The Peak Concentration Hypothesis: A Urea Kinetic Approach to Comparing the Adequacy of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis

1989 ◽  
Vol 9 (4) ◽  
pp. 257-260 ◽  
Author(s):  
Prakash R. Keshaviah ◽  
Karl D. Nolph ◽  
John C. Van Stone
Keyword(s):  
Peritoneal Dialysis ◽  
Steady State ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Peak Concentration ◽  
Treatment Time ◽  
Urea Concentration ◽  
Intermittent Therapy ◽  
The Hours ◽  
National Cooperative

The KTIV urea index ( K, clearance; T, treatment time; V, volume of urea distribution) has become an established index of hemodialysis (HD) adequacy, values of KTIV < 0.8 being associated with overt uremic toxicity. For the typical continuous ambulatory peritoneal dialysis (CAPD) regimen of 4 X 2 L exchanges/day, the equivalent KT/V -0.6. Paradoxically, overt uremic toxicity is not commonly observed in CAPD patients with this typical therapy prescription. Application of the urea kinetic model demonstrates that HD and CAPD have the same time-averaged urea concentration at the same KTIV. However, as HD is an intermittent therapy, the urea concentration in HD exceeds the time-averaged concentration for about half the hours in the week. If uremic toxicity is related to the peak rather than the time-averaged urea concentration, a higher KT/V would be required in HD to achieve a peak concentration at or below the steady state CAPD concentration. This peak concent ration hypothesis predicts, based on the results of the National Cooperative Dialysis Study, that underdialysis with CAPD would occur at KT/V < 0.4 for a protein intake of 1.1 gmlkglday.

scholarly journals Problems in Comparisons of Clearances Prescriptions in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis

1991 ◽  
Vol 11 (4) ◽  
pp. 298-300 ◽  
Author(s):  
Karl D. Nolph ◽  
Prakash Keshaviah ◽  
Robert Popovich
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peak Concentration ◽  
Nitrogen Concentration ◽  
Chronic Hemodialysis ◽  
Intermittent Therapy ◽  
Annual Conference ◽  
Dialysis Therapy ◽  
Urea Nitrogen ◽  
Pros And Cons

There is currently great interest in defining acceptable doses of dialysis therapy with different techniques. In hemodialysis (HD) and in continuous ambulatory peritoneal dialysis (CAPD), doses of weekly clearances of urea and/or creatinine required for achieving acceptable nutrition and quality of life need better definition (1–2). If control of the peak blood urea nitrogen concentration (BUN) is important in preventing uremic toxicity (the peak concentration hypothesis), then any intermittent therapy requires a greater dose of therapy to maintain the peak concentration below or at the steady state value of CAPD (assuming the same urea nitrogen generation rate and, hence, the same weekly net removal [mass transfer] of urea nitrogen) (2). The peak concentration hypothesis remains unproven, but it is certainly compatible with the apparent need for higher weekly clearances with intermittent therapies. Accordingly, it may be appropriate to increase the weekly KTN urea for intermittent PD therapies, such as nightly peritoneal dialysis, as compared to CAPD. For chronic hemodialysis, most centers strive for a weekly KTN urea value at or above 3.0 (2), whereas in CAPD the typical regimen yields a weekly KTN urea between 1.5 and 1.8. There was great interest in kinetic modeling of CAPD clearance prescriptions at the 10th Annual Conference on Peritoneal Dialysis in Dallas, Texas, in February of 1990 (1, 3–6). The focus was on defining adequate peritoneal dialysis and optimizing nutrition. The purpose of this editorial is not to review the pros and cons of modeling dialysis therapy to achieve defined doses of small solute clearances nor to support or refute the peak concentration hypothesis.

Nutritional Status of Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)

1983 ◽  
Vol 3 (3) ◽  
pp. 138-141 ◽  
Author(s):  
Brigitte Heide ◽  
Andreas Pierratos ◽  
Ramesh Khanna ◽  
Jean Pettit ◽  
Raymond Ogilvie ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Biochemical Parameters ◽  
Total Body Potassium ◽  
Total Body ◽  
Over Time

Nutritional follow-up of 20 CAPD patients for 18–24 months showed a decrease in total body nitrogen, increase in total body potassium and body weight, and a decrease in protein intake over time. There was no correlation between changes in TBN and the biochemical parameters measured. Serial dietetic assessments and measurements of total body nitrogen as well as adherence to an adequate protein intake will assist in the prevention of malnutrition in CAPD patients.

Six-Month Overnight Intraperitoneal Amino-Acid Infusion in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients-No Effect on Nutritional Status

1990 ◽  
Vol 10 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Nicholas V. Dombros ◽  
Krystyne Prutis ◽  
Mathew Tong ◽  
G. Harvey Anderson ◽  
Joan Harrison ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Skinfold Thickness ◽  
Amino Acid Infusion ◽  
Long Term Effect ◽  
Total Body

The long-term effect of an AA solution based on Tra-vasol®, a solution for total parenteral nutrition, given in-traperitoneally over a 6-month period was studied in 5 patients 22 to 75 years old, having been on continuous ambulatory peritoneal dialysis (CAPD) for 3 to 57 months. A low oral protein intake (<0.8 g/kg bw /day) and/or a low serum albumin «35 g/L) were used as inclusion criteria. Two liters of 1% AA solution were infused overnight, while a glucose Dianeal® was used for the other exchanges. During the study, BUN increased from 22.04 mM/L to 28.06 mM/L the first month and remained at these levels, indicating the increased protein intake. However, average oral total energy and protein intake, body weight (bw), serum creatinine, cholesterol, triglycerides, total proteins, albumin, transferrin, skinfold thickness, total body potassium, and plasma AA levels remained basically unchanged. The average total body nitrogen decreased from 1.746 to 1.554 Kg, but this decrease did not reach statistical significance (p > 0.05). We conclude that intraperitoneal overnight administration of 2 L of 1% AA based on Travasol® over 6 months did not improve the nutritional status of CAPD patients. This ineffectiveness might be due to the AA composition of the solution, the timing of administration, or to a low caloric intake and/or that our patients were not severely malnourished.

Single Daily Dose of Aminoglycosides in the Treatment of Continuous Ambulatory Peritoneal Dialysis Peritonitis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 355-356 ◽  
Author(s):  
Stephen I. Vas
Keyword(s):  
Peritoneal Dialysis ◽  
Antibiotic Therapy ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Single Daily Dose ◽  
Blood Levels ◽  
Intermittent Therapy ◽  
Postantibiotic Effect ◽  
Daily Dose

Toxicity of amlnoglycosides is a major concern in the treatment of continuous ambulatory peritoneal dialysis (CAPO) peritonitis. The relatively high blood levels and prolonged and repeated usage may all be contributory. The recognition of the so-called postantibiotic effect, together with the Increased phagocytosis of antiblotictreated cells, may introduce a new mode of therapy with once-dally dosage. Intermittent therapy with vancomycin Is already generally accepted. The extension of this modality to antibiotic therapy is discussed.

scholarly journals PERAN EDUKASI GIZI TERHADAP ASUPAN ENERGI-PROTEIN DAN INDEKS MASSA TUBUH PASIEN GAGAL GINJAL KRONIS DENGAN TERAPI CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD)

2021 ◽  
Vol 9 (1) ◽  
pp. 53-58
Author(s):  
Yudhi Adrianto ◽  
Diah Mulyawati Utari ◽  
Fitri Hudayani ◽  
Triyani Kresnawan
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Peritoneal Dialysis ◽  
Food Intake ◽  
Nutritional Status ◽  
Nutrition Education ◽  
Body Mass ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Normal Body Mass Index

Background: Nutrition are the essential factor to maintain body weight, body mass index and food intake in CAPD patients. Dialysis could increase nutrients lost and had to be replaced by adequate intake. Nutrition education should be needed to increase patient’s knowledge, food intake and body mass index.Objectives: To determine the role of nutrition education towards energy-protein intake and body mass index in patient with continuous ambulatory peritoneal dialysis (CAPD)Method: A cross-sectional study design with total sampling technique to obtains thirthy CAPD outpatient at RSUPN Dr. Cipto Mangunkusumo. Energy and protein intake were assessed by 3-days-food records (weekday and weekend). Nutritional status were obtained with BMI by dry body weight. Data were analyzed with independent t-test.Results: Most of subject are male outpatients, 25 – 55 years old (76.7%), had hypertension (83.3%) and normal BMI (50%). Most of subject had been undergoing peritoneal dialysis more than a year (67%), and had less than two times education per year. Energy intake were categorized as sufficient (80%) but protein intake were categorized as insufficient. There were no differences between frequency of nutrition education with energy-protein intake and nutritional status (p0.05)Conclusion: There are no differences between energy-protein intake and nutritional status with the frequency of nutrition education. Nutritional education by nutritionist and/or dietitian according to the recommendations help to maintain normal body mass index.

Comparison of Control of Serum Phosphate Levels during Continuous Ambulatory Peritoneal Dialysis and during Hemodialysis

1983 ◽  
Vol 3 (2) ◽  
pp. 97-98 ◽  
Author(s):  
Jorge B Cannata ◽  
James D Briggs ◽  
Gordon S Fell ◽  
Brian J.R. Junor
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Aluminium Hydroxide ◽  
Protein Intake ◽  
Serum Levels ◽  
Aluminium Toxicity ◽  
Hemodialysis Patients ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Phosphate Control

Recent reports have suggested that oral aluminium hydroxide carries the risk of aluminium toxicity. We have compared the aluminium hydroxide dose and serum levels of phosphate and aluminium in 27 CAPD and 26 hemodialysis patients. Despite a more liberal protein intake and lower aluminium hydroxide dose, the CAPD patients achieved the same serum phosphate level as those on hemodialysis. While the reason for more efficient serum phosphate control with CAPD is uncertain, the better control gives CAPD an advantage in patients in whom it is particularly important to minimise exposure to aluminium.

Nutritional Status of Capd Patients at Three Years

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 195-204 ◽  
Author(s):  
Leocadia Palop ◽  
Nicanor Vega ◽  
Teresa Rodriguez ◽  
Ana Fernandez ◽  
Jose C. Rodriguez ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Steady State ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Nutritional Assessment ◽  
Residual Renal Function ◽  
Control Group ◽  
Protein Calorie Malnutrition

A nutritional assessment was carried out in 63 patients starting treatment from April 1990 up to December 1993. Anthropometric measurements were performed showing a prevalence of protein-calorie malnutrition (PCM) of 21 % in a total of 142 clinical surveys carried out in the above-mentioned sample. A steady state of albumin levels in plasma was verified during a three-year follow-up period at a lower level than that of the control group. The patients’ lymphocytic profile throughout the study was characterized by lymphopenia and decreased B and T 8 lymphocytes. During the first two years of continuous ambulatory peritoneal dialysis (CAPD), a high percentage of patients met the “adequacy” dialysis criteria as residual renal function plays an important role as regards treatment.

Erythropoietin in Continuous Ambulatory Peritoneal Dialysis: Experience with Subcutaneous Administration

1992 ◽  
Vol 12 (1) ◽  
pp. 34-36 ◽  
Author(s):  
George Eisele ◽  
George R. Bailie ◽  
Candace Clement ◽  
Edmund Wong
Keyword(s):  
Peritoneal Dialysis ◽  
Steady State ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Initial Dose ◽  
Maintenance Dose ◽  
Subcutaneous Administration ◽  
Iron Supplements ◽  
Iron Saturation ◽  
Initial Iron ◽  
The Mean

Experience in the use of subcutaneous erythropoietin (EPO) in 32 continuous ambulatory peritoneal dialysis (CAPD) patients is presented. All patients were treated with oral iron supplements. The total and mean I SD durations of EPO treatment were 466 weeks and 14.6±10.1 weeks respectively. Twenty -two patients started treatment with normal or elevated iron stores; 10 had an initial iron saturation <20%. The initial hematocrit was 23.8±3.7%. Thirteen patients reached a steady -state hematocrit by the end of the study period, when the mean I SD hematocrit for all32 patients was 34.1±3.6%. All patients responded to EPO. The initial dose of EPO was 147.1 ± 53.8 U/kg/week. Maintenance dose was 72±36 U/kg/week.

Pharmacokinetics of Intraperitoneal Cefazolin and Gentamicin in Empiric Therapy of Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients

2001 ◽  
Vol 21 (6) ◽  
pp. 587-594 ◽  
Author(s):  
Thanawat Tosukhowong ◽  
Somchai Eiam–Ong ◽  
Kannika Thamutok ◽  
Supeecha Wittayalertpanya ◽  
Duangchit Panomvana Na Ayudhya
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Treatment Time ◽  
Clinical Care ◽  
White Cell Count ◽  
Empiric Therapy ◽  
Pharmacokinetic Studies ◽  
Duration Of Treatment ◽  
Once Daily ◽  
Drug Concentrations

Objective The aim of this study was to measure and evaluate the appropriateness of the actual concentrations of serum and dialysate cefazolin and gentamicin in Thai continuous ambulatory peritoneal dialysis (CAPD) patients treated following the International Society for Peritoneal Dialysis (ISPD) 1996 recommendations for the empiric therapy of CAPD-related peritonitis. Design Prospective and descriptive study. Setting Institutional level of clinical care. Patients CAPD-related peritonitis patients were diagnosed by dialysate effluent white cell count of more than 100/mm3 and polymorphonuclear leukocytes of at least 50%. There were 18 patients, all at least 15 years of age, entered; all completed the study. Intervention In accordance with the ISPD 1996 recommendations, the antibiotic regimen included continuous intraperitoneal (IP) cefazolin and once-daily IP amino-glycoside. Cefazolin was administered as loading and continuous maintenance doses of 500 and 125 mg/L dialysate, respectively. Gentamicin, 0.6 mg/kg body weight, was given IP once daily. Duration of treatment was 120 hours. Main Outcome Measures Serum and dialysate effluent samples of the 18 CAPD patients with peritonitis were measured and used for the synthesis of pharmacokinetic equations that could predict drug concentrations at any treatment time. Results Following administration according to the ISPD 1996 treatment recommendations, serum cefazolin reached levels higher than the recommended levels (8 mg/mL) at 3.3 minutes after drug administration, and persisted through the 5-day duration of the study. Dialysate cefazolin levels during the studied period also were persistently higher than the recommended values. The peak serum gentamicin levels were lower than the suggested values of 4 mg/mL, whereas the trough serum gentamicin levels were higher than the minimal toxic concentrations (2 mg/mL). Dialysate gentamicin levels were higher than therapeutic concentrations for only 4.75 hours in each day. It was difficult, using pharmacokinetic studies, to adjust the dosage regimen of gentamicin to achieve appropriately therapeutic levels in both serum and dialysate. Conclusions The ISPD 1996 recommended dosage of continuous IP cefazolin could be appropriate for the treatment of CAPD-related peritonitis. Once-daily IP gentamicin administration, however, has less therapeutic benefit and should be re-evaluated.

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