scholarly journals Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis

2017 ◽  
Vol 46 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Aniema Udo ◽  
Catriona Goodlad ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Pulse Pressure ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Glycated Haemoglobin ◽  
Diabetic Patients ◽  
Membrane Function ◽  
Arterial Blood ◽  
Increased Risk

Background: Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. Methods: We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. Results: Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). Conclusion: Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.

scholarly journals Relação entre o Tratamento com Metformina e o Desenvolvimento de Hiperlactacidemia no Serviço de Urgência

2014 ◽  
Vol 27 (2) ◽  
pp. 196 ◽  
Author(s):  
Daniela Guelho ◽  
Isabel Paiva ◽  
Francisco Carrilho
Keyword(s):  
Lactate Concentration ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
Independent Predictive Factor ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Type 2 Diabetics ◽  
Increased Risk ◽  
Blood Gas Analyses

<strong>Introduction:</strong> In type 2 diabetic patients treated with metformin the development of hyperlactacidemia or even lactic acidosis seems to result from an acute precipitating event. This study aims to assess the prevalence and relative risk of hyperlactacidemia in diabetic patients admitted in the Emergency Room, the predictive factors for high lactate concentration and the influence of hyperlactacidemia in patients’ prognosis.<br /><strong>Material and Methods:</strong> Transversal observational study including patients observed between June and October 2012: 138 type 2 diabetics, 66 treated with metformin, and 83 non-diabetic patients. Studies’ variables: age, sex, cause of admition, blood pressure, drugs, personal history, analytical study (biochemistry and arterial blood gas analyses with lactate) and destination. Statistical analysis was performed using SPSS 21.0®.<br /><strong>Results:</strong> Mean lactate concentration and hyperlactacidemia prevalence were significantly higher in diabetic patients (2.1 ± 0.1mmol/L vs 1.1 ± 0.1mmol/L, p &lt; 0.001 and 39.1% vs 3.6%, p &lt; 0.001, respectively) and in those under metformin compared to other diabetics (2.7 ± 0.2 mmol/L vs 1.6 ± 0.1 mmol/L, p &lt; 0.001 and 56.9% vs 23.3%, p &lt; 0.001, respectively). Diabetics on metformin presented a 25-fold increased risk of hyperlactacidemia (OR = 25.10, p &lt; 0.05). Creatinine was the only independent predictive factor for lactate<br />concentrations (B = 1.33, p &lt; 0.05). Patients with hyperlactacidemia had 4.4 times higher odds of being hospitalized or dying (OR = 4.37, p &lt; 0.05). When hospitalized, they had longer hospitalization periods (21.66 ± 5.86 days vs 13.68 ± 5.33 days, p &lt; 0.001) and higher rate of deaths (12.5% (n = 4) vs 4.3% (n = 2), p &lt; 0.05).<br /><strong>Conclusion:</strong> There was an increased risk of hyperlactacidemia in patients with type 2 diabetes, particularly for those under metformin. Serum creatinine represented the only independent associated factor of lactate concentration. The presence of hyperlactacidemia was associated with worse prognosis.

scholarly journals Systemic Endotoxin in Peritoneal Dialysis Patients

2018 ◽  
Vol 38 (5) ◽  
pp. 381-384 ◽  
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.

A Retrospective Sequential Comparison of Topical Application of Medicated Honey and Povidone Iodine for Preventing Peritoneal Dialysis Catheter-Related Infections

2018 ◽  
Vol 38 (4) ◽  
pp. 302-305
Author(s):  
Tayler F.L. Wishart ◽  
Laraine Aw ◽  
Karen Byth ◽  
Gopala Rangan ◽  
Kamal Sud
Keyword(s):  
Peritoneal Dialysis ◽  
Cumulative Incidence ◽  
Povidone Iodine ◽  
Incidence Rates ◽  
Diabetic Patients ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Increased Risk ◽  
Multicentre Cohort Study ◽  
Nasal Mupirocin

Application of medicated honey (MH) to peritoneal dialysis (PD) catheter exit sites has been found to be as effective as intra-nasal mupirocin for preventing PD catheter-related infections (CRIs), but was associated with increased risk for CRIs in diabetics. The efficacy of topical MH as a prophylactic agent has not been compared with the exit-site application of povidone iodine (PI). This retrospective multicentre cohort study compared cumulative incidence rates of PD CRIs (peritonitis or exit-site infections) and the number of PD CRIs observed per patient over the study period with PD exit-site application of MH or PI, in both diabetic and non-diabetic patients. Outcomes were compared in incident patients in 2 eras: January 2011 – December 2012, when 147 received exit-site care with PI (PI group), and July 2013 – June 2015, when 171 patients applied MH (MH group). Patients were followed until technique failure, death, transplant, or end of study treatment era. Cumulative incidence of PD CRIs was higher in the PI group (hazard ratio [HR] = 1.7, 95% confidence interval [CI] 1.1 – 2.6, p = 0.019) and the benefit of MH was not modified by diabetic status (present/absent, interaction p = 0.723). A similar trend was observed in the cumulative incidence of peritonitis (HR = 1.6, 95% CI 0.99 – 2.6, p = 0.059). After adjusting for months of exposure, the rate ratio for PD CRIs was 1.58 for PI compared to MH (95% CI, 1.03 – 2.42, p = 0.035). We conclude that exit-site application of MH is more effective than PI in preventing PD CRIs, and this effect is not modified by the presence or absence of diabetes.

Pre-Dialysis Glycemic Control is An Independent Predictor of Mortality Intype Ii Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 179-183 ◽  
Author(s):  
Mai-Szu Wu ◽  
Chun-Chen Yu ◽  
Ching-Herng Wu ◽  
Jeng Yi Haung ◽  
Mei-Lin Leu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Serum Albumin ◽  
Poor Glycemic Control ◽  
Control Group ◽  
Diabetic Patients ◽  
Type Ii ◽  
Good Glycemic Control ◽  
Cholesterol Levels ◽  
Significant Difference

Objective To evaluate the impact of pre-dialysis glycemic control on clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPO). Materials and Methods One hundred and one type II diabetic patients receiving CAPO for at least 3 months were enrolled in a single institute. The patients were classified into two groups according to status of glycemic control. In the good glycemic control group, more than 50% of blood glucose determinations were within 3.3 11.0 mmol/L and glycosylated hemoglobin (HbA 1 C) levels were within 5% -10% at all times. In the poor glycemic control group, less than 50% of blood glucose determinations were within 3.3 -11.0 mmol/L, or HbA1C levels were above 10% at least 6 months before peritoneal dialysis was started. In addition to glycemic control status, pre-dialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and modes of glycemic control were also recorded. Results The patients with good glycemic control had significantly better survival than those with poor glycemic control (p < 0.01). There was no significant difference in pre-dialysis morbidity between two groups. No significant differences were observed in patient survival between patients with serum albumin above 30 g/L and those with serum albumin under 30 g/L; between those with cholesterol levels above or below 5.2 mmol/L; and between those with different peritoneal membrane solute transport characteristics as evaluated by a peritoneal equilibration test (PET). Furthermore, there was no significant difference in survival between patients who controlled blood sugar by diet and those who controlled it by insulin. Cardiovascular disease and infection are the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetic patients maintained on CAPO. Conclusions Glycemic control before starting dialysis is a predictor of survival for type II diabetic patients on CAPO. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.

scholarly journals Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

2017 ◽  
Vol 46 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Ana Fernandes ◽  
Roi Ribera-Sanchez ◽  
Ana Rodríguez-Carmona ◽  
Antía López-Iglesias ◽  
Natacha Leite-Costa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water ◽  
Volume Overload ◽  
Diabetic Patients ◽  
Longitudinal Analyses ◽  
Cross Sectional ◽  
Sodium Removal ◽  
Essential Stability ◽  
Stability Of Water

Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently. Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes. Main Results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics. Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.

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

1993 ◽  
Vol 84 (6) ◽  
pp. 619-626 ◽  
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.

Factors Contributing to Formation of Edema in Volume Overloaded Continuous Ambulatory Peritoneal Dialysis Patients

2011 ◽  
Vol 31 (2) ◽  
pp. 160-167 ◽  
Author(s):  
Wen Tang ◽  
Tian Xue ◽  
Xin-Hong Lu ◽  
Ya-Jun Luo ◽  
Tao Wang
Keyword(s):  
Peritoneal Dialysis ◽  
Endothelial Function ◽  
Serum Albumin ◽  
Volume Overload ◽  
Nutrition Status ◽  
Volume Control ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Significant Volume ◽  
Pitting Edema

BackgroundVolume control is critical for the success of peritoneal dialysis (PD) but dry weight in PD has been difficult to obtain. Edema free is, in general, accepted clinically as a target for volume control in PD patients. However, PD patients can be free of edema despite significant volume overload. The present study investigates the possible factors that influence the formation of pitting edema in volume-overloaded PD patients.MethodsIn this cross-sectional study, patients’ fluid status was evaluated by multifrequency bioelectrical impedance spectroscopy analysis. Values for overhydration were obtained. Patients with overhydration ≥ 2.0 kg were considered volume overloaded and were eligible for inclusion. From 1 March 2009 to 1 December 2009, a total of 96 patients on continuous ambulatory PD were included. Endothelial function was evaluated by flow-mediated dilatation (FMD). Other clinical indicators, such as blood pressure, dialysis adequacy, nutrition status, and biochemical parameters, were recorded. Patients were divided into 2 groups based on edema status: the edema group ( n = 35 volume-overloaded patients with bilateral pitting edema) and the non-edema group ( n = 61 volume-overloaded patients without bilateral pitting edema).ResultsOverhydration in the edema group was significantly higher than in the non-edema group (4.28 ± 1.75 kg vs 3.12 ± 0.81 kg, p < 0.001), whereas both FMD and serum albumin in the edema group were significantly lower than in the non-edema group (6.65% ± 5.2% vs 10.3% ± 5.1%, p = 0.001; 37.6 ± 4.2 g/L vs 39.3 ± 3.5 g/L, p = 0.047, respectively). Edema status (edema = 1, non-edema = 0) was positively correlated with overhydration ( r = 0.341, p < 0.001), gender (male = 1, female = 2: r = 0.184, p = 0.072), and total fluid removal ( r = 0.188, p = 0.074) and negatively correlated with endothelial function, as assessed by FMD ( r = -0.33, p = 0.001), and serum albumin ( r = -0.18, p = 0.055). Logistic regression analysis showed that FMD [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.81 - 0.99; p = 0.036], gender (male = 1, female = 2: OR 4.06, 95% CI 1.23 - 13.35; p = 0.021), overhydration (OR 3.06, 95% CI 1.53 - 6.13; p = 0.002), and serum albumin (OR 0.86, 95% CI 0.75 - 0.99; p = 0.035) were independent factors affecting the edema status of the study population.ConclusionOur study showed that endothelial function (assessed by FMD), gender, serum albumin, and over hydration are independent determinants of edema status in PD patients. This may explain why some PD patients can maintain free of edema despite significant volume overload.

Association between Pulse Pressure and Mortality in Patients Undergoing Peritoneal Dialysis

2009 ◽  
Vol 29 (2) ◽  
pp. 163-170 ◽  
Author(s):  
Wei Fang ◽  
Xiao Yang ◽  
Joanne M. Bargman ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Pulse Pressure ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cardiovascular Death ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Cox Proportional Hazards Model ◽  
Study Cohort ◽  
Increased Risk

Background Pulse pressure has been shown to be associated with adverse outcomes in the general population and in patients on hemodialysis (HD). However, the significance of pulse pressure has not been studied in peritoneal dialysis (PD) patients. This study examined the association between pulse pressure and mortality in patients undergoing chronic PD. Methods All patients aged 18 years or older that commenced PD between 1 January 2000 and 31 December 2005 at the University Health Network, Toronto, were included. The association between pulse pressure and mortality was assessed using the Cox proportional hazards model. Results A total of 306 patients were included in the study. Mean pulse pressure of the study cohort was 56.8 ± 17.8 mmHg. Age and diabetes were significant predictors of elevated pulse pressure ( p < 0.001). After adjusting for the level of systolic blood pressure and other demographic and clinical parameters, multivariable Cox proportional hazards modeling showed a direct and consistent association between pulse pressure and death risk. Each increment of 1 mmHg in pulse pressure was associated with a 2.7% increased hazard of all-cause death [95% confidence interval (CI) 1.001 – 1.054, p = 0.039] and a 4.1% increase in risk for cardiovascular mortality (hazard ratio 1.041, 95% CI 1.003 – 1.081; p = 0.035). Conclusion Elevated pulse pressure is associated with an increased risk of all-cause and cardiovascular death in patients on PD. Recognition of this characteristic as an important predictor of mortality suggests that one goal of antihypertensive therapy in PD patients should be to decrease elevated pulse pressure.

Cardiovascular Risk Factors in Peritoneal Dialysis Patients Revisited

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 223-227
Author(s):  
Angela Yee-Moon Wang
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Residual Renal Function ◽  
Dialysis Patients ◽  
Stage Renal Disease

End-stage renal disease patients are at a heightened risk of developing cardiovascular disease, with contributions from both “traditional” and “nontraditional” cardiovascular risk factors. Some of the nontraditional risk factors, such as extracellular volume overload, inflammation, and hyperphosphatemia, have also been shown to be important predictors of mortality in the dialysis population. This article provides an in-depth review of the evidence that supports the substantial contributions of nontraditional risk factors to adverse cardiovascular outcomes in chronic peritoneal dialysis patients. In addition, it provides evidence to demonstrate how loss of residual renal function may be central to the development of cardiovascular disease in the peritoneal dialysis population.

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