Combination of Crystalloid (Glucose) and Colloid (Icodextrin) Osmotic Agents Markedly Enhances Peritoneal Fluid and Solute Transport during the Long PD Dwell

2007 ◽  
Vol 27 (3) ◽  
pp. 267-276 ◽  
Author(s):  
Philippe Freida ◽  
Magda Galach ◽  
Jose C. Divino Filho ◽  
Andrzej Werynski ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Residual Renal Function ◽  
Transport Rate ◽  
Dialysis Patients ◽  
Fluid Removal ◽  
Sodium Removal ◽  
Ultra Filtration ◽  
Osmotic Agents ◽  
Peritoneal Solute Transport Rate

Background Fluid and sodium removal is often inadequate in peritoneal dialysis patients with high peritoneal solute transport rate, especially when residual renal function is declining. Method We studied the effects of using simultaneous crystalloid (glucose) and colloid (icodextrin) osmotic agents on the peritoneal transport of fluid, sodium, and other solutes during 15-hour single-dwell exchanges using 3.86% glucose, 7.5% icodextrin, and a combination fluid with 2.61% glucose and 6.8% icodextrin in 7 prevalent peritoneal dialysis patients with fast peritoneal solute transport rate. Results The combination fluid enhanced net ultrafiltration (mean 990 mL) and sodium removal (mean 158 mmol) compared with 7.5% icodextrin (mean net ultrafiltration 462 mL, mean net sodium removal 49 mmol). In contrast, the 3.86% glucose-based solution yielded negligible ultra-filtration (mean -85 mL) and sodium removal (mean 16 mmol). The combination solution resulted in significantly improved urea (+41%) and creatinine (+26%) clearances compared with 7.5% icodextrin. Conclusion A solution containing both crystalloid (glucose 2.61%) and colloid (icodextrin 6.8%) osmotic agents enhanced fluid removal by twofold and sodium removal by threefold compared with 7.5% icodextrin solution during a dwell of 15 hours, indicating that such a combination solution could represent a new treatment option for anuric peritoneal dialysis patients with high peritoneal solute transport rate.

scholarly journals Dialysate interleukin-6 predicts increasing peritoneal solute transport rate in incident peritoneal dialysis patients

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Yeoungjee Cho ◽  
David W Johnson ◽  
David A Vesey ◽  
Carmel M Hawley ◽  
Elaine M Pascoe ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Interleukin 6 ◽  
Transport Rate ◽  
Dialysis Patients ◽  
Peritoneal Solute Transport Rate

Effects of Interleukin-6 T15A Single Nucleotide Polymorphism on Baseline Peritoneal Solute Transport Rate in Incident Peritoneal Dialysis Patients

2009 ◽  
Vol 29 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Young-Hwan Hwang ◽  
Min-Jeong Son ◽  
Jaeseok Yang ◽  
Kiwon Kim ◽  
Wookyung Chung ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Interleukin 6 ◽  
Residual Renal Function ◽  
Transport Rate ◽  
Strong Positive Correlation ◽  
Nucleotide Polymorphisms ◽  
Necrosis Factor Alpha ◽  
Single Nucleotide ◽  
Peritoneal Solute Transport Rate

Objective To study the genetic effects of various inflammatory cytokines on peritoneal solute transport rate (PSTR) in incident Korean peritoneal dialysis (PD) patients. Design Case-control association study. Methods 132 patients with baseline peritoneal equilibration test within 1 – 3 months after starting PD were enrolled. We analyzed the influence of single nucleotide polymorphisms (SNPs) of interleukin-6 (IL-6; -572G/C, T15A), tumor necrosis factor-alpha (TNF-α; -1031C/T, -863C/A, -308G/A), and IL-10 (-1082A/G, -592A/C) on baseline PSTR. Clinical parameters such as age, gender, presence of diabetes mellitus, comorbidity, C-reactive protein, and residual renal function were also included as covariates. Results The T15A SNP of IL-6 (rs13306435) was associated with PSTR. Patients with TA genotype ( n = 18) had significantly lower D4/P creatinine (0.65 ± 0.087 vs 0.73 ± 0.110, p = 0.0046) and higher D4/D0 glucose (0.39 ± 0.174 vs 0.31 ± 0.119, p = 0.027) than patients with TT genotype ( n = 114). The log value of the dialysate appearance rate of IL-6 had a strong positive correlation with D4/P creatinine ( r2 = 0.1294, p < 0.0001) and was significantly lower in the TA genotype than the TT genotype (201.7 ± 14.42 vs 116.8 ± 88.91 pg/minute, p = 0.0358). By multiple logistic regression, TA genotype was negatively associated with a higher PSTR (high or high average; odds ratio 0.18; 95% confidence interval 0.048 – 0.666). Conclusions In incident Korean PD patients, T15A polymorphism of IL-6 is associated with dialysate IL-6 concentration and baseline PSTR.

Use of Icodextrin during Nocturnal Automated Peritoneal Dialysis Allows Sustained Ultrafiltration While Reducing the Peritoneal Glucose Load: A Randomized Crossover Study

2007 ◽  
Vol 27 (3) ◽  
pp. 260-266 ◽  
Author(s):  
Ana Rodríguez-Carmona ◽  
Miguel Pérez Fontán ◽  
Elvia García López ◽  
Teresa García Falcón ◽  
Helena Díaz Cambre
Keyword(s):  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Serum Levels ◽  
Residual Renal Function ◽  
Similar Amount ◽  
Glucose Load ◽  
Sodium Removal ◽  
Dependent Variables ◽  
Ultra Filtration ◽  
Randomized Crossover Study

Background Optimization of ultrafiltration and preservation of the peritoneal membrane are desirable objectives in peritoneal dialysis (PD) patients. Mixtures of glucose-and non-glucose-based solutions may help to meet both targets simultaneously. Aim To analyze the effects, in terms of ultrafiltration and peritoneal glucose load, of including icodextrin-based dialysate in the nocturnal schedule of patients undergoing automated PD (APD). Method Following a randomized crossover design, 17 APD patients underwent two 10-day study periods under identical prescription (including amino acid-based solution for the night schedule), except for the substitution of 2 L glucose-based dialysate in the nocturnal mixture (control) by a similar amount of icodextrin-based dialysate (icodextrin phase) in one period. Dependent variables included ultra-filtration, sodium removal, peritoneal glucose load, and residual renal function. We measured serum and urine levels of icodextrin metabolites at the end of each phase. Results Ultrafiltration was marginally higher during the icodextrin phase (median 815 vs 763 mL/day, p = 0.07), while peritoneal sodium removal was similar in both phases (74 vs 71 mmol/L/day). Peritoneal glucose load (median 67.5 vs 104.0 g/day, p < 0.005) and absorption (14.0 vs 35.6 g/day, p < 0.005) were lower during the icodextrin phase. Diuresis was also modestly lower during the icodextrin phase (500 vs 600 mL/day, p < 0.05). Serum levels of icodextrin metabolites were moderately higher in the icodextrin phase ( p < 0.005) in patients both on and off diurnal icodextrin. Conclusion Inclusion of amino acid- and icodextrin-based solutions in the nocturnal schedule of APD patients may allow sustained ultrafiltration and sodium removal while significantly reducing the peritoneal glucose load in these patients.

Acute Systemic Inflammation is Associated with an Increase in Peritoneal Solute Transport Rate in Chronic Peritoneal Dialysis Patients

2004 ◽  
Vol 24 (6) ◽  
pp. 597-600 ◽  
Author(s):  
Soon Bae Kim ◽  
Jai Won Chang ◽  
Sang Koo Lee ◽  
Jung Sik Park
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Systemic Inflammation ◽  
Acute Inflammation ◽  
Transport Rate ◽  
Temporary Increase ◽  
Chronic Peritoneal Dialysis ◽  
Hs Crp ◽  
Inflammation Group ◽  
Peritoneal Solute Transport Rate

Background This study was performed to evaluate the effects of acute systemic inflammation on peritoneal solute transport rate (PSTR) in chronic peritoneal dialysis (CPD) patients. Methods A baseline standard peritoneal equilibration test (PET) was performed on each patient every 6 months, and blood concentration of high-sensitivity C-reactive protein (hs-CRP) was assayed every 2 months in our peritoneal dialysis clinic. Acute systemic inflammation was defined as a greater than 10-fold increase in hs-CRP concentration compared with baseline value, in the absence of peritonitis, and returning to baseline level in 2 months. In patients with acute systemic inflammation, PET and hs-CRP concentration assays were performed during inflammation and after recovery. Ten patients with acute systemic inflammation were enrolled in the inflammation group and 42 other patients served as controls. Results There were no significant changes in hs-CRP and dialysate-to-plasma ratio of creatinine (D/Pcreat) in the control group during the study period. In the inflammation group, median hs-CRP levels at baseline, during acute inflammation, and at recovery were 2.3 mg/L (range 0.3 – 4.5 mg/L), 39.2 mg/L (range 15.1 – 117.4 mg/L), and 3.7 mg/L (range 0.9 – 8.9 mg/L), respectively. Median D/Pcreat increased significantly from baseline (0.64; range 0.55 – 0.98) to time of acute inflammation (0.72; range 0.60 – 0.96) ( p < 0.05). The D/Pcreat at recovery was 0.67 (range 0.52 – 0.94), which decreased significantly from time of acute inflammation ( p < 0.05). There was no correlation between changes in log (hs-CRP) and changes in D/Pcreat. Conclusion We have shown here that acute systemic inflammation is associated with a temporary increase in PSTR in CPD patients.

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