Calcium Balance with Automated Peritoneal Dialysis

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 38-41 ◽  
Author(s):  
Carlos Andres Granja ◽  
Jean Francis ◽  
David Simon ◽  
David Bushinsky ◽  
Fredric O. Finkelstein
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Phosphate Binders ◽  
Calcium Balance ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Unit ◽  
Factors Influencing ◽  
Potential Association ◽  
Calcimimetic Agents ◽  
Continuous Cycling

Background Calcium balance in chronic kidney disease patients on peritoneal dialysis (PD) has not been well studied. This issue is particularly important, given the careful attention now being paid to vascular calcification, the increasing use of cinacalcet therapy (with accompanying reductions in serum Ca levels), the increasing use of vitamin D and its analogs (which increase Ca), and the increasing use of Ca-containing phosphate binders. The present study was conducted to examine the factors influencing transperitoneal calcium balance during continuous cycling peritoneal dialysis (CCPD) therapy, with particular attention to net ultrafiltration (UF) and serum ionized Ca (iCa). Patients and Methods This open, prospective cohort study included 40 medically stable patients maintained on CCPD for at least 3 months. Most patients used low-Ca (2.5 mEq/L) PD fluid; the Ca content of PD fluid for patients on icodextrin-based solutions was 3.5 mEq/L. Patients were instructed to record the quantity of dialysate instilled in a 24-hour period and net UF, and to bring a well-mixed aliquot of PD drainage to the dialysis unit. Concentrations of iCa and dialysate Ca were measured. Total Ca instilled into and drained from the PD fluid was calculated, and then the transperitoneal calcium balance was determined. Results Significant correlations were noted between transperitoneal calcium balance and both serum iCa ( r = –0.360) and the UF rate ( r = –0.708). Of the patients whose iCa was over 5 mg/dL, 71% were in negative calcium balance; of those with iCa levels below 5 mg/dL, 62% were in positive calcium balance. Of patients with UF below 1000 mL daily, 58% were in positive calcium balance; of those with 1000 mL UF or more, net Ca gain was noted in only 38%. Conclusions The present study demonstrates the importance of UF and iCa in determining transperitoneal Ca transport. These findings are of particular importance given the widening use of calcimimetic agents, vitamin D analogs, and Ca-based phosphate binders (all of which alter iCa) and the potential association between UF rate and outcome in PD patients.

scholarly journals Dynamic changes in calcium and phosphate plasma concentrations in the patients on peritoneal dialysis

2006 ◽  
Vol 63 (1) ◽  
pp. 27-30
Author(s):  
Natasa Jovanovic ◽  
Mirjana Lausevic ◽  
Biljana Stojimirovic
Keyword(s):  
Vitamin D ◽  
Renal Failure ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Stage Renal Disease ◽  
End Stage

Background/Aim. The disturbances of active forms of vitamin D synthesis and disturbances in calcium and posphate metabolism develop early in chronic renal failure, when creatinine clearance is about 30 ml/min. Chronic hemodialysis and peritoneal dialysis only partially correct the biochemical environment of patients on chronic renal replacement therapy because of end-stage renal disease. These dialysis modalities can?t significantly affect the endocrine disturbances of chronic renal failure and they have minimal modulatory effect. The management of disturbed calcium (Ca) and phosphate (P) metabolism and the maintainance of Ca ? P product below 4.4 mmol/l thanks to the use of dialysate solutions with the appropriate calcium concentration and the careful dosage of phosphate binders, calcium and active vitamin D metabolits, are extremely important for the prevention of renal osteodystrophy, secondary hyperparathyroidism as well as low-bone turnover disease. The aim of the study was to analyze the plasma levels of calcium, phosphate, albumin, alkaline phosphatase and parathormon (PTH) in 58 patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) from March to August 2003. The use of phosphate binders and the substitution with active vitamin D metabolits were also analyzed. Methods. We examined 58 patients, 30 males and 28 female, mean-age 52 years (range, 26-78 years), affected by end-stage renal disease of the different leading cause. The average time on peritoneal dialysis program was 20 months (2-66 months). Most of the patients were treated by CAPD, while only few of them performed automatic, cyclic or intermittent peritoneal dialysis. Most of the patients used a dialysate with 1.75 mmol/l calcium concentration. Results. The study showed that our patients on chronic CAPD program during several months had normal calcemia, phosphatemia and the level of alkaline phosphatase, and that they had Ca ? P product in the recommended range. PTH serum level ranged from 16 to 490 pg/l in our patients. Conclusion. The study showed that a balanced diet and a correct dosage of phosphate binders, as well as a careful substitution with active vitamin D metabolits render a good control of calcium and phosphate serum balance, as well as an effective prevention of renal osteodystrophy development in the patients on chronic peritoneal dialysis treatment.

Renal Osteodystrophy in Peritoneal Dialysis: Special Considerations

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 11-19 ◽  
Author(s):  
Ronen Levy ◽  
Anca Gal-Moscovici
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Lesion ◽  
Phosphate Binders ◽  
Vitamin D Metabolites ◽  
Bone Disorder

Bone disease is one of the most challenging complications in patients with chronic kidney disease. Today, it is considered to be part of a complex systemic disorder manifested by disturbances of mineral metabolism and vascular calcifications called chronic kidney disease – mineral bone disorder (CKD-MBD). The term renal osteodystrophy is reserved to define the specific bone lesion in CKD-MBD, whose spectrum ranges from high turnover to low turnover disease. Phosphate retention, decreased serum calcium, and 1,25-dihydroxy vitamin D synthesis are involved in the pathogenesis of high bone turnover. However, the various therapeutic approaches (calcium supplements, phosphate binders, and vitamin D metabolites, among others), the renal replacement modality (hemodialysis or continuous ambulatory peritoneal dialysis), and the types of patients to whom dialysis is offered (more patients who are diabetic or older, or both) may influence the evolution of the bone disorder. As a result, recent studies have reported a greater prevalence of adynamic forms of renal osteodystrophy, especially in diabetic and peritoneal dialysis patients. The present article reviews, for patients treated with peritoneal dialysis, the pathophysiologic mechanisms involved in the evolution and perpetuation of this bone disease and the therapeutic modalities for treating and preventing adynamic bone.

scholarly journals Transperitoneal Calcium Balance in Anuric Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Chieko Hamada ◽  
Yasuhiko Tomino
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Biochemical Parameters ◽  
Calcium Balance ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Intact Pth ◽  
Rapid Removal ◽  
The Difference ◽  
Short Time

Backgrounds. Calcium (Ca) and bone metabolism in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients show a remarkable difference depending on dialysis modalities. The levels of serum Ca and phosphate (P) in HD patients fluctuate contributing to the intermittent and rapid removal of plasma solute unlike in CAPD. Characteristics of plasma solute transport in automated peritoneal dialysis (APD) patients are resembled with that in HD. The purpose of the present study was to examine the difference of transperitoneal Ca removal between APD and CAPD anuric patients.Subjects and Methods. Twenty-three APD anuric patients were enrolled in this study. Biochemical parameters responsible for transperitoneal Ca removal in 24-hour and 4-hour peritoneal effluents were analyzed on CAPD and APD.Results. Transperitoneal Ca removal on APD was smaller compared with that on CAPD. The Ca removal was related to the ultrafiltration during short-time dwell. Decrease of the Ca removal during NPD induced by short-time dialysate dwell caused negative or small Ca removal in APD patients. The levels of intact PTH were increased at the end of PET.Conclusion. It appears that short-time dwell and frequent dialysate exchanging might suppress the transperitoneal Ca removal in anuric APD patients.

Comparison of Exit -Site Infections in Disconnect versus Nondisconnect Systems for Peritoneal Dialysis

1992 ◽  
Vol 12 (3) ◽  
pp. 317-320 ◽  
Author(s):  
John M. Burkart ◽  
Jean R. Jordan ◽  
Theresa A. Durnel ◽  
L. Douglas Case
Keyword(s):  
Peritoneal Dialysis ◽  
Marked Reduction ◽  
Site Infection ◽  
Automated Peritoneal Dialysis ◽  
Infection Rates ◽  
Exit Site ◽  
Endstage Renal Disease ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Private Setting

Objective To determine if disconnect systems reduce the incidence of exit-site infections when compared to nondisconnect systems. Design We prospectively monitored exit-site infections and peritonitis rates in 96 disconnect patients (Yset, automated peritoneal dialysis (APD)) and 60 nondisconnect patients (spike, ultraviolet connection device (UVXD)). Setting A freestanding chronic peritoneal dialysis unit staffed by physicians from both a medical school and a private setting. Patients All patients who began peritoneal dialysis at our unit were monitored, regardless of cause of endstage renal disease (ESRD) or age. Intervention Patients were dialyzed using the system (Y-set, spike, etc.) most appropriate for their life-style and their ability to administer self-care. Main Outcome We attempted to follow disconnect and nondisconnect patients for a similar median time on dialysis and compared differences in exit-site infections. Results Peritonitis rates (episodes/pt year) were reduced for disconnect (0.60) versus nondisconnect (0.99) systems (p=0.0006). Despite the marked reduction in peritonitis rates, there was no difference in exit-site infection rates (0.35 vs 0.38), the time to the first exit -site infection, or the time to the first catheter removal for disconnect versus nondisconnect groups. When individual systems were compared, differences in exit-site infection rates (episodes/pt years) were noted (0.62, spike; 0.26,UVXD; 0.32,Y-set; 0.41,APD). Conclusion We found no overall difference in exit site infection rates for disconnect versus nondisconnect systems, despite a reduction in peritonitis rates for disconnect systems.

Calcimimetics for the Treatment of Secondary Hyperparathyroidism in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (2_suppl) ◽  
pp. 42-46 ◽  
Author(s):  
Jean Francis ◽  
David B. Simon ◽  
Peter Jeurgensen ◽  
Fredric O. Finkelstein
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Secondary Hyperparathyroidism ◽  
Hormone Secretion ◽  
Phosphate Binders ◽  
Serum Phosphate Level ◽  
Dialysis Patients ◽  
Intravenous Vitamin ◽  
Stage Renal Disease ◽  
End Stage

Secondary hyperparathyroidism is a common complication in patients with end-stage renal disease. It has been associated with increased cardiovascular events and mortality. Traditional therapy has been based on vitamin D analogs and phosphate binders; but these therapies often do not control secondary hyperparathyroidism, particularly in peritoneal dialysis patients for whom phosphate clearances are limited and intravenous vitamin D is impractical. Cinacalcet, a calcimimetic, suppresses parathormone secretion by interacting with the calcium-sensing receptor on the surface of parathyroid gland cells. The resulting suppression of parathyroid hormone secretion produces a reduction in serum phosphate level and CaxPO4 product. The present paper reviews the efficacy of cinacalcet in the management of secondary hyperparathyroidism in peritoneal dialysis patients.

scholarly journals Calcium Balance and Negative Impact of Calcium Load in Peritoneal Dialysis Patients

2014 ◽  
Vol 34 (4) ◽  
pp. 345-352 ◽  
Author(s):  
Angela Yee-Moon Wang
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Calcification ◽  
Negative Impact ◽  
Safety Concern ◽  
Phosphate Binders ◽  
High Dose ◽  
Calcium Excretion ◽  
Calcium Balance ◽  
Dialysis Patients ◽  
Valvular Calcification

Like hemodialysis patients, peritoneal dialysis (PD) patients are facing an excessively increased burden of vascular and valvular calcification. According to some surveys, more than 80% of prevalent PD patients are complicated with vascular calcification, and more than one third have heart valve calcification.Dysregulated phosphate metabolism is well recognized to play an important role in inducing vascular calcification, but increasing evidence is suggesting that dysregulated calcium metabolism also promotes vascular calcification and might in fact be more potent than phosphate in inducing that calcification. Growing evidence from randomized controlled trials shows more progression of vascular calcification and higher mortality among chronic kidney disease (CKD) patients receiving calcium-based phosphate binders than among those receiving non-calcium-containing phosphate binders. Those results raise important safety concern about the use of high-dose calcium-based phosphate binders in the CKD population, including both non-dialysis and dialysis patients (especially anuric dialysis patients), who have markedly reduced urinary calcium excretion. To prevent calcium overload, this review recommends restricting the dose of calcium-based phosphate binders in CKD patients, especially those who are elderly, who have increased cardiovascular risk, who already have baseline vascular or valvular calcification, or who have low intact parathyroid hormone and adynamic bone disease.

scholarly journals Patients’ outcome with polycystic kidney disease firstly treated with peritoneal dialysis. Experience of our home dialysis unit since 1997.

2021 ◽  
Vol 4 (1) ◽  
pp. 11-19
Author(s):  
Jean-michel Poux ◽  
Carlos Cardozo ◽  
Laville Maurice ◽  
Anne Jolivot ◽  
Jean-Pierre Fauvel
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Medical Monitoring ◽  
Automated Peritoneal Dialysis ◽  
Polycystic Kidney ◽  
Dialysis Unit ◽  
Home Dialysis ◽  
Hemodialysis Unit

We extracted data from the French Speaking Registry of Peritoneal Dialysis and retrospectively studied peritonitis and the outcome of 30 patients with polycystic kidney disease firstly treated with peritoneal dialysis within our dialysis unit since 1997. There were 15 men and 15 women with a mean age of 54 years. Eighty-five per-cent of the patients had hepatic impairment. Ten patients did not suffer from comorbidities. Charlson comorbidity index was greater than or equal to 4 in five patients. Most of the patients was treated with automated peritoneal dialysis during the night. Only one patient was not autonomous with peritoneal dialysis. The whole medical monitoring lasted 836 months, representing an average of 28 months per patient. Eleven patients had a total of 24 peritonitis, 9 with gram negative bacillus. The incidence of peritonitis was one episode every 35 months-patient. Peritonitis was responsible for sudden admission in hemodialysis unit in two cases and death in one case. Fifteen patients (50%) benefited from renal transplantation. Only one patient had to undergo nephrectomy prior to renal transplantation. Seven patients were admitted to hemodialysis unit (the median duration time on peritoneal dialysis was 36 months). Four patients died. Four patients are currently treated with peritoneal dialysis. In conclusion, this retrospective study points out that peritoneal dialysis, especially automated peritoneal dialysis, is a good option for patients with polycystic kidney disease necessitating dialysis.

Treatment and outcome of Peritonitis in Automated Peritoneal Dialysis, using a Once-Daily Cefazolin-Based Regimen

2002 ◽  
Vol 22 (3) ◽  
pp. 345-349 ◽  
Author(s):  
Richard E. Fielding ◽  
Michelle Clemenger ◽  
Lawrence Goldberg ◽  
Edwina A. Brown
Keyword(s):  
Peritoneal Dialysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Automated Peritoneal Dialysis ◽  
Patient Death ◽  
Dialysis Unit ◽  
Once Daily ◽  
Yeast Infection ◽  
Primary Peritonitis ◽  
Culture Negative

Objective We determined the effectiveness of a once-daily cefazolin-based regimen in treating automated peritoneal dialysis (APD) peritonitis. Design We carried out a retrospective analysis of all APD peritonitis episodes treated with a once-daily cefazolin protocol. Setting The study was performed in a peritoneal dialysis unit in a tertiary care hospital. Patients and Methods We studied 60 episodes of primary peritonitis in 40 patients on APD. Each patient was treated with a vancomycin-free regimen consisting of intraperitoneal cefazolin (1.5 g IP) with gentamicin IP administered in the daytime exchange. The main outcome measures were successful treatment of peritonitis, removal of peritoneal catheter, relapse of peritonitis, and patient death. Results Gram-positive infections occurred in 35 episodes (58.3%), gram-negative infections in 10 episodes (16.7%), culture-negative infections in 14 episodes (23.3%), and a yeast infection in 1 episode (1.7%). Of the 60 episodes, 47 (78.3%) were successfully treated. In 10 episodes (16.7%), catheters were removed (9 for treatment failure, 1 for yeast infection). Four patients (8%) had a relapse of infection within 4 weeks of completing antibiotic therapy. One patient (1.7%) died. Conclusions Our results demonstrate that once-daily cefazolin with gentamicin IP is an effective treatment for APD peritonitis, with the advantage of being easy to administer and enabling patients to remain on APD during treatment.

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