Ionic conductivity of peritoneal dialysate: a new, easy and fast method of assessing peritoneal membrane function in patients undergoing peritoneal dialysis

Abstract Background Optimal fluid balance for peritoneal dialysis (PD) patients requires both water and sodium removal. Previous studies have variously reported that continuous ambulatory peritoneal dialysis (CAPD) removes more or equivalent amounts of sodium than automated PD (APD) cyclers. We therefore wished to determine peritoneal dialysate losses with different PD treatments. Methods Peritoneal and urinary sodium losses were measured in 24-h collections of urine and PD effluent in patients attending for their first assessment of peritoneal membrane function. We adjusted fluid and sodium losses for CAPD patients for the flush before fill technique. Results We reviewed the results from 659 patients, mean age 57 ± 16 years, 56.3% male, 38.9% diabetic, 24.0% treated by CAPD, 22.5% by APD and 53.5% APD with a day-time exchange, with icodextrin prescribed to 72.8% and 22.7 g/L glucose to 31.7%. Ultrafiltration was greatest for CAPD 650 (300–1100) vs 337 (103–598) APD p < 0.001, vs 474 (171–830) mL/day for APD with a day exchange. CAPD removed most sodium 79 (33–132) vs 23 (− 2 to 51) APD p < 0.001, and 51 (9–91) for APD with a day exchange, and after adjustment for the CAPD flush before fill 57 (20–113), p < 0.001 vs APD. APD patients with a day exchanged used more hypertonic glucose dialysates [0 (0–5) vs CAPD 0 (0–1) L], p < 0.001. Conclusion CAPD provides greater ultrafiltration and sodium removal than APD cyclers, even after adjusting for the flush-before fill, despite greater hypertonic usage by APD cyclers. Ultrafiltration volume and sodium removal were similar between CAPD and APD with a day fill.

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

Journal of Nephrology ◽

10.1007/s40620-020-00934-7 ◽

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

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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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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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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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Sustained low peritoneal effluent CCL18 levels are associated with preservation of peritoneal membrane function in peritoneal dialysis

PLoS ONE ◽

10.1371/journal.pone.0175835 ◽

2017 ◽

Vol 12 (4) ◽

pp. e0175835 ◽

Cited By ~ 4

Author(s):

Marta Ossorio ◽

María Auxiliadora Bajo ◽

Gloria del Peso ◽

Virginia Martínez ◽

María Fernández ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Membrane ◽

Membrane Function

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Glycated Albumin in Serum and Dialysate of Patients on Continuous Ambulatory Peritoneal Dialysis

Clinical Science ◽

10.1042/cs0840619 ◽

1993 ◽

Vol 84 (6) ◽

pp. 619-626 ◽

Cited By ~ 36

Author(s):

E. Lamb ◽

W. R. Cattell ◽

A. Dawnay

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Glucose Concentration ◽

Glycated Albumin ◽

Protein Glycation ◽

Structural Proteins ◽

Diabetic Patients ◽

Peritoneal Membrane ◽

Membrane Function ◽

Ultrafiltration Failure

1. Chronic use of hyperosmolar glucose solutions in continuous ambulatory peritoneal dialysis may cause glycation of peritoneal structural proteins which could contribute to membrane dysfunction and ultrafiltration failure. To determine whether glycation can occur in the environment of the dialysate, we have carried out studies using albumin as a model protein. 2. Glycated albumin was measured in the serum and dialysate of 46 patients on continuous ambulatory peritoneal dialysis (31 non-diabetic patients, 15 diabetic patients). Dialysate and serum glycated albumin (ranges 1.0-12.7% and 0.9-10.2%, respectively) were related to each other (r = 0.988, P <0.001), but dialysate glycated albumin was significantly higher than serum glycated albumin (P <0.0001), with the dialysate to serum glycated albumin ratio being greater than unity in 76% of patients (mean ratio 1.14). This implies either preferential transfer of glycated albumin across the peritoneal membrane or intraperitoneal glycation during the dwell period. 3. In vitro, significant glycation occurred in dialysate during a 6 h incubation period (P <0.01) at a rate related to the glucose concentration in the dialysate (rs = 0.63, P <0.05). The glycation rate was not significantly affected (P = 0.05) by factors other than the glucose concentration. 4. Our results demonstrate that protein glycation occurs within the peritoneum during continuous ambulatory peritoneal dialysis. Further studies are required to establish the relationship of glycation of structural proteins in the peritoneal membrane to membrane function.

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Antiangiogenic and Antifibrotic Gene Therapy in a Chronic Infusion Model of Peritoneal Dialysis in Rats

Journal of the American Society of Nephrology ◽

10.1681/asn.v133721 ◽

2002 ◽

Vol 13 (3) ◽

pp. 721-728 ◽

Cited By ~ 1

Author(s):

Peter J. Margetts ◽

Steve Gyorffy ◽

Martin Kolb ◽

Lisa Yu ◽

Catherine M. Hoff ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Growth Factor ◽

Gene Transfer ◽

Transforming Growth Factor ◽

Angiogenesis Inhibitor ◽

Transforming Growth Factor Β ◽

Collagen Content ◽

Peritoneal Membrane ◽

Peritoneal Fibrosis ◽

Membrane Function

ABSTRACT. To identify the relative importance of peritoneal fibrosis and angiogenesis in peritoneal membrane dysfunction, adenoviral mediated gene transfer of angiostatin, a recognized angiogenesis inhibitor, and decorin, a transforming growth factor-β–inhibiting proteoglycan, were used in a daily infusion model of peritoneal dialysis. A peritoneal catheter and subcutaneous port were inserted in rats. Five and fourteen d after insertion, adenovirus-expressing angiostatin, decorin, or AdDL70, a null control virus, were administered. Daily infusion of 4.25% Baxter Dianeal was initiated 7 d after catheter insertion and continued until day 35. Three initial doses of lipopolysaccharide were administered on days 8, 10, and 12 to promote an inflammatory response. Net ultrafiltration was used as a measure of membrane function, and peritoneum-associated vasculature and mesenteric collagen content was quantified. Ultrafiltration dysfunction, angiogenesis, and fibrosis were observed in daily infusion control animals. Animals treated with AdAngiostatin demonstrated an improvement in net ultrafiltration (−3.1 versus −7.8 ml for control animals; P = 0.0004) with a significant reduction in vessel density. AdDecorin-treated animals showed a reduction in mesenteric collagen content (1.8 versus 2.9 μg/mg; P = 0.04); however, AdDecorin treatment had no effect on net ultrafiltration. In a rodent model of peritoneal membrane failure, net ultrafiltration was significantly improved and peritoneal-associated blood vessels were significantly reduced by using adenovirus-mediated gene transfer of angiostatin. Decorin, a transforming growth factor-β–inhibiting proteoglycan, reduced collagen content but did not affect net ultrafiltration. Improvement in the function of the peritoneum as a dialysis membrane after treatment with angiostatin has implications for treatment of peritoneal membrane dysfunction seen in patients on long-term dialysis.

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Utility of Peritoneal Scintigraphy in Peritoneal Dialysis Patients: One Center Experience

Kidney360 ◽

10.34067/kid.0000302020 ◽

2020 ◽

Vol 1 (5) ◽

pp. 354-358

Author(s):

R. Haridian Sosa Barrios ◽

María Eugenia Rioja Martín ◽

Víctor Burguera Vion ◽

Astrid Lucía Santos Carreño ◽

Milagros Fernández Lucas ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Membrane ◽

Polycystic Kidney ◽

Dialysis Patients ◽

First Line ◽

Peritoneal Dialysate ◽

Other Substances ◽

Line Imaging ◽

Technique Failure ◽

Peritoneal Scintigraphy

BackgroundPeritoneal dialysis (PD) is the RRT of choice in 15% of patients with CKD and has multiple advantages over hemodialysis. PD leaks can prompt technique failure and dropout. Use of peritoneal scintigraphy (PS) for diagnosis of PD leaks has declined in favor of more complex and expensive tests. We analyzed the utility of PS for PD leak diagnosis in our center.MethodsWe retrospectively analyzed all PS done in our center from January 2000 until December 2018, inclusive, in all patients on PD with a suspected dialysate leak.ResultsA total of 39 PS procedures were done in 36 patients on PD in the study period. Of those, 81% were male and 11% had CKD due to polycystic kidney disease. During this period, 23 leaks were diagnosed, showing an incidence of 6% (three episodes per patient per year). In all cases with negative PS, other tests did not confirm a peritoneal dialysate leak.ConclusionsPS is a safe, inexpensive, reproducible, and highly effective diagnostic tool for peritoneal dialysate leaks that allows nephrologists to tailor or stop PD therapy if required. In our opinion, it should be the first-line imaging test to diagnose PD leaks with minimum exposure to radiation, contrast, or other substances that could irritate the peritoneal membrane. We believe PS should be considered as the initial test of choice to diagnose this PD complication as soon as possible, minimizing technique failure and dropout due to leaks.

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