Peritoneal dialysis

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0480 ◽

2020 ◽

pp. 4874-4879

Author(s):

Simon Davies

Keyword(s):

Peritoneal Dialysis ◽

Kidney Injury ◽

Peritoneal Membrane ◽

Dialysis Fluid ◽

Membrane Function ◽

Fluid Removal ◽

Visceral Peritoneum ◽

Life Threatening ◽

Gram Negative Organisms ◽

Capillary Circulation

Peritoneal dialysis is achieved by repeated cycles of instillation and drainage of dialysis fluid within the peritoneal cavity, with the two main functions of dialysis—solute and fluid removal—occurring due to the contact between dialysis fluid and the capillary circulation of the parietal and visceral peritoneum across the peritoneal membrane. It can be used to provide renal replacement therapy in acute kidney injury or chronic kidney disease. Practical aspects—choice of peritoneal dialysis as an effective modality for renal replacement in the short to medium term (i.e. several years) is, for most patients, a lifestyle issue. Typically, a patient on continuous ambulatory peritoneal dialysis will require three to four exchanges of 1.5 to 2.5 litres of dialysate per day. Automated peritoneal dialysis and use of the glucose polymer dialysis solution icodextrin enables flexibility of prescription that can mitigate the effects of membrane function (high solute transport). Peritonitis—this remains the most common complication of peritoneal dialysis, presenting with cloudy dialysis effluent, with or without abdominal pain and/or fever, and confirmed by a leucocyte count greater than 100 cells/µl in the peritoneal fluid. Empirical antibiotic treatment, either intraperitoneal or systemic, with cover for both Gram-positive and Gram-negative organisms, should be commenced immediately while awaiting specific cultures and sensitivities. Long-term changes in peritoneal membrane function influence survival on peritoneal dialysis if fluid removal is less efficient (ultrafiltration failure), especially in the absence of residual kidney function. This is the main limitation of treatment, along with avoiding the risk of encapsulating peritoneal sclerosis—a life-threatening complication of peritoneal dialysis, particularly if of long duration (15–20% incidence after 10 years), that is characterized by severe inflammatory thickening, especially of the mesenteric peritoneum, resulting in an encapsulation and progressive obstruction of the bowel.

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Peritoneal dialysis

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.210702_update_002 ◽

2010 ◽

pp. 3944-3946

Author(s):

Simon Davies

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Peritoneal Dialysis ◽

Kidney Disease ◽

Kidney Injury ◽

Automated Peritoneal Dialysis ◽

Dialysis Fluid ◽

Fluid Removal ◽

Visceral Peritoneum ◽

Capillary Circulation

Abbreviations: CAPD, Continuous ambulatory peritoneal dialysis; APD, automated peritoneal dialysis; CKD Chronic Kidney Disease; AKI, Acute kidney injury; EPS, Encapsulating Peritoneal Sclerosis. Peritoneal dialysis is achieved by repeated cycles of instillation and drainage of dialysis fluid within the peritoneal cavity, with the two main functions of dialysis—solute and fluid removal—occurring due to the contact between dialysis fluid and the capillary circulation of the parietal and visceral peritoneum across the peritoneal membrane. It can be used to provide renal replacement therapy in acute kidney injury or chronic kidney disease....

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Taking Peritoneal Dialysis beyond the Year 2000

Peritoneal Dialysis International ◽

10.1177/089686089901903s07 ◽

1999 ◽

Vol 19 (3_suppl) ◽

pp. 35-42 ◽

Cited By ~ 9

Author(s):

Ram Gokal

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Membrane ◽

Membrane Function ◽

Fluid Removal ◽

The Past ◽

First Choice ◽

Year 2000 ◽

Economic Considerations ◽

Appropriate Prescription ◽

Better Than

Over the past 25 years, peritoneal dialysis (PD) has steadily improved so that now its outcomes, in the form of patient survival, are equivalent to, and at times better than, those for hemodialysis. We now have a better understanding of the pathophysiology of peritoneal membrane function and damage and the importance of appropriate prescription to meet agreed-upon targets of solute and fluid removal. In the next millennium, greater emphasis will be put on prescription setting and subsequent monitoring. This will entail an increase in automated PD, especially for lifestyle reasons as well as for patients with a hyperpermeable peritoneal membrane. To improve outcomes, dialysis should be started earlier than is currently the case. It is easy to do this with PD, where an incremental approach is made easier by the introduction of icodextrin for long-dwell PD. In the future, solutions will be tailored to be more biocompatible and to provide improved nutrition and better cardiovascular outcomes. Finally, economic considerations favor PD, which is cheaper than in-centre hemodialysis. Thus, for many, PD has become a first-choice therapy, and with further improvements this trend will continue.

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Peritoneal Dialysis

10.2310/nephro.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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Systemic Endotoxin in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00036 ◽

2018 ◽

Vol 38 (5) ◽

pp. 381-384 ◽

Cited By ~ 1

Author(s):

Ali M. Shendi ◽

Nathan Davies ◽

Andrew Davenport

Keyword(s):

Peritoneal Dialysis ◽

Extracellular Volume ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Fungal Cell ◽

Membrane Function ◽

Patient Demographics ◽

Markers Of Inflammation ◽

Systemic Endotoxemia

Previous reports linked systemic endotoxemia in dialysis patients to increased markers of inflammation, cardiovascular disease, and mortality. Many peritoneal dialysis (PD) patients use acidic, hypertonic dialysates, which could potentially increase gut permeability, resulting in systemic endotoxemia. However, the results from studies measuring endotoxin in PD patients are discordant. We therefore measured systemic endotoxin in 55 PD outpatients attending for routine assessment of peritoneal membrane function; mean age 58.7 ± 16.4 years, 32 (58.2%) male, 21 (38.2%) diabetic, median duration of PD treatment 19.5 (13 – 31) months, 32 (58.2%) using 22.7 g/L dextrose dialysates, and 47 (85.5%) icodextrin. The median systemic endotoxin concentration was 0.0485 (0.0043 – 0.103) Eu/mL. We found no association between endotoxin levels and patient demographics, markers of inflammation, serum albumin, N-terminal pro-brain natriuretic peptide, extracellular volume measured by bioimpedance, blood pressure, PD prescriptions or peritoneal membrane transporter status, or medications. The measurement of endotoxin can be lowered by failure to effectively release protein-bound endotoxin prior to analysis and increased by contamination when taking blood samples and processing and storing the samples. Additionally, contamination with β–glucan from fungal cell walls and the use of different assays to analyze endotoxin can also give differing results. These factors may help to explain the disparate results reported in different studies. Our study would suggest that exposure to standard peritoneal dialysates does not substantially increase systemic endotoxin. However, until endotoxin assays can measure free and bound endotoxin separately, the role of endotoxin causing inflammation in PD patients remains to be determined.

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Peritoneal Dialysis

10.2310/im.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

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Monitoring of Long-Term Peritoneal Membrane Function

Peritoneal Dialysis International ◽

10.1177/089686080102100222 ◽

2001 ◽

Vol 21 (2) ◽

pp. 225-232 ◽

Cited By ~ 12

Author(s):

Simon J. Davies

Keyword(s):

Peritoneal Dialysis ◽

Solute Transport ◽

Water Transport ◽

Drop Out ◽

Published Data ◽

Peritoneal Membrane ◽

Membrane Function ◽

Technique Survival ◽

Ultrafiltration Failure

Objective Peritoneal membrane function influences dialysis prescription and clinical outcome and may change with time on treatment. Increasingly sophisticated tools, ranging from the peritoneal equilibration test (PET) to the standard permeability analysis (SPA) and personal dialysis capacity (PDC) test, are available to the clinician and clinical researcher. These tests allow assessment of a number of aspects of membrane function, including solute transport rates, ultrafiltration capacity, effective reabsorption, transcellular water transport, and permeability to macromolecules. In considering which tests are of greatest value in monitoring long-term membrane function, two criteria were set: those that result in clinically relevant interpatient differences in achieved ultrafiltration or solute clearances, and those that change with time in treatment. Study Selection Clinical validation studies of the PET, SPA, and PDC tests. Studies reporting membrane function using these methods in either long-term (5 years) peritoneal dialysis patients or longitudinal observations (> 2 years). Data Extraction Directly from published data. Additional, previously unpublished analysis of data from the Stoke PD Study. Results Solute transport is the most important parameter. In addition to predicting patient and technique survival at baseline, there is strong evidence that it can increase with time on treatment. Whereas patients with initially high solute transport drop out early from treatment, those with low transport remain longer on treatment, although, over 5 years, a proportion develop increasing transport rates. Ultrafiltration capacity, while being a composite measure of membrane function, is a useful guide for the clinician. Using the PET (2.27% glucose), a net ultrafiltration capacity of < 200 mL is associated with a 50% chance of achieving less than 1 L daily ultrafiltration at the expense of 1.8 hypertonic (3.86%) exchanges in anuric patients. Using a SPA (3.86% glucose), a net ultrafiltration capacity of < 400 mL indicates ultrafiltration failure. While there is circumstantial evidence that, with time on peritoneal dialysis, loss of transcellular water transport might contribute to ultrafiltration failure, none of the current tests is able to demonstrate this unequivocally. Of the other membrane parameters, evidence that interpatient differences are clinically relevant (permeability to macro-molecules), or that they change significantly with time on treatment (effective reabsorption), is lacking. Conclusion A strong case can be made for the regular assessment by clinicians of solute transport and ultrafiltration capacity, a task made simple to achieve using any of the three tools available.

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Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088900900116 ◽

1989 ◽

Vol 9 (1) ◽

pp. 75-78 ◽

Cited By ~ 19

Author(s):

Min Sun Park ◽

Jean Lee ◽

Moon Sung Lee ◽

Seung Ho Baick ◽

Seung Duk Hwang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Glucose Absorption ◽

Peritoneal Membrane ◽

Vasoactive Agents ◽

Membrane Function ◽

Dialysis Solution ◽

Before And After ◽

Dialysate Volume

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (D PC), peritoneal glucose absorption (% GA), and drained dialysate volume ( VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month). There were no differences in the control (without NP) Curea, Ccr, D PC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and D PC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but D PC with NP was significantly lower in the long-term CAPD patients. The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.

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Relationship of Demographic, Dietary, and Clinical Factors to the Hydration Status of Patients on Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080402400305 ◽

2004 ◽

Vol 24 (3) ◽

pp. 231-239 ◽

Cited By ~ 17

Author(s):

Ramzana B. Asghar ◽

Sandra Green ◽

Barbara Engel ◽

Simon J. Davies

Keyword(s):

Body Weight ◽

Peritoneal Dialysis ◽

Solute Transport ◽

Extracellular Fluid ◽

Fat Free Mass ◽

Single Frequency ◽

Hydration Status ◽

Clinical Factors ◽

Membrane Function ◽

Fluid Removal

Objectives To establish which clinical factors are associated with an increased proportion of extracellular fluid (ECF) in peritoneal dialysis (PD) patients. Design A single-center, cross-sectional analysis of 68 stable PD patients. Method Bioelectrical impedance measurements (RJL, single frequency; RJL Systems, Clinton, Michigan, USA) of resistance and reactance were used to determine the proportion of ECF comprising total body water (TBW) in 68 stable PD patients attending for routine clearance and membrane studies. All patients underwent detailed dietetic, adequacy, and membrane function tests. Blood pressure and antihypertensive requirements were also documented. Results Significant gender differences in body composition were observed, such that women had lower absolute TBW and fat-free mass per kilogram body weight, but proportionately more ECF for a given TBW, mean ECF:TBW 0.5 ± 0.03 versus 0.44 ± 0.05, p < 0.005. In view of this, patients were split into two groups, defined as “over-” or “normally” hydrated, either by using the single discriminator (median ECF:TBW = 0.47) for the whole population, which resulted in groups distorted by gender, or by using different discriminators according to gender (women: 0.49, men 0.45). In both analyses, overhydrated patients were older, had significantly lower plasma albumin, less total fluid removal per kilogram body weight, and higher peritoneal solute transport. When split by a single discriminator, the overhydrated patients had lower sodium removal and significantly less intracellular fluid volume due to an excess of women in this group who also had less residual function and had been on dialysis longer. Using gender-specific discrimination, overhydrated patients were heavier due to expansion of the ECF volume: 20 ± 4.1 L versus 16 ± 3.3 L, p < 0.001. Stepwise multivariate analysis found age ( p = 0.001), albumin ( p = 0.009), and fluid losses per kilogram body weight ( p = 0.025) to be independent predictors of gender-adjusted hydration status. Sodium intake did not vary according to hydration status. Conclusion Gender influences the assessment of hydration status of PD patients when employing bioimpedance, such that women tend to have more ECF. Taking this into account, age, albumin, and achieved fluid removal appear to be independently associated with hydration status, whereas peritoneal solute transport is not. Advice on dietary sodium should take account of hydration status and achievable losses.

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