SP506PERITONEAL GLUCOSE EXPOSURE PREDICTS FUTURE PERITONEAL MEMBRANE TRANSPORT EVOLUTION IN CONTINUOUS AMBULANCE PERITONEAL DIALYSIS PATIENTS

Adiponectin and leptin are two adipokines playing important roles in the regulation of body weight, appetite, carbohydrate and lipid metabolism. In patients with chronic kidney disease (CKD) adipokines accumulate in serum due to reduced renal clearance. Since adipokines have pleiotropic actions, the adipokine balance may have an impact on peritoneal membrane transport. The aim of this study was to assess whether serum adiponectin and leptin levels were related to peritoneal transport and residual renal function (RRF) in newly started peritoneal dialysis patients. 25 clinically stable patients, 4 to 6 weeks after the onset of PD, were included in the study. For each patient clinical and laboratory data were reviewed and standard PET test was performed. Serum adiponectin and leptin concentrations were determined and leptin/adiponectin (L/A) ratio was calculated. Serum adiponectin correlated negatively with weight, BMI and glucose concentration. Serum leptin and L/A ratio correlated positively with BMI. Serum adiponectin correlated positively with dialysate to plasma (D/P) creatinine ratio and ultrafiltration in PET test. Serum leptin level and L/A ratio correlated strongly negatively with peritoneal creatinine clearance. Serum adiponectin concentration is positively associated with baseline solute transport. Leptin concentration and L/A ratio are negatively associated with dialysis adequacy in newly started PD patients.

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Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group.

Journal of the American Society of Nephrology ◽

10.1681/asn.v971285 ◽

1998 ◽

Vol 9 (7) ◽

pp. 1285-1292 ◽

Cited By ~ 10

Author(s):

D N Churchill ◽

K E Thorpe ◽

K D Nolph ◽

P R Keshaviah ◽

D G Oreopoulos ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Serum Albumin ◽

Membrane Transport ◽

Patient Survival ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Technique Survival ◽

Survival Probabilities ◽

The Mean ◽

Technique Failure

The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-yr patient survival probabilities were 91, 80, 72, and 71% for L, LA, HA, and H, respectively (P = 0.11). The 2-yr probabilities of both patient and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique failure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.33, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the mean 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and H, respectively (P < 0.001). The mean serum albumin values (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HA, and H, respectively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death. The decreased drain volume, increased albumin loss, and decreased serum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be considered in H and HA transporters.

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Effluent and serum protein N-glycosylation is associated with inflammation and peritoneal membrane transport characteristics in peritoneal dialysis patients

Scientific Reports ◽

10.1038/s41598-018-19147-x ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 6

Author(s):

Evelina Ferrantelli ◽

Karima Farhat ◽

Agnes L. Hipgrave Ederveen ◽

Karli R. Reiding ◽

Robert H. J. Beelen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Membrane Transport ◽

Serum Protein ◽

Peritoneal Membrane ◽

Dialysis Patients

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Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.01910309 ◽

2009 ◽

Vol 4 (7) ◽

pp. 1201-1206 ◽

Cited By ~ 54

Author(s):

Jeffrey Perl ◽

Kit Huckvale ◽

Michelle Chellar ◽

Biju John ◽

Simon J. Davies

Keyword(s):

Peritoneal Dialysis ◽

Membrane Transport ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Protein Clearance ◽

Peritoneal Protein Clearance

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The Influence of Glucose Exposure Load and Peritoneal Membrane Transport on Body Composition and Nutritional Status Changes after 1 Year on Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00265 ◽

2017 ◽

Vol 37 (4) ◽

pp. 458-463 ◽

Cited By ~ 6

Author(s):

Rafaela Siviero Caron-Lienert ◽

Carlos Eduardo Poli-de-Figueiredo ◽

Ana Elizabeth Prado Lima Figueiredo ◽

Bartira Ercília Pinheiro da Costa ◽

Carlo Crepaldi ◽

...

Keyword(s):

Body Composition ◽

Peritoneal Dialysis ◽

Nutritional Status ◽

Membrane Transport ◽

Dry Weight ◽

First Year ◽

Peritoneal Membrane ◽

Tissue Mass ◽

Glucose Exposure ◽

Composition Changes

BackgroundThe characteristics of peritoneal membrane transport differ among patients, affecting the prescription of peritoneal dialysis (PD) modality and glucose exposure in order to achieve an effective dialysis. This study aims to verify the influence of glucose exposure load and peritoneal membrane transport on body composition and nutritional status changes after the first year of PD.MethodsWe examined a cohort of 85 incident PD patients during the first year of treatment. We established a cut-off of 5% to define changes in dry weight (DW), lean tissue mass (LTM), and fat mass (FM).ResultsIn total, 50.6% of the patients presented DW gain, 41.2% showed LTM loss, and 65.9% presented FM gain. Over the time (T0 – T12), we found significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI). Patients with lower dialysate-to-plasma creatinine ratio showed DW and FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with DW no gain. As for glucose exposure load, no body composition changes were seen.ConclusionsMost patients presented DW gain, FM gain, and LTM loss. The characteristics of peritoneal membrane transport affected DW during the first year, changes being greater in nonfast than in fast transporters.

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PERITONEAL MEMBRANE TRANSPORT CHARACTERISTICS AND ITS EFFECT ON BLOOD PRESSURE CONTROL IN PERITONEAL DIALYSIS PATIENTS

ASAIO Journal ◽

10.1097/00002480-200203000-00204 ◽

2002 ◽

Vol 48 (2) ◽

pp. 176

Author(s):

Shiang-Cheng Kung ◽

Rasib Raja

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Membrane Transport ◽

Blood Pressure Control ◽

Pressure Control ◽

Peritoneal Membrane ◽

Dialysis Patients

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Effects of Peritoneal Resting on Peritoneal Fluid Transport Kinetics

Peritoneal Dialysis International ◽

10.1177/089686080702700519 ◽

2007 ◽

Vol 27 (5) ◽

pp. 575-579 ◽

Cited By ~ 7

Author(s):

Xing-wei Zhe ◽

Xin-kui Tian ◽

Lei Cheng ◽

Tao Wang

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Fluid ◽

Absorption Rate ◽

Fluid Transport ◽

Fluid Absorption ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Dialysis Solution ◽

Before And After ◽

Glucose Exposure

Background Peritoneal resting has been used to restore peritoneal ultrafiltration capacity in peritoneal dialysis patients. Therefore, in the present study, we made a detailed investigation on the effects of peritoneal resting on peritoneal fluid transport characteristics in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods A temporary transfer to daytime ambulatory peritoneal dialysis with a nocturnal “empty belly” was applied to let the peritoneal membrane rest overnight in patients with poor ultrafiltration capacity. All included patients were asked to record appropriately their dialysis exchanges for the assessment of peritoneal fluid transport characteristics, which were evaluated before and after peritoneal resting. Results Seven CAPD patients were included in the present study. There was a significant improvement in peritoneal ultrafiltration capacity as assessed by ultrafiltration volume per gram of glucose load. Patients’ daily glucose exposure and dialysate-to-plasma ratio of creatinine were significantly decreased after peritoneal resting. The peritoneal fluid absorption rate was also significantly decreased after peritoneal resting: 1.011 ± 0.4484 versus 0.625 ± 0.3833 mL/minute. Conclusion The present study suggests that peritoneal resting can improve CAPD patients’ ultrafiltration capacity and decrease the use of hypertonic dialysis solution. The improved ultrafiltration capacity by peritoneal resting was due to decreased membrane solute transport rate and decreased peritoneal fluid absorption rate.

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Does Peritoneal Membrane Transport Affect Peritoneal Clearance of Beta 2–Microglobulin in Peritoneal Dialysis Patients?

Turkish Nephrology Dialysis Transplantation ◽

10.5262/tndt.2013.1001.15 ◽

2013 ◽

Vol 22 (01) ◽

pp. 101-105

Author(s):

Mesut Akcakaya ◽

Oktay Oymak ◽

Feridun Kavuncuoglu ◽

Aydin Unal ◽

Bulent Tokgoz ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Membrane Transport ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Beta 2 ◽

Beta 2 Microglobulin

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Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00255 ◽

2016 ◽

Vol 36 (2) ◽

pp. 188-195 ◽

Cited By ~ 2

Author(s):

Alp Akonur ◽

Catherine A. Firanek ◽

Mary E. Gellens ◽

Audrey M. Hutchcraft ◽

Pranay Kathuria ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Membrane Transport ◽

Kinetic Modeling ◽

Demographic Data ◽

Uremic Toxin ◽

Peritoneal Membrane ◽

Fluid Removal ◽

Glucose Exposure ◽

Total Glucose ◽

Urea Distribution Volume

BackgroundThe use of automated and continuous ambulatory peritoneal dialysis (APD and CAPD) prescriptions (Rxs) to achieve adequate uremic toxin and fluid removal targets is important for attaining optimal patient outcomes. One approach for predicting such Rxs is the use of kinetic modeling.MethodsDemographic data and peritoneal membrane characteristics derived from a peritoneal equilibration test (PET) were available from 1,005 patients in North American centers who participated in a national adequacy initiative in 1999. Twelve patient subgroups were identified according to peritoneal membrane transport type and tertiles of total body water, assumed equal to urea distribution volume (Vurea). Each patient was then modeled using PD Adequest 2.0 to be treated by 12 CAPD and 34 APD Rxs using both glucose and icodextrin solutions to achieve adequacy targets of weekly urea Kt/V of 1.7 and 1 L of daily ultrafiltration (UF). Residual kidney function (RKF) was assumed to be 0, 2, 4, and 6 mL/min. Feasible peritoneal dialysis (PD) Rxs were identified where: 1) the 95% confidence limit achieved the goal of meeting the targets for urea Kt/V, daily UF, and both in 85%, 75%, and 70% of patients, respectively; 2) average PD solution dextrose concentration was < 2.5%; and 3) the number of daytime exchanges was minimized.ResultsFeasible PD Rxs were similar when RKF was ≥ 2 mL/min, allowing condensed recommendations based on RKF ≥ 2 mL/min or < 2 mL/min. Individuals with lower or slower membrane transport required relatively greater 24-h solution volumes to achieve adequacy targets when RKF fell below 2 mL/min. With increasing Vurea, there was disproportionately greater dependence on RKF to achieve targets. While multiple Rxs achieving urea Kt/V and daily UF goals were identified for all membrane transport types, use of icodextrin in the long dwell reduced the need for a midday exchange in APD, glucose exposure, required fill and 24-h dwell volumes, irrespective of RKF and Vurea. While these benefits were most notable in high and high-average transporters, similar results were also seen in low and low-average transporters.ConclusionsKinetic modeling identified multiple APD and CAPD Rxs that achieved adequate uremic solute and fluid removal for patients, irrespective of RKF and Vurea. Use of icodextrin rather than glucose in the long dwell reduced the complexity of the PD regimen, total glucose exposure, and 24-h total treatment solution volumes. Irrespective of modeling, adequacy of any PD prescription should be based upon individual clinical evaluation both for volume and solute removal.

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