Dislipemia in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Pharmacological Therapy (Simvastatin) versus Hemodialysis

Peritoneal dialysis can worsen disllpemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPO) and who had developed an IV-type dislipemia. Twelve have continued CAPO treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPO and have begun HO, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: In patients treated with CAPO and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p<0.001), and highly significant increases were noted in HOL-cholesterol (HOL-cho) (p<0.005) and apolipoprotein-A 1 (Apo-A 1) (p<0.01). In patients treated with HO, only slightly significant decreases were noted in T-cho (p<0.01) and TG (p<0.02), a slightly significant increase in Apo-A1 (p<0.05), and no significant change in HOL-cho. Apollpoprotein-B showed no change in the two groups. Therefore, patients undergoing CAPO, with dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPO must abandon treatment and must be transferred to extracorporeal methods.

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Serial Changes of lnterleukin-6 and lnterleukin-8 Levels in Drain Dialysate of Uremic Patients with Continuous Ambulatory Peritoneal Dialysis during Peritonitis

Nephron ◽

10.1159/000187243 ◽

1993 ◽

Vol 63 (4) ◽

pp. 404-408 ◽

Cited By ~ 26

Author(s):

Ching-Yuang Lin ◽

Chiou-Chyn Lin ◽

Tung-Po Huang

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Uremic Patients

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Histologic Change of Peritoneal Membrane in Relation to Adequacy of Dialysis in Continuous Ambulatory Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080302302s05 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 26-30 ◽

Cited By ~ 3

Author(s):

Irini Savidaki ◽

Dionisios Karavias ◽

Florentia Sotsiou ◽

Sotiria Alexandri ◽

Pantelitsa Kalliakmani ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Structural Changes ◽

Mesothelial Cells ◽

Peritoneal Membrane ◽

Histologic Change ◽

Significant Difference ◽

Uremic Patients ◽

Group B ◽

Histologic Changes

Background Long-term exposure of peritoneal membrane to bioincompatible dialysis solutions leads to structural changes and loss of ultrafiltration capability. Objective We studied the possible relationship between histologic change and the transport characteristics of peritoneal membrane and adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods The study included 18 CAPD patients (11 men, 7 women) who underwent a peritoneal biopsy either at initiation of treatment (group A, n = 9) or after a mean of 4 years on CAPD (group B, n = 9). The morphologic changes in the mesothelial cells and the vascular compartment and the thickness of the submesothelial collagenous zone were estimated and compared with observations from 6 patients with normal renal function who underwent biopsy of the parietal peritoneum during abdominal surgery. The relationship of the observed changes in CAPD patients to results from a peritoneal equilibration test (PET) and to adequacy of dialysis [total weekly creatinine clearance (CCr) and Kt/V urea] were also investigated. Results The main histologic changes in both groups of patients were loss of mesothelial cells and decrease in the normal mesothelial surface, thickening of the submesothelial collagenous zone, and presence of vascular hyalinosis. The thickness of the submesothelial collagenous zone in both groups of patients was significantly greater than that found in controls (410 μm and 580 μm vs 50 μm, p < 0.05). Although no significant difference was found between morphologic change in the peritoneal membrane of uremic patients starting on CAPD and those who had been on peritoneal dialysis (PD) for a mean period of 4 years, a trend was observed toward more severe lesions in the latter patients. The PET, CCr, and Kt/V urea were not significantly different in the two groups of patients. Those parameters also showed no significant changes when examined at initiation of CAPD and after a mean of 4 years of PD in the same patients (group B). No significant correlations were observed between the histologic changes and the PET, CCr, or Kt/V in both groups of patients. Conclusions Significant structural changes are observed in the peritoneal membrane of uremic patients, and those changes become worse with CAPD treatment. Structural changes are not followed by functional changes during the first 4 years on CAPD.

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Lipoproteins from uremic patients on continuous ambulatory peritoneal dialysis are more resistant to oxidative modification

Atherosclerosis ◽

10.1016/s0021-9150(99)80155-5 ◽

1999 ◽

Vol 144 ◽

pp. 41

Author(s):

A.P. Serdyuk ◽

R.E. Morton

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Oxidative Modification ◽

Uremic Patients

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Comparative Analysis of Immunophenotypic Abnormalities in Cellular Immunity of Uremic Patients Undergoing Either Hemodialysis or Continuous Ambulatory Peritoneal Dialysis

Renal Failure ◽

10.1081/jdi-56620 ◽

2005 ◽

Vol 27 (3) ◽

pp. 279-282 ◽

Cited By ~ 12

Author(s):

Ioannis Griveas ◽

George Visvardis ◽

Aleka Fleva ◽

Dorothea Papadopoulou ◽

Eftathios Mitsopoulos ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Comparative Analysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Cellular Immunity ◽

Uremic Patients

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Evaluation of Carnitine Levels According to the Peritoneal Equilibration Test in Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089301302s112 ◽

1993 ◽

Vol 13 (2_suppl) ◽

pp. 444-447 ◽

Cited By ~ 4

Author(s):

Christos Chatzidimitriou ◽

Theodoros Pliakogiannis ◽

Athanasios Evangeliou ◽

Theodora Tsalkidou ◽

Hans Josef Böhles ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Total Cholesterol ◽

Continuous Ambulatory Peritoneal Dialysis ◽

High Total Cholesterol ◽

Normal Range ◽

Peritoneal Equilibration Test ◽

Cholesterol Ratio ◽

Abnormal Metabolism ◽

Males And Females ◽

High Triglyceride

The evidence of carnitine abnormal metabolism in patients on continuous ambulatory peritoneal dialysis (CAPO) is unclear, and previous studies have reported conflicting results. The total (TC), free (FC), and acylated (AC) carnitines were estimated in blood and dialysate, as well as the AC/FC ratio, in 29 patients on CAPO, grouped into high (H-Abs) and low (L-Abs) absorbers, according to the results of the peritoneal equilibration test (fast PE-test). Ourdata demonstrated that patients with higher peritoneal transport rates, which was the H-Abs group, males and females, showed a better carnitine metabolic status compared to the L-Abs group. Although the H-Abs group lost significantly more free carnitine than the L-Abs group, the AC/FC ratio of the H-Abs group remained within normal range. All the patients in our study showed abnormally high triglyceride (TAG) levels and an abnormally high total cholesterol/HOL cholesterol ratio. In particular, the patients In the L-Abs group showed significantly higher TAG levels and total cholesterol/HOL cholesterol ratios than the H-Abs group. Those patients who have been on CAPO for more than 2 years showed significantly abnormally higher AC/FC ratios than those with shorter periods on CAPO treatment. In patients with AC/FC ratio greater than 0.4, the supplementation of L-carnitine may have a beneficial effect on their carnitine and lipid metabolism.

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