneal Dialysis Fluid ◽

Group D

Clinical bacterial isolates (105 colony forming units/mi) were inoculated into sterile unused and used continuous ambulatory peritoneal dialysis (CAPD) fluid, incubated for 24 hours at 3SOC and observed for growth as evidenced by turbidity. The CAPD fluids also were tested for selected chemical constituent concentrations. The main differences in sterile unused and used fluids were: pH, 5.25 (unused) vs 7.60–8.62 (used); glucose, 1350–3680 vs 407–1227 mg/dl; potassium, 0 vs 2.0–4.2 mEq/l and phosphorous, 0 and 2.5–5.5 mg/dl respectively. When isolates of Candido albicans (10 strains), Enterobacter sp. (2), Escherichia coli (2), Group D Enterococci (2), Klebsiella pneumoniae (2), Proteus vulgaris (2), Pseudomonas aeruginosa (30), Pseudomonas sp. (2), Serratia marcescens (2), Staphylococcus aureus (2), S. epidermidis (2) and alphahemolytic streptococci (10) were tested against the fluids, none of the isolates grew in unused fluid but all grew in used fluid, which had been in the peritoneal cavity for as little as one and one-halfhours. Although the organisms did not grow in unused fluid, they were still viable at their original concentrations as deterrnined by quantitative subcultures.

Download Full-text