scholarly journals Ongoing exposure to peritoneal dialysis fluid alters resident peritoneal macrophage phenotype and activation propensity

2020 ◽  
Author(s):  
Tara E. Sutherland ◽  
Tovah N. Shaw ◽  
Rachel Lennon ◽  
Sarah E. Herrick ◽  
Dominik Rückerl
Keyword(s):  
Peritoneal Dialysis ◽  
Disease Progression ◽  
Inflammatory Responses ◽  
Macrophage Phenotype ◽  
Positive Effects ◽  
Relative Contribution ◽  
Peritoneal Dialysis Fluid ◽  
Significant Pathology ◽  
Resident Peritoneal Macrophage ◽  
External Stimuli

AbstractPeritoneal dialysis (PD) is a more continuous alternative to haemodialysis, for patients with chronic kidney disease, with considerable initial benefits for survival, patient independence and healthcare cost. However, longterm PD is associated with significant pathology, negating the positive effects over haemodialysis. Importantly, peritonitis and activation of macrophages is closely associated with disease progression and treatment failure. However, recent advances in macrophage biology suggest opposite functions for macrophages of different cellular origins. While monocyte-derived macrophages promote disease progression in some models of fibrosis, tissue resident macrophages have rather been associated with protective roles. Thus, we aimed to identify the relative contribution of tissue resident macrophages to PD induced inflammation in mice. Unexpectedly, we found an incremental loss of homeostatic characteristics, anti-inflammatory and efferocytic functionality in peritoneal resident macrophages, accompanied by enhanced inflammatory responses to external stimuli. Thus, alterations in tissue resident macrophages may render longterm PD patients sensitive to developing peritonitis and consequently fibrosis/sclerosis.

scholarly journals Ongoing Exposure to Peritoneal Dialysis Fluid Alters Resident Peritoneal Macrophage Phenotype and Activation Propensity

2021 ◽  
Vol 12 ◽  
Author(s):  
Tara E. Sutherland ◽  
Tovah N. Shaw ◽  
Rachel Lennon ◽  
Sarah E. Herrick ◽  
Dominik Rückerl
Keyword(s):  
Peritoneal Dialysis ◽  
Disease Progression ◽  
Inflammatory Responses ◽  
Degradation Products ◽  
Complete Disappearance ◽  
Macrophage Phenotype ◽  
Dialysis Fluid ◽  
Positive Effects ◽  
Peritoneal Dialysis Fluid

Peritoneal dialysis (PD) is a more continuous alternative to haemodialysis, for patients with chronic kidney disease, with considerable initial benefits for survival, patient independence and healthcare costs. However, long-term PD is associated with significant pathology, negating the positive effects over haemodialysis. Importantly, peritonitis and activation of macrophages is closely associated with disease progression and treatment failure. However, recent advances in macrophage biology suggest opposite functions for macrophages of different cellular origins. While monocyte-derived macrophages promote disease progression in some models of fibrosis, tissue resident macrophages have rather been associated with protective roles. Thus, we aimed to identify the relative contribution of tissue resident macrophages to PD induced inflammation in mice. Unexpectedly, we found an incremental loss of homeostatic characteristics, anti-inflammatory and efferocytic functionality in peritoneal resident macrophages, accompanied by enhanced inflammatory responses to external stimuli. Moreover, presence of glucose degradation products within the dialysis fluid led to markedly enhanced inflammation and almost complete disappearance of tissue resident cells. Thus, alterations in tissue resident macrophages may render long-term PD patients sensitive to developing peritonitis and consequently fibrosis/sclerosis.

Time to Positivity of Bacteria Cultures in Peritoneal Dialysis Fluid: Evaluation of Different Laboratory Techniques

2017 ◽  
Vol 37 (3) ◽  
pp. 342-344
Author(s):  
Roberta M. Katzap ◽  
Vany Elisa Pagnussatti ◽  
Ana Elizabeth Figueiredo ◽  
Julia Gabriela Motta ◽  
Domingos O. d'Avila ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Antibiotic Sensitivity ◽  
Positive Culture ◽  
Cross Sectional Study ◽  
Essential Elements ◽  
Coagulase Negative Staphylococcus ◽  
Cross Sectional ◽  
Peritoneal Dialysis Fluid

Patients with chronic kidney disease on peritoneal dialysis (PD) are susceptible to infections, with peritonitis being the primary cause of dropout. Peritoneal fluid culture is one of the essential elements for proper diagnosis and peritonitis treatment. The aim of this study was to compare the time required to obtain a positive culture using different laboratory methods. An in vitro cross-sectional study was conducted comparing different techniques for preparation and culture of bacteria in peritoneal fluid. The research was carried out with 21 sterile dialysis bags and 21 PD bags containing peritoneal fluid drained from patients without peritonitis. Fluids from the 42 PD bags were contaminated by injecting a coagulase-negative Staphylococcus suspension and then prepared for culture using 4 distinct techniques: A - direct culture; B - post-centrifugation culture; C - direct culture after 4 h sedimentation; and D - culture after 4 h sedimentation and centrifugation. This was followed by seeding. In the 21 contaminated sterile bags, mean times to obtain a positive culture with techniques D (19.6 h ± 2.6) and C (19.1 h ± 2.3) were longer than with technique A (15.8 h ± 3.0; p < 0.01), but not statistically different from group B (19.0 h ± 3.2). The same occurred in the 21 bags drained from patients, with mean times for techniques D (14.0 h ± 1.9) and C (14.5 h ± 1.7) being longer than technique A (12.22 h ± 1.94; p < 0.05) but not statistically different from technique B (13.2 h ± 1.3). The sedimentation and centrifugation steps seem to be unnecessary and may delay antibiotic sensitivity test results by approximately 8 hours.

scholarly journals Do We Have a Biocompatible Peritoneal Dialysis Fluid?

2012 ◽  
Vol 02 (03) ◽  
pp. 29-34
Author(s):  
Shadi Hassan ◽  
Batya Kristal ◽  
Khalid Khazim ◽  
Fadi Hassan ◽  
Dunia Hassan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dialysis Fluid ◽  
Peritoneal Dialysis Fluid

scholarly journals Peritoneal dialysis fluid inhibition of phagocyte function: effects of osmolality and glucose concentration.

1993 ◽  
Vol 3 (8) ◽  
pp. 1508-1515
Author(s):  
T Liberek ◽  
N Topley ◽  
A Jörres ◽  
G A Coles ◽  
G M Gahl ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lactate Dehydrogenase ◽  
Glucose Concentration ◽  
Lactate Concentration ◽  
Mononuclear Leukocytes ◽  
Dependent Manner ◽  
Dialysis Fluid ◽  
Glucose Content ◽  
Peritoneal Dialysis Fluid ◽  
Dialysis Fluids

Solutions were formulated to examine, independently, the roles of osmolality and glucose in the reduction of viability and inhibition of phagocyte function by dextrose-containing peritoneal dialysis fluids. The exposure of neutrophils (polymorphonuclear leukocytes) to test fluids containing > or = 2.7% (wt/vol) glucose resulted in significant cytotoxicity as assessed by the release of lactate dehydrogenase above control values (7.12 +/- 2.65%). At the highest concentration of glucose (4.5%), lactate dehydrogenase release was 15.83 +/- 0.49% (P < 0.05). These effects were directly related to the presence of D-glucose in the test fluids. In contrast, phagocytosis and the release of leukotriene B4 from PMN stimulated with serum-treated zymosan were significantly inhibited in an osmolality-, but not glucose-, dependent manner. The inhibition of tumor necrosis factor alpha and interleukin-6 release from mononuclear leukocytes was inhibited by a combination of osmolality and monosaccharide concentration. Under the same conditions, PMN respiratory burst activation remained unaffected irrespective of glucose concentration or fluid osmolality. These data indicate that, in addition to the low pH of peritoneal dialysis fluid and its high lactate concentration, its glucose content (either directly or as a consequence of the resulting hyperosmolality of the fluid) inhibits cell functional parameters. These findings suggest clinically significant inhibition of host defense mechanisms because, in high-glucose dialysis fluids, osmolality does not reach physiologic values, even during extended intraperitoneal dwell periods.

scholarly journals IR-Photometry Method for Measuring Glucose Concentration in Peritoneal Dialysis Fluid

2021 ◽  
Vol 24 (4) ◽  
pp. 68-78
Author(s):  
N. M. Zhilo ◽  
M. O. Mikhailov ◽  
E. L. Litinskaia ◽  
K. V. Pozhar
Keyword(s):  
Peritoneal Dialysis ◽  
Optical System ◽  
Glucose Concentration ◽  
Experimental Studies ◽  
The Body ◽  
Artificial Kidney ◽  
Dialysis Fluid ◽  
Glucose Content ◽  
Peritoneal Dialysis Fluid ◽  
Dialysate Solution

Introduction. The transition of glucose into the blood during automated peritoneal dialysis with regeneration of the dialysis fluid leads to a decreased removal of excess fluid from the body and corresponding violations of the water-salt balance.Aim. To consider a system for automatically maintaining the concentration of glucose in the dialysate solution, which provides effective ultrafiltration, as well as to propose a non-contact photometric feedback sensor.Materials and methods. The sensor is an optical system of an IR laser diode with a power of 30 mW and a wavelength of 1600 nm, a photodiode and a quartz tube, through which the test solution circulates. The sensor measures the attenuation of the radiation passing through the solution in a pulsed mode and calculates the glucose concentration. The selected combination of digital filters provides compensation for the noise of the optical system. Experimental studies of the efficiency of the sensor were carried out on peritoneal dialysis solutions with various concentrations of urea, creatinine, uric acid and glucose. At the beginning of the experiments, the sensor was calibrated in a pure solution.Results. It was shown that the developed sensor makes it possible to measure the concentration of glucose in a solution for peritoneal dialysis in the range of 42…220 mmol / l with a relative error of about 15%. The time of one measurement is about 1 minute, which makes it possible to obtain up-to-date information on the current concentration of the solution.Conclusion. This combination of characteristics will allow the sensor to be used in artificial kidney wearable devices for assessing the glucose content in the solution, calculating the time to change the solution and as a feedback sensor in a system for maintaining the concentration of the osmotic agent.

Non-touch Aseptic technique Maintains Sterility of Antibiotic-Admixed peritoneal Dialysis Fluid

2018 ◽  
Vol 38 (1) ◽  
pp. 65-67
Author(s):  
Louis L. Huang ◽  
Ellen Ramas ◽  
Priti Prasad ◽  
Jenny Catania ◽  
Pauline Meade ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Room Temperature ◽  
Positive Culture ◽  
Coagulase Negative Staphylococcus ◽  
Dialysis Fluid ◽  
Aseptic Technique ◽  
Sterile Technique ◽  
Peritoneal Dialysis Fluid ◽  
Culture Positive ◽  
Positive Controls

There is a paucity of data on the sterility of peritoneal dialysis fluid (PDF) after drug admixture. International Society for Peritoneal Dialysis (ISPD) guidelines suggest using sterile technique when admixing antibiotics; however, the degree of sterility remains unclear. This issue is most pertinent when preparing take-home PDF for outpatient treatment of peritonitis. This study compares the sterility of PDF admixed with antibiotics using a non-touch aseptic technique (NTAT) versus sterile technique. Groups of 8 PDF mixtures (1.5% Dianeal or Icodextrin [Baxter International Inc., Spring Grove, IL, USA]) were admixed with 1 g/L ceftazidime and vancomycin, or 20 mL saline, either by a pharmacist using sterile technique in a sterile suite, or a nurse in a clinical room using NTAT. Dianeal inoculated with 1 x 106 colony-forming units (CFU)/L of coagulase-negative Staphylococcus (CNS), with and without antibiotics, served as positive controls. Admixed PDFs were left at room temperature for 72 hours, then cultured using the BacT/ALERT system. A positive culture by day 5 constituted a contamination. Differences in proportion of contamination between groups were assessed using the Chi-squared test. Eighty PDF bags underwent microbiological testing. Sterility was maintained in all bags, independent of technique (NTAT versus sterile technique), type of PDF (Dianeal versus Icodextrin), or whether antibiotics were admixed. Of the positive controls, CNS-inoculated PDFs without antibiotics were all culture positive; however, when inoculated into antibiotic-admixed PDFs, only S. haemolyticus remained culture-positive ( p < 0.0001). In conclusion, PDF sterility can be maintained using NTAT for up to 3 days at room temperature. Currently, there is insufficient evidence to adopt sterile technique in sterile suites when admixing take-home PDF.

scholarly journals Counteracting the Metabolic Effects of Glucose Load in Peritoneal Dialysis Patients; an Exercise-Based Approach

2019 ◽  
Vol 48 (1) ◽  
pp. 25-31 ◽  
Author(s):  
Sana F. Khan ◽  
Claudio Ronco ◽  
Mitchell H. Rosner
Keyword(s):  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Glucose Absorption ◽  
Metabolic Effects ◽  
Glucose Load ◽  
Dialysis Patients ◽  
Metabolic Complications ◽  
Positive Effects ◽  
Stage Renal Disease ◽  
End Stage

Glucose-based peritoneal dialysis (PD) solutions are the predominantly used dialysate in PD patients. Glucose absorption has been shown to be associated with several unfavorable metabolic complications. Several studies have shown positive effects of exercise in end-stage renal disease patients. This paper provides an overview of glucose-associated metabolic complications, and proposed exercise regimens to counteract the caloric load associated with glucose absorption.

Peritoneal Dialysis Solutions Low in Glucose Degradation Products—evidence for Clinical Benefits

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 123-127
Author(s):  
Tadashi Tomo
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Function ◽  
Degradation Products ◽  
Peritoneal Mesothelial Cells ◽  
Advanced Glycosylation End Products ◽  
Glucose Degradation Products ◽  
Peritoneal Dialysis Fluid ◽  
Clinical Benefits ◽  
Human Peritoneal Mesothelial Cells ◽  
Peritoneal Function

In Japan, two types of new peritoneal dialysis fluid (PDF) are ordinarily used: two-chambered PDF, and icodextrin PDF. Two-chambered PDF has several biocompatible characteristics, one being low glucose degradation products (GDPs). Of the several GDPs in PDF, 3,4-dideoxyglucosone-3-ene (3,4-DGE) is thought to be strongly associated with the cytotoxicity of standard PDF. Using a PDF low in GDPs may reduce exposure of the peritoneum to 3,4-DGE, helping to preserve peritoneal function in PD patients. Additionally, use of a PDF low in GDPs may reduce plasma levels of advanced glycosylation end-products in PD patients, a change that may help to preserve vascular function in PD patients. Peritoneal rest for 24 hours after exposure to a PDF with low GDPs improves the activity of human peritoneal mesothelial cells. As compared with the use of standard PDF, the use of low-GDP PDF in combination therapy (peritoneal dialysis plus hemodialysis) may more effectively preserve peritoneal function. The new PDF low in GDPs has bio-compatible characteristics relative to peritoneum and system that may help to preserve peritoneal function or reduce complications such as atherosclerosis or dialysis-related amyloidosis in dialysis patients.

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