Effect of Oral Administration of Losartan, Prazosin, and Verapamil on Peritoneal Solute Transport in Continuous Ambulatory Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (6) ◽  
pp. 576-582 ◽  
Author(s):  
Enrique Rojas-Campos ◽  
Laura Cortés-Sanabria ◽  
Héctor R. Martínez-Ramírez ◽  
Liliana González ◽  
Fabiola Martín-del-Campo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Oral Administration ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Convective Transport ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Peritoneal Transport ◽  
Adequacy Assessment ◽  
To Receive ◽  
Dialysate Volume

Background Several intraperitoneally administered drugs have been shown to modify transport of peritoneal solute and fluid. Fewer studies, however, have evaluated the effect of orally administered drugs. The present study was performed to evaluate the effects of oral losartan, prazosin, and verapamil on peritoneal membrane transport during a peritoneal equilibration test (PET), as well as the effects on creatinine clearance (CrCl), Kt/V urea, 24-hour protein in drained dialysate, and drained volume. Methods This was an open, controlled, crossover clinical trial performed in 20 patients on continuous ambulatory peritoneal dialysis. All subjects used four 2-L 1.5% glucose dialysis exchanges per day. After a 7-day washout period (without antihypertensives), they had a baseline standard PET and dialysis adequacy assessment performed. Subsequently, they were randomly allocated to receive the first of three study drugs (losartan, prazosin, and verapamil), which were administered orally for a 7-day period. Immediately after each drug period, patients had a new 3-day washout and subsequently started the next drug, until they had received each of the three drugs. On the last day of administration of each drug, patients were subjected to a new PET and adequacy of dialysis evaluation. Results None of the studied drugs significantly modified the peritoneal transport of creatinine, glucose, urea, sodium, potassium, or total protein as evaluated by PET. Verapamil significantly increased peritoneal CrCl [51.3 (44.3 – 53.3) vs baseline 45.8 (41.4 – 50.5) L/week/1.73 m2, p < 0.05], weekly Kt/V urea [1.75 (1.60 – 1.78) vs baseline 1.59 (1.54 – 1.73), p < 0.05], and drained dialysate volume [8.80 (8.30 – 8.96) vs baseline 8.44 (8.20 – 8.50) L/day, p < 0.05]. Conclusions Oral administration of losartan, prazosin, and verapamil did not modify the peritoneal transport of solutes during a 4-hour PET. Oral verapamil significantly increased CrCl, Kt/V urea, and 24-hour drained dialysate volume. It is most likely that verapamil increases peritoneal (hydraulic) conductivity, and then net ultrafiltration volume and convective transport of urea, creatinine, and protein. Verapamil could be considered as an alternative in patients requiring increased dialysis dose and/or ultrafiltration.

scholarly journals Peritoneal Transport Properties and Dialysis Dose Affect Growth and Nutritional Status in Children on Chronic Peritoneal Dialysis

1999 ◽  
Vol 10 (8) ◽  
pp. 1786-1792
Author(s):  
FRANZ SCHAEFER ◽  
GÜNTER KLAUS ◽  
OTTO MEHLS
Keyword(s):  
Peritoneal Dialysis ◽  
Body Mass ◽  
Mass Gain ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Dose ◽  
Peritoneal Transport ◽  
Negative Effect ◽  
Positive Effect ◽  
Dialysate Volume ◽  
Small Solute

Abstract. To evaluate a possible effect of peritoneal transport properties and dialysis dose on the physical development of children on chronic peritoneal dialysis, a cohort of 51 children was prospectively followed for 18 mo. Peritoneal transport characteristics were assessed by serial peritoneal equilibration tests (PET), dialysis efficacy by dialysate and residual renal clearance measurements, and growth and nutritional status by the longitudinal changes (Δ) of height SD score (SDS), body mass index (BMI) SDS, and serum albumin. Δ height SDS was negatively correlated with the creatinine equilibration rate observed in the initial PET (r = -0.31, P < 0.05). Multiple regression analysis confirmed the negative effect of the high transporter state (partial r2 = 0.07), and disclosed an additional positive effect of dialytic CCr (partial r2 = 0.11) and a weak negative effect of daily dialysate volume (partial r2 = 0.04) on Δ height SDS. Δ BMI SDS was strongly age-dependent (r = -0.48, P < 0.001); while relative body mass gradually increased below 4 yr of age, it remained stable in older children. Positive changes in BMI SDS were associated with rapid PET creatinine equilibration rates (univariate r = 0.35, P < 0.05) and/or large dialysate volumes (multivariate partial r2 = 0.11), suggesting a role of dialytic glucose uptake in the development of obesity. The change in serum albumin concentrations was positively correlated with dialysate volume (partial r2 = 0.14), and negatively affected by dialytic protein losses (partial r2 = 0.06). In conclusion, the peritoneal transporter state is a weak but significant determinant of growth and body mass gain in children on chronic peritoneal dialysis. Rapid small solute equilibration contributes to impaired growth but enhanced acquisition of body mass. Dialytic small solute clearance has a weak positive effect on statural growth independent of the transporter state, but does not affect body mass gain.

Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)

1989 ◽  
Vol 9 (1) ◽  
pp. 75-78 ◽  
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.

Failure of Demonstrated Clinical Efficacy of Antibiotic-Bonded Continuous Ambulatory Peritoneal Dialysis (CAPD) Catheters

1990 ◽  
Vol 10 (1) ◽  
pp. 57-59 ◽  
Author(s):  
Stanley Z. Trooskin ◽  
Richard A. Harvey ◽  
T. w. J. Lennard ◽  
Ralph S. Greco
Keyword(s):  
Clinical Trial ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Infectious Complications ◽  
Clinical Report ◽  
Age And Gender ◽  
And Gender ◽  
To Receive

Previous in vitro, in vivo, and a preliminary clinical report have demonstrated efficacy of noncovalently bonding antibiotics to the surface of continuous ambulatory peritoneal dialysis (CAPO) catheters in decreasing infectious complications. A larger prospective randomized clinical trial was completed. Eighty-six patients with chronic renal failure were enrolled in the study and randomized to receive either a surfactant treated or untreated control catheter. All catheters were soaked in cefoxitin at the time of insertion. Groups were comparable in terms of pre-existing illnesses, age, and gender. No differences were shown in the incidence of cathetertract infections, peritonitis or mechanical complications. There was also no differences in microbiologic culture results. Therefore, it is concluded that this clinical trial did not demonstrate a reduction in catheter-related infectious complications by antibiotic bonding.

Peritoneal dialysis

2015 ◽  
Author(s):  
Joanna Stachowska-Pietka ◽  
Jacek Waniewski ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Transport System ◽  
Driving Forces ◽  
Convective Transport ◽  
Functional Changes ◽  
Volume Load ◽  
Physiological Processes ◽  
Peritoneal Transport ◽  
High Concentrations ◽  
Detection And Diagnosis

The principles of peritoneal dialysis are based on the physiological processes and their driving forces which permit the exchange of water (by ultrafiltration and fluid absorption) and solutes (by diffusion and convective transport) between the peritoneal microvasculature and the dialysate. In peritoneal dialysis, the peritoneal transport system—mesenchymal cells, interstitium, microvasculature, and lymphatics—is repeatedly exposed to high concentrations of an osmotic agent, and a volume load, leading to increased intraperitoneal hydrostatic and osmotic pressure. This results in immediate as well as long-term structural and functional changes of the peritoneal transport system. Clinical tests supplemented with mathematical modelling have been developed to monitor the quantitative characteristics of the peritoneal transport system, allowing detection and diagnosis of various problems and guidance when predicting consequences of changes in prescription.

Individualized pd Prescription: Apd versus Capd

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 92-94 ◽  
Author(s):  
Reinhard R. Brunkhorst
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Situation ◽  
Private Life ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Bicarbonate Buffer ◽  
Sodium Removal ◽  
Dialysis Solution ◽  
The Individual

The proportion of patients performing automated peritoneal dialysis (APD) is increasing worldwide, a development probably caused by the better possibilities of adapting APD to the patients’ individual needs with respect to private life as well as dialysis adequacy. Patients prefer the independence from dialysis during the day and report a higher quality of life compared to patients on continuous ambulatory peritoneal dialysis (CAPD). In case of declining clearance rates, Kt/V, or sodium removal rates, a change in the APD regimen, together with higher fill volumes and, for example, combination with daytime CAPD, offers the tools to increase the dialysis dose as required by the individual clinical situation. The development of an online dialysis solution production system for APD could even improve the possibilities of individualizing peritoneal dialysis by providing variable concentrations of glucose, sodium, and bicarbonate buffer.

scholarly journals Baseline higher peritoneal transport had been associated with worse nutritional status of incident continuous ambulatory peritoneal dialysis patients in Southern China: a 1-year prospective study

2015 ◽  
Vol 114 (3) ◽  
pp. 398-405 ◽  
Author(s):  
Yun Liu ◽  
Rong Huang ◽  
Qunying Guo ◽  
Qiongqiong Yang ◽  
Chunyan Yi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Prospective Study ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Southern China ◽  
Impedance Analysis ◽  
The Body ◽  
Severe Malnutrition ◽  
Protein Energy Wasting ◽  
Peritoneal Transport

The aim of the present study was to investigate the relationship between baseline peritoneal transport types and nutritional status in Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. In the present single-centre, prospective study, incident CAPD patients were included from 15 April 2010 to 31 December 2011 and were followed up for 12 months. According to the results of baseline peritoneal equilibration test, patients were divided into lower peritoneal transport group (lower transporters) and higher peritoneal transport group (higher transporters). Nutritional status was evaluated by both subjective global assessment (SGA) and protein–energy wasting (PEW) score. The body composition parameters were assessed by body impedance analysis. A total of 283 CAPD patients were included in the study, of which 171 (60·4 %) were males with a mean age of 47·0 (sd14·9) years. Compared with lower transporters (n92), higher transporters (n181) had lower levels of serum albumin (37·1 (sd4·3)v.39·6 (sd4·3) g/l,P< 0·001), serum pre-albumin (356 (sd99)v.384 (sd90) mg/l,P= 0·035), phase angle (6·15 (sd0·39)v.6·27 (sd0·47)°,P< 0·05) and higher rate of malnutrition defined by SGA (52·5v.25·0 %,P< 0·001) and PEW score (37·0v.14·1 %,P< 0·001) at 1-year of follow-up. Baseline higher peritoneal transport, analysed by multivariate binary logistic regressions, was independently associated with malnutrition (SGA mild to moderate and severe malnutrition: OR 3·43, 95 % CI 1·69, 6·96,P< 0·01; PEW: OR 2·40, 95 % CI 1·08, 5·31,P= 0·03). It was concluded that baseline higher peritoneal transport was independently associated with worse nutritional status of CAPD patients in Southern China.

scholarly journals Effects of Peritoneal Dialysis on QT Interval in ESRD Patients

2021 ◽  
Author(s):  
Wenjing Zhang ◽  
Yu Liang ◽  
Jia Lv ◽  
Yan Li ◽  
Jiping Sun
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Qt Interval ◽  
Qtc Interval ◽  
Transport Function ◽  
Qtc Prolongation ◽  
Dialysis Adequacy ◽  
Peritoneal Transport

Abstract Background: Patients with chronic kidney disease (CKD) had a high risk of fatal arrhythmias. The extended corrected QT (QTc) interval is a hallmark of ventricular arrhythmias and sudden cardiac death. Studies have shown that QT interval and QTc were prolonged with the declination in renal function. Notably, QTc prolongation is significantly increased in patients undergoing hemodialysis. However, there were no results available in patients with peritoneal dialysis (PD). This study aimed to report the changes in QT interval and QTc in PD patients.Methods: A total of 66 PD patients were enrolled. The duration of follow-up was 1 year. The demographics, and the etiology of patients were recorded. QTc of ECG and clinical biochemical indexes before dialysis and at 6 months after PD and 1year after PD were determined and analyzed. Dialysis adequacy and peritoneal transport function were assessed in each patient.Results: (1) A total of 66 PD incident patients, including 50 males and 16 females, with an average age of 43.56±15.15 years (males: 43.74±15.53 years; females: 43.00 ± 15.92 years) were enrolled. In terms of etiology, 37 patients (56.06%) had chronic nephritis, followed by diabetic nephropathy in 11 patients (16.67%), IgA nephropathy with 8 patients (12.12%). The peritoneal transport test showed that the most of the peritoneal transport function was low average transport( 25, 37.88%), the least was high transport(2, 3.03%).(2) During the follow-up period, all patients reached the standard of PD. Compared with baseline before dialysis, anemia, low albumin, blood pressure, blood urea nitrogen, creatinine, uric acid, potassium, calcium, phosphorus and parathyroid hormone were improved after PD at 6 months and 1year. The residual renal function was gradually decreases during the follow-up. There were no significant differences in clinical indexes between 6 months and 1 year after PD.(3) The mean QTc of all patients were stable during 1-year follow-up period (pre-PD: 413.49±29.95ms; 6 months: 423.05±51.96ms; 1 year: 409.29±32.32ms, P>0.05). According to gender, the QTc in male patients and in female patients had the same results (P>0.05, respectively).(4) Before PD, diastolic blood pressure (r=-0.261,P=0.039), calcium concentration (r=-0.360,P=0.004) and hemoglobin level (r=-0.432,P=0.000) were found to be the risk factors of QTc prolongation. They were negatively correlated with QTc in end-stage renal disease patients. After patients starting PD, the observed clinical indicators showed no relevance to QTc anymore.Conclusion: Different from hemodialysis induced QTc prolongation, PD did not increase the patient's QT interval and QTc interval. This phenomenon was reported for the first time, suggesting that myocardial electrical activity might be more stable in PD patients.

scholarly journals P1135WHETHER USPD PATIENTS ARE SUITABLE FOR INCREMENTAL PERITONEAL DIALYSIS:YES OR NO?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wenjing Zhang ◽  
Jia LV ◽  
Lan Li ◽  
Zhigang Wang ◽  
Dapeng Hao ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Exit Site Infection ◽  
Full Dose ◽  
Mechanical Complications

Abstract Background and Aims Incremental Peritoneal Dialysis (IPD) is the practice of initiating PD exchange less than four times a day in consideration of residual renal function (RRF). More clinical studies have confirmed the feasibility and effectiveness of IPD, especially in the protection of residual renal function, which is obviously superior to full-dose PD. Urgent-start peritoneal dialysis (USPD) is a popular PD method. Due to lack of pre-dialysis education, most of patients who were newly diagnosed with ESRD in China chose USPD. Well, can incremental peritoneal dialysis be used for USPD patients when starting dialysis? Compared to full-dose PD, whether incremental PD affects the residual renal function in USPD patients? Here we report the first study of incremental peritoneal dialysis’s effect on residual renal function. Method A retrospective analysis of medical records was performed on 169 patients who received USPD from August 2008 to March 2017. Patients were divided into 2 groups according to dialysis dose: incremental PD(i-PD) group (dialysis dose were less than or equal to 6000ml or 3 exchanges per day) and full-dose PD(f-PD) group (dialysis dose were great than or equal to 8000ml or 4 exchanges per day). The demographics, clinical biochemical indexes, dialysis dose, urine volume, dialysis ultrafiltration volume, RRF, dialysis adequacy, peritoneal dialysis infection complications, mechanical complications and survival rates were compared between two groups in 1 year follow-up. Results: (1).A total of 169 patients were enrolled, including 111 patients (average age 45.01±12.84 years) in i-PD group and 58 patients (average age 43.5±15.62 years) in f-PD group. The demographics and clinical biochemical indexes in the two groups before peritoneal dialysis were similar (P&gt;0.05). (2).During the follow-up period, the dialysis dose in f-PD group(8034.48±262.61ml/d, 8080.00±395.80ml/d, 8155.17±523.21ml/d, 8051.72±906.55ml/d) were more than those in i-PD group(5891.89±528.31ml/d, 6159.57±1185.06ml/d, 6468.47±1588.71ml/d, 6900.90±1543.05ml/d), P&lt;0.05. And the dialysis adequacy in both groups were up to standard: the total Kt/V (i-PD group: 1.96±0.56, 2.01±0.70, 2.02±0.55, 1.90±0.52; f-PD group: 2.18±0.47, 2.22±0.55, 2.05±0.44, 2.03±0.42) were greater than 1.7 and the total Ccr (i-PD group: 79.39±29.75, 79.02±25.11, 78.26±30.00, 73.09±29.14; f-PD group: 89.78±29.89, 91.54±35.56, 82.38±29.27, 72.96±23.75) were greater than 60L. (3).During the whole follow-up period, the residual renal function between two groups had no statistically significant(i-PD group: 3.96±2.52ml/min, 3.46±1.95ml/min, 3.58±2.85ml/min, 2.91±2.33ml/min; f-PD group: 4.31±4.83ml/min, 3.45±2.36ml/min, 3.16±2.15ml/min, 2.36±1.65ml/min), P&gt;0.05. (4).During the whole follow-up period, the blood pressure control, correction of anemia, and correction of calcium and phosphorus abnormalities were also similar in both groups, P&gt;0.05. (5).At 1-month and 6-month, the urine volume were higher in i-PD group(1024.33±492.91ml/d, 1017.03±571.66ml/d) than those in f-PD group(782.93±415.89ml/d, 788.27±491.02ml/d), P&lt;0.05. The dialysis ultrafiltration volume in f-PD group (481.67±723.69ml/d, 632.77±687.89ml/d, 338.87±963.14ml/d, 750.43±849.69ml/d) were higher than those in i-PD group(343.30±520.00ml/d, 495.70±916.76ml/d, 341.78±925.57ml/d, 439.65±1297.13ml/d) during the whole follow-up period, but the differences were not statistically significant (P&gt;0.05). (6).The exit-site infection, peritonitis, mechanical complications and technical survival were similar between the two groups (P&gt;0.05). Conclusion Incremental peritoneal dialysis will not cause rapid decline of residual renal function in USPD patients, and the dialysis effect and complications are similar to full-dose peritoneal dialysis. Therefore, we recommend that USPD patients can be treated by incremental peritoneal dialysis.

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