Correlation of Intraperitoneal Antibiotic Pharmacokinetics and Peritoneal Membrane Transport Characteristics

2000 ◽  
Vol 20 (6) ◽  
pp. 694-698 ◽  
Author(s):  
Rowland J. Elwell ◽  
George R. Bailie ◽  
Harold J. Manley
Keyword(s):  
Peritoneal Dialysis ◽  
Drug Disposition ◽  
Residual Renal Function ◽  
Pharmacokinetic Studies ◽  
Peritoneal Membrane ◽  
Peritoneal Equilibration Test ◽  
Dialysis Adequacy ◽  
Renal Clearances ◽  
Design And Methods ◽  
Higher Doses

Objective To identify correlations between the pharmacokinetic variables that describe drug disposition in peritoneal dialysis (PD) patients and the measures used to assess dialysis adequacy. Design and Methods This retrospective study re-evaluated data collected during previous pharmacokinetic studies for intraperitoneally administered cefazolin, ceftazidime, and gentamicin in continuous ambulatory peritoneal dialysis (CAPD) patients, and intravenous cefazolin and tobramycin in automated PD patients. Pharmacokinetic variables were compared to creatinine clearance (CCr), Kt/V, and peritoneal equilibration test data using the Pearson product correlation coefficient ( r). Results Prominent correlations were found between renal CCr and renal Kt/V, with renal clearances of CAPD cefazolin and ceftazidime, and automated PD tobramycin and cefazolin ( r values ranged from 0.698 to 0.986; p < 0.05). Conclusion These findings support current peritonitis treatment recommendations that patients with residual renal function may require higher doses or more frequent drug administration.

Careful Patient Selection and Dialysis Prescription are Required for Effective Nightl Y Intermittent Peritoneal Dialysis

1994 ◽  
Vol 14 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Jean L. Holley ◽  
Beth Piraino
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Creatinine ◽  
Clinical Status ◽  
Residual Renal Function ◽  
Peritoneal Equilibration Test ◽  
Dialysis Adequacy ◽  
Continuous Cycling ◽  
Continuous Peritoneal Dialysis ◽  
Dialysis Time

Objective To evaluate the adequacy of dialysis in patients on nighttime intermittent peritoneal dialysis (NIPD). Design Retrospective review of prospectively collected data. Patients Seven patients on NIPD. Measurements The fast peritoneal equilibration test (PET) was used to determine peritoneal membrane permeability for small solutes. Adequacy of dialysis measured by 24hour collections of dialysate and urine for weekly KT/V and creatinine clearance in liters/week/1.73 m2 was assessed in patients with (n=3) and without (n=4) residual renal function and evaluated in concert with the patient's clinical status. Outcome for each patient was also noted. Results Five of the patients had a high-average dialysate/serum creatinine by PET (>0.66). Despite a weekly KT/V of 1.7 or more, four of the seven patients on NIPD were uremic and either transferred to hemodialysis or continuous cycling peritoneal dialysis (CCPD). A fifth patient had a KT/V of 1.4 and was also uremic on NIPD. The patient who was clinically well and continued on NIPD had significant residual renal function. Conclusions NIPD should be restricted to patients with high-average dialysate/serum creatinine as determined by PET and residual renal function or those with high dialysate/serum creatinine. Extended dialysis time and large volumes of dialysate are required for successful NIPD in patients without residual renal function. Accepted parameters of dialysis adequacy used for patients on continuous peritoneal dialysis are not appropriate for intermittent forms of peritoneal dialysis.

scholarly journals Adipokines and parameters of peritoneal membrane transport in newly started peritoneal dialysis patients.

2013 ◽  
Vol 60 (4) ◽  
Author(s):  
Edyta Golembiewska ◽  
Krzysztof Safranow ◽  
Kazimierz Ciechanowski ◽  
Joanna Bober ◽  
Anna Bogacka ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Membrane Transport ◽  
Laboratory Data ◽  
Residual Renal Function ◽  
Serum Adiponectin ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Dialysis Adequacy ◽  
Serum Leptin ◽  
Serum Adiponectin Concentration

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.

How to Increase Adequacy of Peritoneal Dialysis in Children?

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 135-136
Author(s):  
Cornelis H. Schröder
Keyword(s):  
Peritoneal Dialysis ◽  
Surface Area ◽  
Body Surface ◽  
Glucose Concentration ◽  
Peritoneal Membrane ◽  
Dialysis Fluid ◽  
Peritoneal Equilibration Test ◽  
Dialysis Adequacy ◽  
Intraperitoneal Pressure ◽  
Dialysis Solution

Since children on dialysis are treated most often with nightly intermittent peritoneal dialysis, adequacy of dialysis is determined by the number and duration of cycles, the volume of the dialysis fluid applied, and the choice of dialysis solution. The number and duration of cycles are dependent on the maximal acceptable duration of night rest and the permeability properties of the peritoneal membrane. The latter can be established by performance of a peritoneal equilibration test. The volume used should be about 1200 mL/m2 body surface area, and intraperitoneal pressure should be between 5 and 15 cm H2O. The dialysis solution administered should have a glucose concentration as low as possible, and an icodextrin daytime dwell may be considered.

Recommended Clinical Practices for Maximizing Peritoneal Dialysis Clearances

1996 ◽  
Vol 16 (5) ◽  
pp. 448-456 ◽  
Author(s):  
Peter Blake ◽  
John M. Burkart ◽  
David N. Churchill ◽  
John Daugirdas ◽  
Thomas Depner ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ad Hoc ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Clinical Practices ◽  
Dialysis Adequacy ◽  
Baxter Healthcare ◽  
The Individual ◽  
Almost All

Data from the Canada-U.S.A. (CANUSA) Study have recently confirmed a long-suspected linkage between total clearance and patient survival in peritoneal dialysis (PD). Recognizing that what we have historically accepted as adequate PD simply is not, the Ad Hoc Committee on Peritoneal Dialysis Adequacy met in January, 1996. This committee of invited experts was convened by Baxter Healthcare Corporation to prepare a consensus statement that provides clinical recommendations for achieving clearance guidelines for peritoneal dialysis. Through an analysis of 806 PD patients, the group concluded that adequate clearance delivered with PD can be achieved in almost all patients if the prescription is individualized according to the patient's body surface area, amount of residual renal function, and peritoneal membrane transport characteristics. Use of 2.5 L to 3.0 L fill volumes, the addition of an extra exchange, and giving automated peritoneal dialysis patients a “wet” day are all options to consider when increasing weekly creatinine clearance and KTN. Rather than specify a single clearance or KTN target, the recommended clinical practice is to provide the most dialysis that can be delivered to the individual patient, within the constraints of social and clinical circumstances, quality of life, life-style, and cost. The challenge to PD practitioners is to make prescription management an integral part of everyday patient management. This includes assessment of peritoneal membrane permeability, measurement of dialysis and residual renal clearance, and adjustment of the dialysis prescription when indicated.

Pharmacokinetics of Intraperitoneal Cefepime in Automated Peritoneal Dialysis

2005 ◽  
Vol 25 (4) ◽  
pp. 380-386 ◽  
Author(s):  
Rowland J. Elwell ◽  
Reginald F. Frye ◽  
George R. Bailie
Keyword(s):  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Exponential Model ◽  
Volume Of Distribution ◽  
Pharmacokinetic Parameters ◽  
Automated Peritoneal Dialysis ◽  
Post Dose ◽  
Individualized Approach ◽  
Renal Clearances ◽  
Design And Methods

Objective This study determined the pharmacokinetics of intraperitoneal (IP) cefepime in automated peritoneal dialysis (APD) patients. Design and Methods A prospective pharmacokinetic study was performed in 6 noninfected adult APD patients. All patients were administered a single IP dose of cefepime (15 mg/kg) over a 6-hour dwell. Patients then underwent a fixed APD regimen consisting of the first 6-hour dwell, followed by an 8-hour dialysate-free period and a subsequent series of 3 overnight APD exchanges. Blood and dialysate samples were collected at t = 0, 1, 2, 4, 6 (end of dwell), and 24 hours. Any urine produced during the study period was collected. Cefepime concentrations in serum, dialysate, and urine were determined by liquid chromatography mass spectrometry. Pharmacokinetic parameters were calculated assuming a mono-exponential model. Results One hour after IP administration, serum cefepime levels exceeded the minimum inhibitory concentration (8 μg/mL) for susceptible organisms. The mean serum and dialysate concentrations at 24 hours were 15.8 ± 3.6 and 6.2 ± 2.3 μg/mL respectively. Bioavailability was 84.3% ± 6.2%, volume of distribution 0.34 ± 0.07 L/kg, and serum half-life 13.8 ± 3.2 hours. Total, peritoneal, and renal clearances were 16.5 ± 4.4, 4.3 ± 0.7, and 3.5 ± 2.5 mL/minute, respectively. Conclusions IP cefepime dosed at 15 mg/kg resulted in adequate serum concentrations in APD patients at 24 hours post dose. Pharmacokinetic predictions suggest that most APD and CAPD patients would achieve adequate serum cefepime concentrations if treated with standard doses of 1000 mg given IP once daily. Patients using APD regimens different from that used in this study, anuric patients, and those with significant residual renal function may require a more individualized approach.

Selected Growth Factors in Peritoneal Dialysis: Their Relationship to Markers of Inflammation, Dialysis Adequacy, Residual Renal Function, and Peritoneal Membrane Transport

2002 ◽  
Vol 22 (6) ◽  
pp. 670-676 ◽  
Author(s):  
Tomasz Stompór ◽  
Anna Zdzienicka ◽  
Marcin Motyka ◽  
Aldona Dembińska–Kieć ◽  
Simon J. Davies ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Growth Factors ◽  
Growth Factor ◽  
Solute Transport ◽  
Membrane Transport ◽  
Chronic Inflammation ◽  
Serum Levels ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Dialysis Adequacy

Objectives Markers of chronic inflammation, acute-phase reactants, and growth factors may be concomitantly involved in a number of pathologic processes in the general population and uremic patients. In addition, growth factors may influence peritoneal membrane transport characteristics. However, the association between plasma growth factors, markers of chronic inflammation, and peritoneal membrane transport remains largely unknown. The aim of this study was to evaluate the relationship between plasma levels of selected growth factors [basic fibroblast growth factor (bFGF), transforming growth factor β1 (TGFβ1), vascular endothelial growth factor (VEGF)] and markers of chronic inflammation [interleukin (IL)-6, C-reactive protein (CRP), and fibrinogen] in continuous ambulatory peritoneal dialysis (CAPD) patients. The potential link between the above substances and dialysis adequacy was also explored. Design Single-center, cross-sectional study. Setting Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Kraków, Poland. Patients 32 stable end-stage renal disease patients (13 M, 19 F; mean age 53.6 ± 13.7 years) on CAPD for a median period of 19.5 months. Patients free from signs and symptoms of any inflammatory disease (including peritonitis) for at least 3 months were included into the study. All patients underwent measurements of dialysis dose [Kt/V, weekly creatinine clearance (wCCr)] and peritoneal solute transport using a standard peritoneal equilibration test (PET). Methods TGFβ1, bFGF, VEGF, and IL-6 were measured with ELISA, CRP was assayed with immunonephelometry, and fibrinogen with Multifibren U reagent (Dade Behring Marburg GmbH, Marburg, Germany). Nephron 97 for Windows software was used to assess dialysis adequacy. Results Significant positive correlations between plasma bFGF and IL-6, as well as fibrinogen concentrations ( R = 0.36, p < 0.05 and R = 0.39, p < 0.05, respectively), were found. VEGF correlated significantly with IL-6 and CRP ( R = 0.65, p < 0.0001 and R = 0.51, p < 0.005, respectively). An association between VEGF and bFGF was also found ( R = 0.59, p < 0.0005). Serum level of TGFβ1 revealed no relationship with any marker of acute-phase activation, remaining growth factors, or dialysis adequacy. Positive correlation between TGFβ1 concentration and dialysate-to-plasma ratio for creatinine in PET ( R = 0.35, p < 0.05) was found. In addition, patients with lower solute transport (low/low-average transporters) had lower serum levels of both bFGF and TGFβ1 compared to patients with higher solute transport. Patients with total wCCr > 60 L/week/m2 were characterized by lower levels of bFGF and IL-6. Serum level of IL-6 and plasma levels of bFGF and VEGF were significantly lower among subjects with residual renal function (RRF) > 2.0 mL/minute. Conclusions Our results indicate that systemic inflammation in peritoneal dialysis patients is associated with increased plasma VEGF and bFGF but not TGFβ1. The negative correlation with RRF suggests that either the renal clearance of these cytokines and growth factors may contribute to their elimination, or cytokines and growth factors have a negative impact on RRF. We also suggest an association between serum levels of growth factors tested and peritoneal membrane function.

MO710GALECTIN-3, IS IT A NEW PLAYER IN PERITONEAL INFLAMMATION AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Yael Einbinder ◽  
Keren Cohen-Hagai ◽  
Sydney Benchetrit ◽  
Tali Zitman-Gal
Keyword(s):  
Cell Culture ◽  
Peritoneal Dialysis ◽  
Endothelial Cell ◽  
Protein Expression ◽  
Inflammatory Process ◽  
Peritoneal Membrane ◽  
Peritoneal Equilibration Test ◽  
Endothelial Cell Culture ◽  
Dialysis Vintage ◽  
Mrna And Protein Expression

Abstract Background and Aims Peritoneal dialysis (PD) is a common used method for renal replacement therapy. Prolonged PD treatment causes structural and functional changes in the peritoneal membrane which are attributed to local inflammatory process in the peritoneal cavity. Galectin-3 (Gal-3) is a galactoside-binding lectin with pro-inflammatory and pro-fibrotic effects. The aim of this study was to assess correlation between Gal-3 serum and dialysate effluent levels with peritoneal membrane transport characteristics. Method Gal-3 levels in serum and dialysate effluent were measured simultaneously in prevalent PD patients in morning visit or during peritoneal equilibration test (PET). Gal-3 levels were correlated with clinical and laboratory parameters. Interlukin (IL) -6 levels were measured in dialysate effluent. Gal-3 mRNA and protein expression were evaluated after exposure of primary endothelial cell culture to several dialysate solutions. Results 37 PD patients were included in the study; mean age was 65.7±13.1 years, mean dialysis vintage was 17.5±13 months. Gal-3 levels in dialysate effluent correlated with peritoneal equilibration test (PET) results (0.663, p=0.005) and effluent IL-6 levels (0.674, p=0.002) but not with serum Gal-3 levels or dialysis vintage. Patients with high PET results had higher effluent Gal-3 levels as compared average low PET results. In multivariate regression analysis effluent IL-6 level was the most dominant predictor of effluent Gal-3 levels. Gal-3 mRNA and protein expression in primary endothelial cell culture were not affected by stimulation with dialysate solutions. Conclusion Our study demonstrated presence of Gal-3 within the dialysate effluent in PD patients. Gal-3 levels correlated with peritoneal membrane transport characteristics and effluent IL-6 levels suggesting a role in the inflammatory process within the peritoneal cavity.

scholarly journals Sodium removal in peritoneal dialysis: is there room for a new parameter in dialysis adequacy?

2019 ◽  
Vol 2 (3) ◽  
pp. 151-157
Author(s):  
Anna Lima ◽  
Joana Tavares ◽  
Nicole Pestana ◽  
Maria João Carvalho ◽  
António Cabrita ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Volume Overload ◽  
Residual Renal Function ◽  
Dialysis Adequacy ◽  
Sodium Removal ◽  
Low Sodium ◽  
Major Attention ◽  
New Strategies ◽  
Small Solute ◽  
Solute Clearance

In peritoneal dialysis (PD) (as well as in hemodialysis) small solute clearance measured as Kt/v urea has long been used as a surrogate of dialysis adequacy. A better urea clearance was initially thought to increase survival in dialysis patients (as shown in the CANUSA trial)(1), but  reanalysis of the data showed a superior contribution of residual renal function as a predictor of patient survival. Two randomized controlled trials (RCT)(2, 3)  supported this observation, demonstrating no survival benefit in patients with higher achieved Kt/v. Then guidelines were revised and a minimum Kt/v of 1,7/week was recommended but little emphasis was given to additional parameters of dialysis adequacy. As such, volume overload and sodium removal have gained major attention, since their optimization has been associated with decreased mortality in PD patients(4, 5). Inadequate sodium removal is associated with fluid overload which leads to ventricular hypertrophy and increased cardiovascular mortality(6). Individualized prescription is key for optimal sodium removal as there are differences between PD techniques (CAPD versus APD) and new strategies for sodium removal have emerged (low sodium solutions and adapted PD). In conclusion, future guidelines should address parameters associated with increased survival outcomes (sodium removal playing an important role) and abandon the current one fit all prescription model.

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.

Sign in / Sign up

Export Citation Format

Share Document