scholarly journals Ultrafiltration in Patients on Automated Peritoneal Dialysis with Homechoice Claria connected to Sharesource: A Pilot Study

2021 ◽  
Author(s):  
Yu-An Hsiao ◽  
Ya-Chung Tian ◽  
Tzung-Hai Yen ◽  
Ming-Yang Chang ◽  
Chan-Yu Lin ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Membrane ◽  
Fill Volume ◽  
Reasonable Range ◽  
Peritoneal Permeability ◽  
The Mean ◽  
Baseline Characteristics ◽  
Poor Outcomes

Abstract Introduction: Fluid overload is an unavoidable problem in patients on peritoneal dialysis (PD) and is associated with poor outcomes. The aim of our study was to estimate ultrafiltration (UF) under different dextrose concentrations and clarify possible predictors of UF.Materials and methods: Seventy patients, with 1848 daily treatment records and 8266 single dwells on automated PD through Homechoice Claria with Sharesource were followed in October 2020 and categorized into 2 groups according to the dextrose concentration (group D1.5% and D2.5%). Baseline characteristics, peritoneal membrane characteristics, and daily PD treatment records from Sharesource were obtained. We compared UF under the different conditions.Results: Multivariate linear regression revealed that the mean fill volume (FV) per cycle (p=0.006) and dextrose concentration (p=0.000) were independent predictors of UF. The mean night UF per cycle, the mean night UF corrected by FV per cycle, and the mean night UF corrected by FV and dwelling time (DT) per cycle were 95.8 ml, 5.5%, and 5.0 ‱/minutes in group D1.5% and 220.3 ml, 12.0%, and 11.6 ‱/minutes in group D2.5%, respectively. After an approximately 120-minute DT, there was a trend toward higher UF in the low peritoneal permeability group and lower UF in the high peritoneal permeability group.Conclusion: This retrospective study presents precise UF measurements with two solutions at different dextrose concentrations and four peritoneal transport levels. UF is positively correlated with DT and FV of the dialysate within a reasonable range. High peritoneal permeability is associated with decreased UF, and low peritoneal permeability requires a longer DT to reach the maximal UF.

scholarly journals Long-term sonographic evaluation of the peritoneum in peritoneal dialysis patients: A retrospective cohort study

2020 ◽  
Author(s):  
Shinya Taguchi ◽  
Takayasu Ohtake ◽  
Yasuhiro Mochida ◽  
Kunihiro Ishioka ◽  
Hidekazu Moriya ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Morphological Changes ◽  
Membrane Thickness ◽  
Peritoneal Membrane ◽  
Change Rate ◽  
Peritoneal Permeability ◽  
The Mean ◽  
Peritoneal Function ◽  
Repeated Evaluation

Abstract Background Long-term peritoneal dialysis (PD) causes morphological changes to the peritoneum. However, the sequential morphological changes of the peritoneum remain unclear due to the invasiveness and ethical dilemmas surrounding peritoneal biopsies. We aimed to evaluate these long-term morphological peritoneal changes using sonography, which was recently reported to be useful for morphological peritoneal evaluation. Methods We retrospectively identified 115 PD patients who underwent sonographic peritoneal membrane thickness (PMT) measurement. Univariate and multivariate linear regression analyses identified factors related to PMT at baseline (bPMT), at last measurement (lPMT), and the PMT change rate. Of the 115 patients, 42 patients had at least two PMT measurements, including a bPMT measurement. We evaluated the PMT change between bPMT and lPMT. We also evaluated the annual PMT change for 3 years before PD withdrawal in patients who discontinued PD due to peritoneal dysfunction. Clinical characteristics and parameters were analyzed according to PMT change rates (≤ 0 [n = 28] or > 0 [n = 20]). Results The mean age at PD introduction and mean PD duration were 63.7 ± 12.7 years and 40.5 ± 30.1 months, respectively. There was a significant positive correlation between the dialysate to plasma ratio of creatinine (D/P Cr) and lPMT (r = 0.386, p = 0.004), but not bPMT (r=-0.114, p = 0.326). In the multivariate analyses, D/P Cr remained an independent predictor of lPMT (r = 0.478, p = 0.001) after adjusting for age, sex, body mass index, PD duration, diabetes, and peritonitis rate. The mean bPMT and lPMT were 0.67 ± 0.15 mm and 0.69 ± 0.10 mm, respectively, without statistical difference (p = 0.49). Annual PMTs for 3 years before PD withdrawal were 0.67 ± 0.13 mm, 0.66 ± 0.11 mm, and 0.67 ± 0.08 mm, respectively, with no significant differences among measurements (p = 0.967). There were no differences in PD duration, the use of a dialysate containing over 2.5% glucose or icodextrin, and the peritonitis rate between groups divided by the PMT change rate. Conclusions PMT, measured by sonography, was positively correlated with peritoneal permeability. Repeated evaluation of the peritoneum by sonography will enable the recognition of transition in peritoneal function in real time and allow for more appropriate PD management. Furthermore, the peritoneum was not necessarily thickened regardless of PD duration or cause of withdrawal.

The Influence of Peritoneal Surface Area on Dialysis Adequacy

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 137-140 ◽  
Author(s):  
Michel Fischbach ◽  
Céline Dheu ◽  
Pauline Helms ◽  
Joëlle Terzic ◽  
Anne Cécile Michallat ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surface Area ◽  
Contact Area ◽  
Peritoneal Membrane ◽  
Dialysis Adequacy ◽  
Peritoneal Surface ◽  
Vascular Area ◽  
Fill Volume ◽  
Peritoneal Dialysis Fluid ◽  
Dialysis Fluids

In children, the prescription of peritoneal dialysis is based mainly on the choice of the peritoneal dialysis fluid, the intraperitoneal fill volume (mL/m2 body surface area (BSA)], and the contact time. The working mode of the peritoneal membrane as a dialysis membrane is more related to a dynamic complex structure than to a static hemodialyzer. Thus, the peritoneal surface area impacts on dialysis adequacy. In fact, the peritoneal surface area may be viewed as composed of three exchange entities: the anatomic area, the contact area, and the vascular area. First, in infants, the anatomic area appears to be twofold larger than in adults when expressed per kilogram body weight. On the other hand, the anatomic area becomes independent of age when expressed per square meter BSA. Therefore, scaling of the intraperitoneal fill volume by BSA (m2) is necessary to prevent a too low ratio of fill volume to exchange area, which would result in a functional “hyperpermeable” peritoneal exchange. Second, the contact area, also called the wetted membrane, is only a portion of the anatomic area, representing 30% to 60% of this area in humans, as measured by computed tomography. Both posture and fill volume may affect the extent of recruitment of contact area. Finally, the vascular area is influenced by the availability of both the anatomic area and the recruited contact area. This surface is governed essentially by both peritoneal vascular perfusion, represented by the mesenteric vascular flow and, hence, by the number of perfused capillaries available for exchange. This vascular area is dynamically affected by different factors, such as composition of the peritoneal fluid, the fill volume, and the production of inflammatory agents. Peritoneal dialysis fluids that will be developed in the future for children should allow an optimization of the fill volume owing to a better tolerance in terms of lower achieved intraperitoneal pressure for a given fill volume. Moreover, future peritoneal dialysis fluids should protect the peritoneal membrane from hyperperfusion (lower glucose degradation products).

scholarly journals Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group.

1998 ◽  
Vol 9 (7) ◽  
pp. 1285-1292 ◽  
Author(s):  
D N Churchill ◽  
K E Thorpe ◽  
K D Nolph ◽  
P R Keshaviah ◽  
D G Oreopoulos ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Membrane Transport ◽  
Patient Survival ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Survival Probabilities ◽  
The Mean ◽  
Technique Failure

The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-yr patient survival probabilities were 91, 80, 72, and 71% for L, LA, HA, and H, respectively (P = 0.11). The 2-yr probabilities of both patient and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique failure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.33, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the mean 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and H, respectively (P < 0.001). The mean serum albumin values (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HA, and H, respectively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death. The decreased drain volume, increased albumin loss, and decreased serum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be considered in H and HA transporters.

How to Reach Optimal Creatinine Clearances in Automated Peritoneal Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 167-171 ◽  
Author(s):  
Pierre Yves Durand ◽  
Philippe Freida ◽  
Belkacem Issad ◽  
Jacques Chanliau
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Flow Rate ◽  
Clinical Results ◽  
Automated Peritoneal Dialysis ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Peritoneal Permeability ◽  
Number Of Cycles ◽  
Tidal Peritoneal Dialysis

This paper summarizes the basis of prescription for automated peritoneal dialysis (APD) established during a French national conference on APD. Clinical results and literature data show that peritoneal clearances are closely determined by peritoneal permeability and hourly dialysate flow rate, independently of dwell time or number of cycles. With APD, peritoneal creatinine clearance increases according to the hourly dialysate flow rate to a maximum (plateau), then decreases because of the multiplication of the drain-fill times. The hourly dialysate flow giving the maximum peritoneal creatinine clearance is defined as the “maximal effective dialysate flow” (MEDF). MEDF is higher for high peritoneal permeabilities: MEDF is 1.8 and 4.2 L/hr with nocturnal tidal peritoneal dialysis (TPD) for a 4-hr creatinine dialysate-to-plasma ratio (DIP) of 0.50 and 0.80, respectively. With nightly intermittent peritoneal dialysis (NIPD), MEDF is 1.6 and 2.3 Llhr for a DIP of 0.50 and 0.78, respectively. Under these conditions, tidal modalities can only be considered as a way to increase the MEDF. Using the MEDF concept for an identical APD session duration, the maximal weekly normalized peritoneal creatinine clearance can vary by 340% when 4hr DIP varies from 0.41 to 0.78. APD is not recommended when 4-hr creatinine DIP is lower than 0.50. However, the limits of this technique may be reached at higher peritoneal permeabilities in anurics because of the duration of sessions andlor the additional exchanges required by these patients.

Elimination of Iomeprol in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 19 (4) ◽  
pp. 380-385 ◽  
Author(s):  
Masako Iwamoto ◽  
Kinya Hiroshige ◽  
Takeshi Suda ◽  
Takayuki Ohta ◽  
Akira Ohtani ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Elimination Rate ◽  
Iodine Concentration ◽  
Residual Renal Function ◽  
University Hospitals ◽  
Before And After ◽  
Peritoneal Permeability ◽  
The Mean

Objective To examine the elimination of iomeprol, its safety in clinical use, and its peritoneal permeability in continuous ambulatory peritoneal dialysis (CAPD) patients with variable degrees of residual renal function (RRF). Design A nonrandomized comparison study. Setting Hospitalized patients in CAPD unit of Chikuho and University Hospitals. Participants Fourteen patients treated by CAPD and 6 by hemodialysis (HD). Interventions Total dialysate, blood, and 24-hour urine collections were obtained for 4 consecutive days after the administration of iomeprol. A peritoneal equilibration test was performed just before and after the administration of iomeprol. Measurements Iomeprol (iodine) concentration was measured. Residual renal function was estimated as the mean of renal creatinine and urea clearances. Dialysate-to-plasma ratios (D/P) of creatinine and iomeprol were also determined. Results In all CAPD patients, plasma iomeprol clearance was markedly slow, with a biological half-life ( T1/2) of over 32 hours. However, no patients suffered from any adverse effects, and over 80% of plasma iomeprol was eliminated during the 4-hour HD. The plasma iomeprol elimination rate was significantly higher from 4 hours after the iomeprol administration in CAPD patients with RRF [mean estimated creatinine clearance (CCr) 3.8 mL/min, n = 7] compared to the remaining patients (mean estimated CCr 0.6 mL/min, n = 7); however, T1/2 in patients with RRF was over 24 hours. D/P creatinine was significantly correlated with D/P iomeprol, and peritoneal iomeprol permeability may depend on an individual's peritoneal solute transport properties. Conclusions A prolonged elimination rate of iomeprol was documented in our CAPD patients both with and without RRF. A HD procedure or intensive peritoneal dialysis just after the use of iomeprol may be advisable to promptly remove circulating iomeprol.

Can the Inflammation Markers of Patients with High Peritoneal Permeability on Continuous Ambulatory Peritoneal Dialysis be Reduced on Nocturnal Intermittent Peritoneal Dialysis?

2006 ◽  
Vol 26 (3) ◽  
pp. 341-348 ◽  
Author(s):  
Alfonso M. Cueto-Manzano ◽  
Enrique Rojas-Campos ◽  
Héctor R. Martínez-Ramírez ◽  
Isela Valera-González ◽  
Miguel Medina ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Final Evaluation ◽  
Inflammation Markers ◽  
Overload Control ◽  
Tnf Α ◽  
Peritoneal Permeability ◽  
Serum Crp

Background Patients with high peritoneal permeability have the greatest degree of inflammation on continuous ambulatory peritoneal dialysis (CAPD), which may be associated with their higher mortality. Nocturnal intermittent peritoneal dialysis (NIPD; “dry day”) may decrease inflammation by reducing the contact between dialysate and peritoneum and/or providing better fluid overload control. Therefore, the aims of this study were to determine and compare serum and dialysate concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) of patients with high or high-average peritoneal transport on CAPD, changed to NIPD, and ultimately to continuous cyclic peritoneal dialysis (CCPD). Methods Crossover clinical trial in 11 randomly selected patients. All subjects had been on CAPD and were changed to NIPD, and ultimately to CCPD (6.4 ± 3.1 months after initiation of study). All patients used glucose-based dialysate. Evaluations of clinical and biochemical parameters, dialysis adequacy, and serum and dialysis inflammation markers were performed at baseline on CAPD, 7 – 14 days after changing to NIPD, 7 – 14 days after switching to CCPD, and after 1 year of follow-up. All patients used only 1.5% glucose dialysate during evaluation days. CRP was determined by nephelometry, and IL-6 and TNF-α by ELISA. Results Seven patients were high transporters and 4 high average. Ultrafiltration increased ( p < 0.05) when patients changed from CAPD [0.38 L (-0.3 – 1.1 L)] to NIPD [2.64 L (0.7 – 4.7 L)]; it then decreased on CCPD [0.88 L (0.4 – 1.3 L) and at the end of study [0.65 L (0.3 – 1.0 L)]. This better fluid overload control was accompanied by decreased weight and systolic and diastolic blood pressure when patients changed from CAPD (89 ± 13 kg, 160 ± 23 and 97 ± 9 mmHg, respectively) to NIPD (86 ± 17 kg, 145 ± 14 and 86 ± 9 mmHg, respectively), and increased weight and systolic and diastolic blood pressure on CCPD (85 ± 15 kg, 143 ± 23 and 88 ± 14 mmHg, respectively) and at the end of follow-up (87 ± 16 kg, 155 ± 24 and 89 ± 12 mmHg, respectively). Median serum CRP decreased ( p = 0.03), from 3.8 (1.6 – 8.5) mg/L on CAPD to 1.0 (0.4 – 4.4) mg/L on NIPD, but increased on CCPD [1.8 (1.3 – 21) mg/L] and at the end of the study [3.2 (0.3 – 8.2) mg/L]. Dialysate CRP decreased nonsignificantly, from 0.10 (0 – 0.5) mg/L on CAPD to 0 (0 – 0.03) mg/L on NIPD, to 0.01 (0 – 0.08) mg/L on CCPD, and to 0 (0 – 0) mg/L at final evaluation. Serum TNF-α concentration decreased, from 0.14 (0.04 – 0.6) pg/mL on CAPD to 0.01 (0 – 0.08) pg/mL on NIPD, and then increased to 0.06 (0 – 0.4) pg/mL on CCPD and to 0.11 (0 – 0.2) pg/mL at the end of the study; whereas dialysate TNF-α decreased, from 0.08 (0.03 – 0.2) pg/mL on CAPD to 0.04 (0 – 0.2) pg/mL on NIPD, and to 0 (0 – 0) pg/mL and 0 (0 – 0.05) pg/mL on CCPD and final evaluation respectively. Serum IL-6 decreased ( p = 0.07), from 2.5 (2.0 – 4.2) pg/mL on CAPD to 1.0 (0.7 – 2.0) pg/mL on NIPD, and to 1.0 (0.8 – 2.9) pg/mL on CCPD and 1.0 (0.5 – 9.8) pg/mL at the end of the study; whereas dialysate levels remained similar on CAPD [8.0 (3.7 – 13) pg/mL] and NIPD [7.8 (5.1 – 23) pg/mL], and increased on CCPD [11.2 (9.5 – 19) pg/mL] and at final evaluation [11.2 (8.3 – 15) pg/mL]. Conclusions NIPD significantly decreased serum CRP and displayed a trend to decrease TNF-α and IL-6 serum concentrations compared with CAPD; whereas CCPD tended to reverse these effects. These results did not appear to be due to decreased local peritoneal inflammation, but they could be associated with better control of fluid overload on NIPD. Thus, NIPD, as long as the residual renal function allows it, may be useful in reducing the systemic inflammation of patients with high peritoneal membrane permeability.

Biocompatibility of New Peritoneal Dialysis Solutions: What Can We Hope to Achieve?

2000 ◽  
Vol 20 (5_suppl) ◽  
pp. 57-67 ◽  
Author(s):  
Sung Hee Chung ◽  
Peter Stenvinkel ◽  
Jonas Bergström ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Survival ◽  
Fluid Overload ◽  
Systemic Effects ◽  
Peritoneal Membrane ◽  
Local Effects ◽  
Positive Effects ◽  
Baxter Healthcare ◽  
And Function ◽  
Mia Syndrome

Despite the bioincompatibility of the “old”, standard, high glucose, lactate-buffered peritoneal dialysis (PD) solutions, PD is itself a highly successful dialysis modality with patient survival equivalent to that of hemodialysis (HD) during the initial 3 – 5 years of dialysis therapy. Nevertheless, PD technique survival is often limited by infectious complications and alterations in the structure and function of the peritoneal membrane. These local changes also have a negative impact on patient survival owing to systemic effects such as those often seen in patients with high peritoneal transport rate and loss of ultrafiltration (UF) capacity. Patient mortality remains unacceptably high in both HD and PD patients, with most premature deaths being associated with signs of malnutrition, inflammation, and atherosclerotic cardiovascular disease (MIA syndrome). These systemic signs are likely to be influenced by PD solutions both directly and indirectly (via changes in the peritoneal membrane). New, biocompatible PD solutions may have favorable local effects (viability and function of the peritoneal membrane) and systemic effects (for example, on MIA syndrome). Amino acid–based solution [Nutrineal (N): Baxter Healthcare Corporation, Deerfield, IL, U.S.A.] may improve nutritional status as well as peritoneal membrane viability. Bicarbonate/lactate–buffered solution [Physioneal (P): Baxter Healthcare Corporation] may ameliorate local and systemic effects of low pH, high lactate, and high glucose degradation products. Icodextrin-based solution [Extraneal (E): Baxter Healthcare SA, Castlebar, Ireland] may improve hypertension and cardiovascular problems associated with fluid overload and may extend time on therapy in patients with loss of UF capacity. The positive effects of each of these new, biocompatible solutions have been demonstrated in several studies. It is likely that the combined use of N, P, and E solutions will produce favorable synergies in regard to both local effects (peritoneal viability) and systemic effects (less malnutrition, inflammation, and fluid overload). Solution combination is an exciting area for clinical study in the coming years. Furthermore, dialysis fluid additives such as hyaluronan, which protects and improves the function of the peritoneal membrane, may further improve PD solutions. The new, biocompatible PD solutions represent an entirely new era in the evolution of the PD therapy; they are likely to have markedly positive effects on both PD technique and PD patient survival in coming years.

Hypoproteinemia in Patients with Diabetes Undergoing Continuous Ambulatory Peritoneal Dialysis is Attributable to High Permeability of Peritoneal Membrane

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 72-78 ◽  
Author(s):  
◽  
Hidetomo Nakamoto ◽  
Hiromichi Suzuki
Keyword(s):  
Peritoneal Dialysis ◽  
Membrane Transport ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Protein ◽  
Peritoneal Membrane ◽  
High Permeability ◽  
Membrane Area ◽  
Plasma Loss ◽  
The Mean ◽  
Peritoneal Function

Background The present study used the newly developed personal dialysis capacity (PDC) peritoneal function test to investigate differences in individual peritoneal membrane transport function and nutritional status in non diabetic (non DM) and diabetic (DM) patients on continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods To clarify the differences in peritoneal function that determine plasma protein levels, we carried out PDC tests in non DM and DM patients. Between May 1995 and May 1999, in multicenter study in Japan, we carried out 232 PDC tests on 232 non DM patients and 47 PDC tests on 47 DM patients who had been on CAPD for 1 – 210 months. Results Plasma levels of total protein and albumin in DM patients were significantly lower than those in non DM patients (total protein: 6.5 ± 0.1 g/dL non DM vs. 5.9 ± 0.1 g/dL DM, p < 0.0001; albumin: 3.5 ± 0.1 g/dL non DM vs. 2.9 ± 0.1 g/dL DM, p < 0.0001). The mean membrane area in the DM group was significantly larger than that in the non DM group (21943 ± 608 cm/1.73 m2 non DM vs. 26 304 ± 1699 cm/1.73 m2 DM, p = 0.0076). The mean plasma loss through the large pores in the DM group was significantly greater than that in the non DM group (0.095 ± 0.004 mL/min/1.73 m2 non DM vs. 0.119 ± 0.008 mL/min/1.73 m2 DM, p = 0.0113). Protein loss into dialysate in DM patients was significantly greater than that in non DM patients. We observed a significant correlation between total protein or albumin and plasma loss from dialysis solution in non DM and DM patients on CAPD. Conclusions The study demonstrated that peritoneal function, including peritoneal membrane transport and peritoneal permeability to protein was significantly higher in DM patients than in non DM patients. Hypoproteinemia in DM patients might be associated with high permeability of peritoneal membrane in CAPD.

scholarly journals Comparison of sodium removal in peritoneal dialysis patients treated by continuous ambulatory and automated peritoneal dialysis

2019 ◽  
Vol 32 (6) ◽  
pp. 1011-1019 ◽  
Author(s):  
Sarju Raj Singh Maharjan ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fluid Balance ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Membrane Function ◽  
Peritoneal Dialysate ◽  
Hypertonic Glucose ◽  
Sodium Removal

Abstract Background Optimal fluid balance for peritoneal dialysis (PD) patients requires both water and sodium removal. Previous studies have variously reported that continuous ambulatory peritoneal dialysis (CAPD) removes more or equivalent amounts of sodium than automated PD (APD) cyclers. We therefore wished to determine peritoneal dialysate losses with different PD treatments. Methods Peritoneal and urinary sodium losses were measured in 24-h collections of urine and PD effluent in patients attending for their first assessment of peritoneal membrane function. We adjusted fluid and sodium losses for CAPD patients for the flush before fill technique. Results We reviewed the results from 659 patients, mean age 57 ± 16 years, 56.3% male, 38.9% diabetic, 24.0% treated by CAPD, 22.5% by APD and 53.5% APD with a day-time exchange, with icodextrin prescribed to 72.8% and 22.7 g/L glucose to 31.7%. Ultrafiltration was greatest for CAPD 650 (300–1100) vs 337 (103–598) APD p < 0.001, vs 474 (171–830) mL/day for APD with a day exchange. CAPD removed most sodium 79 (33–132) vs 23 (− 2 to 51) APD p < 0.001, and 51 (9–91) for APD with a day exchange, and after adjustment for the CAPD flush before fill 57 (20–113), p < 0.001 vs APD. APD patients with a day exchanged used more hypertonic glucose dialysates [0 (0–5) vs CAPD 0 (0–1) L], p < 0.001. Conclusion CAPD provides greater ultrafiltration and sodium removal than APD cyclers, even after adjusting for the flush-before fill, despite greater hypertonic usage by APD cyclers. Ultrafiltration volume and sodium removal were similar between CAPD and APD with a day fill.

Cross-Over Efficiency Comparison of Different Tidal Automated Peritoneal Dialysis Schedules

2016 ◽  
Vol 42 (4) ◽  
pp. 287-293 ◽  
Author(s):  
Alessandro Domenici ◽  
Anna Giuliani ◽  
Francesca Sivo ◽  
Clorinda Falcone ◽  
Giorgio Punzo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Analysis Of Variance ◽  
Automated Peritoneal Dialysis ◽  
Urea Clearance ◽  
Sodium Removal ◽  
Fill Volume ◽  
Efficiency Comparison ◽  
Alternative Schedules

This study compares 5 different tidal automated peritoneal dialysis (APD) prescriptions. Six low-average and 6 high-average transporters performed 3 separate sessions with 5 different schedules: (A) 50% tidal with initial fill volume (FV) 2 liters, (B) 50% tidal with 2.2 liters initial FV, (C) 2.2 liters initial FV with 70% tidal, (D) as in B, with one complete renewal of the initial FV at midsession, (E) 2.2 liters FV with breakpoint modality. Urea, creatinine and phosphate peritoneal clearances, sodium removal and ultrafiltration (UF) were compared using analysis of variance. Compared to treatment A, all the tested alternative schedules were associated with 10% significantly higher urea clearance; B, D and E, but not C, were associated with 10% higher creatinine clearance. Phosphate clearance was significantly higher with D, while sodium removal was larger with both C and D. UF was lower with A and E in high average transporters. Manipulation of the main prescriptive parameters of tidal APD has significant impact on its efficiency.

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