P1131STEADY CONCENTRATION PERITONEAL DIALYSIS INCREASES ULTRAFILTRATION AND SODIUM REMOVAL COMPARED TO CAPD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ola Carlsson ◽  
Ann-Cathrine Johansson ◽  
Olof Heimbürger ◽  
Giedre Martus ◽  
Martin Wilkie ◽  
...  
Keyword(s):  
Glucose Uptake ◽  
Glucose Concentration ◽  
Small Volume ◽  
Glucose Absorption ◽  
Control Data ◽  
Peritoneal Equilibration Test ◽  
Fluid Removal ◽  
Sodium Removal ◽  
Sodium Sieving ◽  
One Way Anova

Abstract Background and Aims Fluid and sodium removal may be a challenge during glucose-based PD, leading to increased use of high glucose solutions to maintain sufficient fluid removal. This may in turn lead to increased sodium sieving, resulting in a decreased sodium removal. Carry Life® UF uses Steady Concentration PD (SCPD), where the infusion of glucose compensates for glucose uptake and maintains the intraperitoneal glucose concentration at a sufficient level providing a continuous ultrafiltration throughout the dwell. The present study investigated the effect of Carry Life UF compared to a standard CAPD dwell regarding ultrafiltration, sodium removal and glucose absorption. Method Eight stable PD patients were included in the study. Subjects were treated with 5-hour Carry Life UF treatments using three different glucose doses (11, 14, 20 g/h). An initial fill with 1500 ml, 13.6 g/l glucose PD solution was used. A small volume of dialysate was drained hourly to avoid overfill. A standard 4-hour Peritoneal Equilibration Test (PET) (2000 ml, 22.7 g/l glucose) was used as control. Data expressed as mean ± SD, statistical analysis using one-way ANOVA. Results Ultrafiltration was significantly increased during the Carry Life UF treatments compared to PET (646±256, 739±312, 863±380 ml for 11 g/h, 14 g/h and 20 g/h, respectively, vs. 162±242 ml for PET, p<0.01). Sodium removal increased significantly during Carry Life UF treatments (86±27, 92±33, 110±37 mmol/dwell for 11, 14, and 20 g glucose/h) compared to PET (22±33 mmol/dwell, p<0.001). Figure a shows that the intraperitoneal glucose concentration increased during the first hours of the Carry Life UF treatments and remained stable during the remainder of the treatments. During PET the glucose concentration decreased gradually during the treatment. The maximum intraperitoneal glucose concentration did not exceed 26 g/l (144 mmol/l) during the Carry Life UF treatments. The UF volume per gram of glucose uptake was significantly higher for the two lower Carry Life UF glucose doses compared to PET (Figure b). Conclusion SCPD performed with Carry Life® UF maintained a stable intraperitoneal glucose concentration during the 5-hour treatment which generated significantly higher UF volumes compared to 4-hour PET. During the Carry Life UF treatments glucose was used more efficiently, particularly for the two lowest doses, in comparison to PET. The increased sodium removal with Carry Life® UF enables a better balance between UF volume and sodium removal than for example during APD. In summary, SCPD using Carry Life® UF increases the efficiency of PD compared to standard, glucose-based CAPD with respect to ultrafiltration and sodium removal.

P1160INCREASED REMOVAL RATES OF FLUID AND SODIUM DURING STEADY CONCENTRATION PERITONEAL DIALYSIS COMPARED TO ICODEXTRIN AND PERITONEAL EQUILIBRATION TEST

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Ola Carlsson ◽  
Olof Heimbürger ◽  
Ann-Cathrine Johansson ◽  
Giedre Martus ◽  
Martin Wilkie ◽  
...  
Keyword(s):  
Glucose Concentration ◽  
Small Volume ◽  
Treatment Time ◽  
Peritoneal Equilibration Test ◽  
Removal Rates ◽  
Efficient Treatment ◽  
Sodium Removal ◽  
Novel Treatment ◽  
One Way Anova ◽  
H 20

Abstract Background and Aims Removal of fluid and sodium may be a major challenge in PD, which can be addressed using icodextrin for the long dwells. Steady concentration PD (SCPD) with Carry Life® UF is a novel treatment modality where the intraperitoneal glucose concentration can be kept stable throughout the treatment maintaining ultrafiltration and sodium removal. This is performed by transferring a small volume of the dialysate into the device, where glucose is added and the dialysate returned to the patient. The present study was performed to compare the effect of SCPD with icodextrin and peritoneal equilibration test (PET) on ultrafiltration and sodium removal. Method Eight stable PD patients (high or high average transporters) were included in the study. Subjects were treated with three 5-hour Carry Life UF treatments using three different glucose doses (11, 14, 20 g/h). An initial fill with 1500 ml, 1.36% glucose PD solution was used. A small volume of dialysate was drained hourly to avoid overfill. An icodextrin 11-hour dwell (2000 ml, 7.5% Extraneal®), and a 4-hour PET (2000 ml, 2.27% glucose PD solution), were used as controls. Data expressed as mean ± SD, statistical analysis using one-way ANOVA, **p<0.01, ***p<0.001. Results The treatment time for icodextrin was 11.4±1.5 hours, for PET 4.1±0.1 hours, and for the Carry Life UF treatments 5.2±0.3 hours. Carry Life UF treatments generated increased ultrafiltration rates compared to icodextrin and PET (Figure a). The sodium removal rates with Carry Life UF treatments were also significantly increased compared to icodextrin and PET (Figure b). However, the total ultrafiltration volumes during Carry Life UF treatments were not significantly different compared to the icodextrin dwell (646±256, 739±312, 863±380, 595±239, ml/treatment for 11 g/h, 14 g/h, 20 g/h, and icodextrin, respectively). The ultrafiltration volume during PET was significantly lower than all other treatments (162±242 ml, p<0.001). Peritoneal sodium removal did not differ between Carry Life UF treatments and the icodextrin dwells (86±27, 92±33, 110±37, 88±34 mmol/treatment for 11 g/h, 14 g/h, 20 g/h, and icodextrin, respectively). Peritoneal sodium removal during PET was significantly lower than during the other treatments (22±33 mmol/treatment, p<0.01). Conclusion Treatments performed with Carry Life UF maintain a stable intraperitoneal glucose concentration during the entire dwell, resulting in higher ultrafiltration and sodium removal rates than for controls (PET and icodextrin). The fluid and sodium was removed during the 5-hour Carry Life UF treatments was comparable to the 11-hour icodextrin dwells. In summary, the increased removal rates of fluid and sodium during SCPD result in a more efficient treatment than conventional CAPD or icodextrin.

scholarly journals Computational Modelling of Glucose Uptake by SGLT1 and Apical GLUT2 in the Enterocyte

2021 ◽  
Vol 12 ◽  
Author(s):  
Nima Afshar ◽  
Soroush Safaei ◽  
David P. Nickerson ◽  
Peter J. Hunter ◽  
Vinod Suresh
Keyword(s):  
Blood Flow ◽  
Glucose Uptake ◽  
Glucose Concentration ◽  
Glucose Transporter ◽  
Blood Glucose Concentration ◽  
Computational Modelling ◽  
Glucose Absorption ◽  
Osmotic Gradient ◽  
Volume Changes ◽  
Blood Concentrations

It has been suggested that glucose absorption in the small intestine depends on both constitutively expressed SGLT1 and translocated GLUT2 in the brush border membrane, especially in the presence of high levels of luminal glucose. Here, we present a computational model of non-isotonic glucose uptake by small intestinal epithelial cells. The model incorporates apical uptake via SGLT1 and GLUT2, basolateral efflux into the blood via GLUT2, and cellular volume changes in response to non-isotonic conditions. The dependence of glucose absorption on luminal glucose, blood flow rate, and inlet blood glucose concentration is studied. Uptake via apical GLUT2 is found to be sensitive to all these factors. Under a range of conditions, the maximum apical GLUT2 flux is about half of the SGLT1 flux and is achieved at high luminal glucose (> 50 mM), high blood flow rates, and low inlet blood concentrations. In contrast, SGLT1 flux is less sensitive to these factors. When luminal glucose concentration is less than 10 mM, apical GLUT2 serves as an efflux pathway for glucose to move from the blood to the lumen. The model results indicate that translocation of GLUT2 from the basolateral to the apical membrane increases glucose uptake into the cell; however, the reduction of efflux capacity results in a decrease in net absorption. Recruitment of GLUT2 from a cytosolic pool elicits a 10–20% increase in absorption for luminal glucose levels in the a 20–100 mM range. Increased SGLT1 activity also leads to a roughly 20% increase in absorption. A concomitant increase in blood supply results in a larger increase in absorption. Increases in apical glucose transporter activity help to minimise cell volume changes by reducing the osmotic gradient between the cell and the lumen.

scholarly journals Metabolic Implications of Peritoneal Dialysis in Patients with Acute Kidney Injury

2013 ◽  
Vol 33 (6) ◽  
pp. 635-645 ◽  
Author(s):  
Cassiana Regina Góes ◽  
Marina Nogueira Berbel ◽  
Andre Luis Balbi ◽  
Daniela Ponce
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Glucose Uptake ◽  
Nitrogen Balance ◽  
Kidney Injury ◽  
High Volume ◽  
Glucose Absorption ◽  
Protein Loss ◽  
Sodium Removal ◽  
Urea Nitrogen Appearance

BackgroundPeritoneal dialysis (PD) is a treatment for selected acute kidney injury patients (AKI), but little is known about its metabolic implications. The aim of the present study was to evaluate the metabolic implications of glucose absorption, sodium removal, protein loss into the dialysate, and catabolism in AKI patients undergoing high-volume PD and to identify risk factors associated with those metabolic effects.MethodsA prospective cohort study over 18 consecutive months evaluated 208 sessions of high-volume PD performed in 31 AKI patients. One session of high-volume PD lasted 24 hours. Repeated-measures analysis was performed, and correlations were calculated using the Spearman test for continuous variables and generalized linear models for categorical variables.ResultsGlucose absorption remained at approximately 35.3% ± 10.5% per session. Protein loss measured 4.2 ± 6.1 g daily, with higher values initially, which declined significantly after 2 sessions. Nitrogen balance (NB) was initially negative, but stabilized at approximately zero after 3 sessions. Glucose uptake was positively correlated with the Acute Tubular Necrosis Individual Severity Score [ATNISS ( r = 0.21, p = 0.0036)], C-reactive protein ( r = 0.26, p = 0.0167), protein loss ( r = 0.36, p < 0.0001), and sodium removal ( r = 0.24, p = 0.002). Protein loss was positively correlated with sodium removal ( r = 0.22, p = 0.0085) and gastrointestinal disease ( p = 0.0004). Sodium removal was positively correlated with serum sodium ( r = 0.21, p = 0.0064), ATNISS ( r = 0.15, p = 0.0411), urea nitrogen appearance [UNA ( r = 0.24, p = 0.0019)], and fluid overload as an indication for dialysis ( p < 0.0001). Urea nitrogen appearance was positively correlated with the indication for dialysis (electrolyte disturbances: p = 0.0287) and negatively correlated with nephrotoxic AKI ( p < 0.0001). Nitrogen balance was negatively correlated with UNA ( r = –0.389, p < 0.0001) and ischemic AKI ( p = 0.0047).ConclusionsHigh-volume PD did not increase hypercatabolism in AKI patients, and protein loss and glucose uptake remained constant during treatment. Those parameters were influenced by the clinical condition of the patients, including the cause of AKI, inflammation, and comorbidities—factors that should be known before the prescription of dialysis and nutrition, thus avoiding metabolic complications such as hyperglycemia, hypernatremia, and worsening catabolism.

Computer simulations of steady concentration peritoneal dialysis

2020 ◽  
Vol 40 (1) ◽  
pp. 76-83
Author(s):  
Kyoung Jin Lee ◽  
Dong Ah Shin ◽  
Hee Su Lee ◽  
Jung Chan Lee
Keyword(s):  
Peritoneal Dialysis ◽  
Computer Simulations ◽  
Glucose Concentration ◽  
Infusion Rate ◽  
Dwell Time ◽  
Fluid Overload ◽  
Glucose Solution ◽  
Glucose Absorption ◽  
Osmotic Gradient ◽  
Sodium Removal

Background: Steady concentration peritoneal dialysis (SCPD), which maintains transperitoneal osmotic gradient by infusing 50% glucose solution throughout the dwell time, has been proposed as a potent treatment for peritoneal dialysis (PD) patients with fluid overload. However, SCPD has yet to be explored theoretically. Here, we investigated SCPD via computer simulations. Methods: A model was developed by adding the variables for infusing 50% glucose solution to a traditional three-pore model for continuous ambulatory PD. The simulated scenarios involved the instillation of 2-L dialysate, 1.36% or 2.27%, followed by the infusion of 50% glucose solution, varying the rate from 0 mL/h to 90 mL/h. A dwell with 3.86% dialysate was also simulated for the purpose of comparison. Four sets of patient parameters corresponding to peritoneal transport categories were used. Results: The net ultrafiltration (UF) during SCPD increased with time as well as with glucose infusion rate. The glucose absorption and sodium removal of SCPD were slightly higher than those of the conventional dwell with 3.86% dialysate under the condition of the same net UF and dwell time. SCPD resulted in the larger UF and the lower peak intraperitoneal glucose concentration when it was simulated with the higher transport properties. Conclusions: These simulations indicate that SCPD can improve UF beyond those achievable by a conventional 3.86% glucose exchange while also exhibiting a lower peak osmolarity in the dialysate as compared to a conventional 3.86% dwell. However, further studies are needed to confirm these theoretical findings.

scholarly journals A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis

2016 ◽  
Vol 36 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Vicente Pérez-Díaz ◽  
Alfonso Pérez-Escudero ◽  
Sandra Sanz-Ballesteros ◽  
Guadalupe Rodríguez-Portela ◽  
Susana Valenciano-Martínez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Fluid Overload ◽  
Glucose Solution ◽  
Osmotic Gradient ◽  
Single Session ◽  
Peritoneal Equilibration Test ◽  
Peritoneal Transport ◽  
Constant Rate ◽  
Limited Power

Background Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. Methods We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). Results Ultrafiltration averaged 653 ± 363 mL/4 h — twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload ( p < 0.01) and inversely proportional to final peritoneal glucose concentration ( p < 0.05). Conclusion This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.

IN VITRO HYPOGLYCEMIC EFFECTS OF CAESALPINIA BONDUCELLA AND MYRISTICA FRAGRANS SEED EXTRACTS

INDIAN DRUGS ◽  
2018 ◽  
Vol 55 (02) ◽  
pp. 57-62
Author(s):  
M. A Bhutkar ◽  
◽  
S. D Bhinge ◽  
D. S. Randive ◽  
G. H Wadkar ◽  
...  
Keyword(s):  
Glucose Uptake ◽  
Plant Extracts ◽  
Glucose Concentration ◽  
Yeast Cells ◽  
In Vivo Models ◽  
Myristica Fragrans ◽  
Glucose Diffusion ◽  
Caesalpinia Bonducella

The present investigation was undertaken to assess the hypoglycemic potential of Caesalpinia bonducella (C.bonducella) and Myristica fragrans (M.fragrans), employing various in vitro techniques. The extracts of seeds of C. bonducella and M. fragrans were studied for their effects on glucose adsorption capacity, in vitro glucose diffusion, in vitro amylolysis kinetics and glucose transport across the yeast cells. It was observed that the plant extracts under study adsorbed glucose and the adsorption of glucose increased remarkably with an increase in glucose concentration. There were no significant (p≤0.05) differences between their adsorption capacities. The results of amylolysis kinetic experimental model revealed that the rate of glucose diffusion was found to be increased with time from 30 to 180 min and both the plant extracts demonstrated significant inhibitory effects on movement of glucose into external solution across dialysis membrane as compared to control. Also, the plant extracts promoted glucose uptake by the yeast cells. It was observed that the enhancement of glucose uptake was dependent on both the sample and glucose concentration. C. bonducella extract exhibited significantly higher (p≤0.05) activity than the extract of M. fragrans at all concentrations. The results of the study verified the hypoglycemic activity of the extracts of C. bonducella and M. fragrans. However, the observed effects exhibited by the extracts of seeds of C. bonducella and M. fragrans need to be confirmed by using different in vivo models and clinical trials for their effective utilization as therapeutic agents in better management of diabetes mellitus.

In vitro analysis of glucose metabolism and embryonic growth in postimplantation rat embryos

Development ◽  
1987 ◽  
Vol 100 (3) ◽  
pp. 431-439 ◽  
Author(s):  
S.K. Ellington
Keyword(s):  
Glucose Metabolism ◽  
Embryonic Development ◽  
Glucose Uptake ◽  
Glucose Concentration ◽  
Culture Media ◽  
Rat Embryos ◽  
Embryonic Growth ◽  
Stage Of Development

The glucose metabolism and embryonic development of rat embryos during organogenesis was studied using embryo culture. Glucose uptake and embryonic growth and differentiation of 10.5-day explants (embryos + membranes) were limited by the decreasing glucose concentration, but not the increasing concentration of metabolites, in the culture media during the second 24 h of a 48 h culture. No such limitations were found on the embryonic development of 9.5-day explants during a 48 h culture although glucose uptake was slightly reduced at very low concentrations of glucose. From the head-fold stage to the 25-somite stage of development, glucose uptake was characteristic of the stage of development of the embryo and not the time it had been in culture. Embryonic growth of 9.5-day explants was similar to that previously observed in vivo. Glucose uptake by 9.5-day explants was dependent on the surface area of the yolk sac and was independent of the glucose concentration in the culture media (within the range of 9.4 to 2.5 mM). The proportion of glucose converted to lactate was 100% during the first 42h of culture then fell to about 50% during the final 6h. The protein contents of both the extraembryonic membranes and the embryo were dependent on the glucose uptake.

Pathophysiology of Ultrafiltration in Peritoneal Dialysis

1990 ◽  
Vol 10 (2) ◽  
pp. 119-126 ◽  
Author(s):  
Claudio Ronco ◽  
Mariano Feriani ◽  
Stefano Chiaramonte ◽  
Alessandra Brendolan ◽  
Luisa Bragantini ◽  
...  
Keyword(s):  
Blood Flow ◽  
Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Peritoneal Membrane ◽  
Dialysis Membrane ◽  
Ultrafiltration Rate ◽  
Peritoneal Equilibration Test ◽  
Common Causes ◽  
Catheter Malposition ◽  
Causes Of Failure

Pathophysiology of peritoneal ultrafiltration is analyzed in the present study. Peritoneal equilibration test is the easiest procedure to study in detail the possible causes of failure to control the ultrafiltration rate in patients undergoing peritoneal dialysis. Membrane failure, reduction in peritoneal blood flow, excessive lymphatic reabsorption catheter malposition, and fluid sequestration are the most common causes of ultrafiltration loss. Pharmacologic manipulation of peritoneal membrane, correction of mechanical inconvenients, reduction in peritonitis rate and in the level of immunostimulation of the mesotelial macrophages, together with a careful policy in terms of glucose concentration in the dialysate and dwell times may contribute not only to treat different forms of ultrafiltration loss but also to prevent their incidence.

Glucose and amino acid absorption in house sparrow intestine and its dietary modulation

1996 ◽  
Vol 271 (3) ◽  
pp. R561-R568 ◽  
Author(s):  
E. Caviedes-Vidal ◽  
W. H. Karasov
Keyword(s):  
Glucose Uptake ◽  
House Sparrow ◽  
Passer Domesticus ◽  
Glucose Absorption ◽  
Uptake Capacity ◽  
House Sparrows ◽  
High Lipid ◽  
In Vivo Absorption ◽  
High Starch

We acclimated house sparrows (Passer domesticus; 26 g) to high-starch (HS), high-protein (HP), and high-lipid (HL) diets and tested the predictions that uptake of D-glucose and amino acids will be increased with increased levels of dietary carbohydrate and protein, respectively. HS birds had lower mediated D-glucose uptake rate than HP birds. Total uptake of L-leucine at low concentration (0.01 mM), but not of L-proline at 50mM, was increased by dietary protein. Measures of D-glucose maximal mediated uptake (1.2 +/- 0.2 nmol.min-1.mg-1) and intestinal mass (1 g) indicated that the intestine's mediated uptake capacity was only approximately 10% of the D-glucose absorbed at the whole animal level. This implied that nonmediated glucose absorption predominated. We applied a pharmacokinetic technique to measure in vivo absorption of L-glucose, the stereoisomer that does not interact with the Na(+)-glucose cotransporter. At least 75% of L-glucose that was ingested was apparently absorbed. This adds to the increasing evidence that substantial passive glucose absorption occurs in birds and may explain why mediated D-glucose uptake does not increase on high-carbohydrate diets.

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