Effects of 3-Month Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Izhar U. Qamar ◽  
Leo Levin ◽  
J. Williamson Balfe ◽  
Judith A. Balfe ◽  
Donna Secker ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Tertiary Care ◽  
Pediatric Nephrology ◽  
Biochemical Data ◽  
Single Amino Acid ◽  
Biochemical Effects ◽  
Total Plasma Protein ◽  
Amino Acid Levels

Objectives To compare the nutritional and biochemical effects of amino acid dialysis to dextrose dialysis in children receiving continuous ambulatory peritoneal dialysis (CAPD). Design Prospective randomized crossover study. Setting Pediatric Nephrology Unit in a tertiary care, teaching hospital of the University of Toronto. Patients Seven children aged 0.7–16.5 years receiving CAPD. All patients had poor linear growth, with 5 patients showing evidence of energy deficit. Interventions Each patient received either amino acid or dextrose dialysate for 3 months, then crossed over to the alternate regimen for a subsequent 3 months. Main Outcome Measures Nutritional and biochemical data were obtained on each patient during each dialysis regimen. Results Analysis of the patients’ nutritional data showed comparable weight gain with both regimens but no significant improvement in lean body mass with either regimen. Appetite improved in most patients during amino acid dialysis. Biochemical data during amino acid dialysis showed a tendency to higher plasma potassium and urea levels with no clinical side effects or worsening of acidosis; however, there was a reduced anion gap and increased total plasma protein, due mostly to a rise in plasma albumin and a smaller increase in immunoglobulins. With the exception of tryptophan, fasting amino acid levels at the start and end of amino acid dialysis did not show any significant change. An interesting phenomenon of early blunting of the rise in amino acid levels, following a single amino acid dialysate exchange, was noticed at the end of the amino acid dialysis period. This newly described phenomenon could have been due to tolerance or hepatic enzyme induction. Conclusions Overall amino acid dialysis was comparable to dextrose dialysis with no additional proven nutritional benefit, was equally effective in ultrafiltration and creatinine clearance, and produced no adverse clinical or biochemical effects.

Effects of Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Cycling Peritoneal Dialysis

1999 ◽  
Vol 19 (3) ◽  
pp. 237-247 ◽  
Author(s):  
Izhar U. Qamar ◽  
Donna Secker ◽  
Leo Levin ◽  
Judith A. Balfe ◽  
Stanley Zlotkin ◽  
...  
Keyword(s):  
Amino Acids ◽  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Creatinine Clearance ◽  
Single Amino Acid ◽  
Fasting Plasma ◽  
Continuous Cycling Peritoneal Dialysis ◽  
Total Plasma Protein ◽  
Continuous Cycling ◽  
Total Body

Objective To compare the biochemical and nutritional effects of amino acid dialysis with dextrose dialysis in children receiving continuous cycling peritoneal dialysis (CCPD). Design A prospective randomized cross-over study. Setting Nonhospitalized patients. Patients Seven children aged 1.8 to 16.0 years (mean 8.1 years) with end-stage renal disease who were receiving CCPD. Interventions Each patient received nighttime automated CCPD of dextrose, plus a single daytime dwell of either amino acid dialysate or dextrose dialysate. After 3 months, subjects crossed over to the alternative regimen for a subsequent 3 months. Main Outcome Measures Creatinine clearance, ultra-filtration, urea, creatinine, electrolytes, total protein, albumin, fasting plasma amino acids, anthropometrics, total body nitrogen. Results Amino acid dialysis was comparable to dextrose dialysis for creatinine clearance and ultrafiltration. Plasma urea concentrations were higher during amino acid dialysis. No clinical side effects or worsening of metabolic acidosis was observed. Caloric intake increased and protein intake improved. Appetite and total body nitrogen increased in at least half the children during amino acid dialysis. Total plasma protein and albumin concentrations did not change significantly. Fasting plasma concentrations of amino acids after 3 months of amino acid dialysis were comparable to baseline values. For several amino acids, the dose-response curve was blunted after a single amino acid exchange following 3 months of amino acid dialysis, which may, in part, be due to the induction of hepatic enzyme synthesis. Conclusions Amino acid dialysis is an efficient form of peritoneal dialysis that should be considered for children with poor nutritional status for whom enteral nutrition supplementation has been unsuccessful. Further study is needed to determine the optimal amount of amino acids to deliver, the best time to administer the amino acid dialysis fluid, and the benefits of adding dextrose to the amino acid solution.

Effects of Oral Glucose on Intermediary Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients versus Healthy Subjects

1998 ◽  
Vol 18 (5) ◽  
pp. 505-511 ◽  
Author(s):  
Jacques Delarue ◽  
Claude Maingourd ◽  
Charles Couet ◽  
Sophie Vidal ◽  
Philippe Bagros ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Peritoneal Dialysis ◽  
Lipid Oxidation ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Healthy Subjects ◽  
Tertiary Care ◽  
Substrate Oxidation ◽  
Oral Glucose ◽  
Dialysis Unit ◽  
Nonesterified Fatty Acids

Objective To explore the mechanisms and metabolic consequences of the insulin resistance of patients treated by continuous ambulatory peritoneal dialysis (CAPD). Design CAPD patients and healthy subjects ingested a similar mean oral glucose load per kilogram of fat-free mass (FFM) [1.20 ± 0.03 g/(kg FFM) vs 1.20 ± 0.06 g/(kg FFM); CAPD vs healthy subjects]. Substrate oxidation was monitored over 6 hours using indirect calorimetry. Setting Peritoneal dialysis unit of a tertiary-care institutional center. Outcome Measures Glycemia, insulinemia, substrate oxidation. Patients Six CAPD patients (68 ± 5 yr) and 6 healthy subjects (24 ± 1 yr). The CAPD patients had similar body mass index (21.4 ± 1.3 vs 22.9 ± 1.1 kg/m2), a higher percent fat (25.8% ± 3.7% vs 16% ± 2.2%; p < 0.05), and a lower FFM (42.2 ± 2.2 kg vs 56.5 ± 2.6 kg; p < 0.01) than healthy subjects. Results The CAPD patients displayed a higher glycemic and insulinemic responses to glucose than did healthy subjects (p < 0.05), but similar glucose oxidation and storage. Lipid oxidation and plasma nonesterified fatty acids were not increased in CAPD patients versus healthy subjects, in spite of a higher adiposity. Fat oxidation was related to fat mass in CAPD patients (r2 = 0.77, p < 0.05) but not in healthy subjects (r2 = 0.05). Conclusion CAPD patients display an insulin -resistance not explained by an increased lipid oxidation. The maintenance of intracellular glucose utilization at the expense of higher glycemic and insulinemic responses suggests a defective glucose transport.

Predictors of Survival in Continuous Ambulatory Peritoneal Dialysis Patients: A Five-Year Prospective Study

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 190-194 ◽  
Author(s):  
Morrell M. Avram ◽  
Paul A. Fein ◽  
Luigi Bonomini ◽  
Neal Mittman ◽  
Raphael Loutoby ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Tertiary Care ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Survival ◽  
Predictors Of Mortality

Our objective was to examine the influence of various demographic, clinical, and enrollment biochemical variables on the long-term survival of continuous ambulatory peritoneal dialysis (CAPD) patients. This was a prospective cohort study investigating the relationship between demographics and enrollment biochemical markers and mortality in CAPD patients in a CAPD unit in a large tertiary care teaching hospital. One hundred and sixtynine patients in the CAPD program were enrolled between 1989 and 1994, and were followed up to 60 months. Independent predictors of mortality determined by Cox proportional hazards model included age, diabetes, serum albumin and creatinine. Enrollment level of serum albumin, and creatinine can predict mortality in CAPD patients up to 60 months. Markers of visceral and somatic nutrition at enrollment are important predictors of mortality in CAPD patients up to five years.

scholarly journals Experience of Continuous Ambulatory Peritoneal Dialysis in Children with Chronic Kidney Disease Stage” V

2017 ◽  
Vol 25 (1) ◽  
pp. 32-38
Author(s):  
Shireen Afroz ◽  
Tahmina Ferdaus ◽  
Rokeya Khanam ◽  
Maliha Alam Simi ◽  
Sanjida Sharmim ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Chronic Kidney Disease Stage ◽  
Pediatric Nephrology ◽  
Disease Stage ◽  
Uncontrolled Hypertension ◽  
College Hospital ◽  
Prospective Longitudinal Study ◽  
Medical College ◽  
Prospective Longitudinal

The lifespan and outcome of End Stage Kidney Failure (ESKF) children have dramatically improved since the development of continuous ambulatory peritoneal dialysis (CAPD), it offers several advantages over hemodialysis. This study was done to evaluate the efficacy, outcome and to find out the complication profile of CAPD. This prospective longitudinal study was carried out in the department of Pediatric Nephrology, Dhaka Medical College Hospital (DMCH), Bangladesh, over a period of 3 year. A total of 8 children with ESKF were included. (Age 5-14 year, M:F=1:1), All underwent CAPD. Average duration of CAPD 40.6 months with a total of 185 patient months of CAPD. The rate of complications was recorded. Common complications being observed were peritonitis 1 episode per 13.9 patient months, catheter obstruction by omental capture was in 4. Catheter tip dislocation was found in 3 children and all needed laparotomy and omentectomy. Satisfactory level of improvement of mean weight, mean serum albumin and declining of serum creatinine has been found after CAPD in all 8 study children. At the end of the study, 3 out of 8 are still on CAPD, 2 transferred to haemodialysis and 3 expired due to uncontrolled hypertension with congestive heart failure and sepsis. So, CAPD is an effective modality of renal replacement therapy for children. Early detection of complications and prompt therapy is essential for a favourable outcome. Placement of catheter by surgical method with elective omentectomy will reduce catheter related complications.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 32-38

Continuous Ambulatory Peritoneal Dialysis: An Option in the Developing World?

1994 ◽  
Vol 14 (1) ◽  
pp. 48-51 ◽  
Author(s):  
Roy Lent ◽  
Jonathan E. Myers ◽  
Deidre Donald ◽  
Brian L. Rayner
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Tertiary Care ◽  
Therapeutic Success ◽  
Explanatory Variables ◽  
Large Tertiary Care ◽  
Selection For ◽  
The Relationship ◽  
Selection Of Patients ◽  
Selection Of

Objective To evaluate specified biomedical, socio-economic, and psychosocial criteria as predictors of therapeutic success to optimize patient selection for continuous ambulatory peritoneal dialysis (CAPD) in a developing country. Design A restrospective cohort study investigating the relationship between episodes of peritonitis and exitsite infection, and predetermined biomedical, socioeconomic, and psychosocial data. Setting A CAPD unit in a large tertiary care teaching hospital. Patients AI1132 patients entering the CAPD program between 1987 and 1991. Results Overall mean survival time on CAPD was 17.3 months. Peritonitis rates were high, especially among blacks. Multivariate analysis demonstrated that increased peritonitis rates were associated with age, black race, diabetes, and strongly so with several psychosocial factors. Because being black was strongly linked to poor socioeconomic conditions, repeat analysis excluding blacks showed the same associations with the above variables, but, additionally, several socioeconomic factors were associated with high peritonitis rates. No significant explanatory variables were shown for exit-site infections. Conclusions The association of biomedical, socio-economic, and psychosocial variables with high peritonitis rates has important implications for the selection of patients for CAPD in this setting.

Hyperleptinemia in Patients with End-Stage Renal Disease Undergoing Continuous Ambulatory Peritoneal Dialysis

1998 ◽  
Vol 18 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Samuel Dagogo-Jack ◽  
Fernando Ovalle ◽  
Michael Landt ◽  
Barbara Gearing ◽  
Daniel W. Coyne
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Healthy Subjects ◽  
Tertiary Care ◽  
Prospective Comparison ◽  
Stage Renal Disease ◽  
End Stage ◽  
Plasma Leptin

Objective To determine whether the increased plasma leptin levels reported in hemodialyzed patients is a feature of end-stage renal disease or an artifact of hemodialysis, we studied plasma levels in patients treated exclusively by continuous ambulatory peritoneal dialysis (CAPD). Design Prospective comparison of end points in CAPD patients and matched healthy subjects. Setting Tertiary care institutional dialysis center. Participants Fifty-six healthy subjects, age 50.8 ± 2.3 years, body mass index (BMI) 27.7 ± 1.3 kg/m2, recruited through public announcement, and 36 patients with end-stage renal disease, age 51.0 ± 2.4 yr, BM128.2 ± 1.3 kg/m2, enrolled in a CAPD treatment program. Intervention Four exchanges of CAPD per day, using 2.0, 2.5, or 3.0 L of dialysate over a period of 1 -96 months (median 22 mth). Main Outcome Measures The primary outcome measure was plasma leptin concentration. Secondary measures included plasma glucose, insulin, C-peptide, and cortisol concentrations; and residual renal function and dialysis adequacy (Kt/V). Results Plasma leptin levels in CAPD patients were 27.1 -490 ng/mL(women)and 1.3 -355 ng/mL(men); the levels in healthy subjects were 2.0 84.7 ng/mL (women) and 1.8 -55.4 ng/mL (men). The mean leptin levels were 5-fold higher among CAPD-treated men than control men (49.9 ± 18.4 vs 9.8 ± 2.5 ng/mL, p < 0.001) and 7.5-fold higher among CAPD-treated women than control women (220 ± 28.1 vs 29.3 ± 3.7 ng/mL, p < 0.0001). Female gender and BMI were the strongest predictors of hyperleptinemia in CAPD patients. Conclusion These results indicate that hyperleptinemia is a feature of terminal renal failure, not an artifact of hemodialysis.

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