scholarly journals Survival of Peritoneal Membrane Function on Biocompatible Dialysis Solutions in a Peritoneal Dialysis Cohort Assessed by a Novel Test

2021 ◽  
Vol 10 (16) ◽  
pp. 3650
Author(s):  
Olga Balafa ◽  
Anila Duni ◽  
Paraskevi Tseke ◽  
Karolos Rapsomanikis ◽  
Paraskevi Pavlakou ◽  
...  
Keyword(s):  
Solute Transport ◽  
Water Transport ◽  
Repeated Measures ◽  
Urine Volume ◽  
Free Water ◽  
Test Methods ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Sodium Removal ◽  
Ultrafiltration Failure

Background: Longitudinal surveillance of peritoneal membrane function is crucial in defining patients with a risk of ultrafiltration failure. Long PD is associated with increased low molecular weight solute transport and decreased ultrafiltration and free water transport. Classic PET test only provides information about low molecular solute transport, and the vast majority of longitudinal studies are based on this test and include patients using conventional dialysates. Our aim was to prospectively analyze longitudinal data on peritoneal function in patients on biocompatible solutions using a novel test. Methods: Membrane function data were collected based on uni-PET (a combination of modified and mini PET). A total of 85 patients (age 61.1 ± 15.1 years) with at least one test/year were included. Results: The median follow up was 36 months (21.3, 67.2). A total of 219 PETs were performed. One-way repeated measures ANOVA showed that there were no statistically significant differences over time in ultrafiltration, free water transport, ultrafiltration through small pores, sodium removal, D/D0 and D/PCre in repeated PET-tests. Twenty-three tests revealed ultrafiltration failure in 16 (18.8%) patients. Those patients were longer on PD, had higher D/P creatinine ratios, lower ultrafiltration at one hour with lower free water transport and higher urine volume at baseline. Multivariate analysis revealed that the variation of ultrafiltration over repeated PET-tests independently correlated only with D/Pcreatinine, free water transport and ultrafiltration through small pores. Conclusions. Uni-PET is a combination of two tests that provides more information on the function of the membrane compared with PET. Our study on a PD cohort using only biocompatible solutions revealed that function membrane parameters remained stable over a long time. Ultrafiltration failure was correlated with increased D/P creatinine and decreased free water transport and ultrafiltration through small pores.

Monitoring of Long-Term Peritoneal Membrane Function

2001 ◽  
Vol 21 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Simon J. Davies
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Water Transport ◽  
Drop Out ◽  
Published Data ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Technique Survival ◽  
Ultrafiltration Failure

Objective Peritoneal membrane function influences dialysis prescription and clinical outcome and may change with time on treatment. Increasingly sophisticated tools, ranging from the peritoneal equilibration test (PET) to the standard permeability analysis (SPA) and personal dialysis capacity (PDC) test, are available to the clinician and clinical researcher. These tests allow assessment of a number of aspects of membrane function, including solute transport rates, ultrafiltration capacity, effective reabsorption, transcellular water transport, and permeability to macromolecules. In considering which tests are of greatest value in monitoring long-term membrane function, two criteria were set: those that result in clinically relevant interpatient differences in achieved ultrafiltration or solute clearances, and those that change with time in treatment. Study Selection Clinical validation studies of the PET, SPA, and PDC tests. Studies reporting membrane function using these methods in either long-term (5 years) peritoneal dialysis patients or longitudinal observations (> 2 years). Data Extraction Directly from published data. Additional, previously unpublished analysis of data from the Stoke PD Study. Results Solute transport is the most important parameter. In addition to predicting patient and technique survival at baseline, there is strong evidence that it can increase with time on treatment. Whereas patients with initially high solute transport drop out early from treatment, those with low transport remain longer on treatment, although, over 5 years, a proportion develop increasing transport rates. Ultrafiltration capacity, while being a composite measure of membrane function, is a useful guide for the clinician. Using the PET (2.27% glucose), a net ultrafiltration capacity of < 200 mL is associated with a 50% chance of achieving less than 1 L daily ultrafiltration at the expense of 1.8 hypertonic (3.86%) exchanges in anuric patients. Using a SPA (3.86% glucose), a net ultrafiltration capacity of < 400 mL indicates ultrafiltration failure. While there is circumstantial evidence that, with time on peritoneal dialysis, loss of transcellular water transport might contribute to ultrafiltration failure, none of the current tests is able to demonstrate this unequivocally. Of the other membrane parameters, evidence that interpatient differences are clinically relevant (permeability to macro-molecules), or that they change significantly with time on treatment (effective reabsorption), is lacking. Conclusion A strong case can be made for the regular assessment by clinicians of solute transport and ultrafiltration capacity, a task made simple to achieve using any of the three tools available.

scholarly journals P1149PERITONEAL MEMBRANE CHARACTERISTICS OVER TIME: A LONGITUDINAL STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Olga Balafa ◽  
ANILA DUNI ◽  
Paraskevi Tseke ◽  
Karolos Pavlos Rapsomanikis ◽  
Margarita Oikonomou ◽  
...  
Keyword(s):  
Urine Volume ◽  
Free Water ◽  
Repeated Measurements ◽  
Plasma Sodium ◽  
Membrane Function ◽  
Sodium Removal ◽  
Ultrafiltration Failure ◽  
Dialysate Sodium ◽  
Sodium Sieving ◽  
Over Time

Abstract Background and Aims Modified PET (use of 3.86% glucose dialysate instead of 2.27%) and temporal drainage at one hour allows a more complete study of peritoneal membrane transport, as it provides information about sodium sieving, free water transport (FWT) and ultrafiltration failure (UFF). Longitudinal data using this PET are sporadic. Aims of our study were a) longitudinal follow-up of the membrane function using modified PET b) evaluation of UFF and association with clinical and membrane characteristics. Method We analyzed all modified PET tests performed in our unit during the last 9 years. Patients who underwent the first test during the first year of treatment and then once a year were included. We estimated classic peritoneal transport parameters like D/P creatinine, D/D0 glucose and ultrafiltration (UF) at 4 hours. Moreover we calculated sodium seiving expressed as Dip/DPNa= (Dialysate sodium time 0/plasma sodium)-(Dialysate sodium time 1 hour/plasma sodium)], sodium removal (in one hour) and FWT. We collected clinical and lab data of the patients too. Results A total of 219 PETs were performed in 85 PD patients, (median age 64 years (range 18-45). The baseline membrane characteristics of the patients were: DP creatinine=0.74±0.11, D/D0glucose=0.28±0.08, DipDPNa=0.05±0.04, sodium removal=29,804 ±26,894 (mmol/L), FWT=214.9±194.7 ml and UF =655.1±265.5 ml. On multivariate regression analysis D/P creatinine, FWT and sodium removal were significant independent covariates accounting for 50% of the variability of ultrafiltration . The patients were followed-up for a median of 36 months (range 2.4-143).For the repeated measurements, the analysis showed that the observed values of D/Pcre,D/D0, Dip/DPNa, FWT and UF remained rather stable across the different time measurements. During the study, 23 out of 85 pts developed peritoneal UF failure (UFF). Analysis was performed using univariate random effects logistic time-series models and only D/D0 (OR=0.84, P=0.001), D/P Cre (OR=1.15, p&lt;0.001), urine volume (OR=1.26, p=0.027) and sodium removal (OR=0.99, p=0.003) were significantly associated with relative risk of UFF development. Conclusion Surprisingly, our patients present a stable membrane function over time. Possible explanations could be the low peritonitis rate and strict use of hypertonic glucose dialysates. Ultrafiltration failure was correlated with higher D/P creatinine and lower D/D0 glucose values, higher baseline urine volume and lower sodium sieving.

Update on Mechanisms of Ultrafiltration Failure

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 123-127 ◽  
Author(s):  
Yong-Lim Kim
Keyword(s):  
Growth Factor ◽  
Mast Cells ◽  
Solute Transport ◽  
Gene Polymorphisms ◽  
Transforming Growth Factor ◽  
Continuous Exposure ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Mesenchymal Transition ◽  
Ultrafiltration Failure

Ultrafiltration failure (UFF) continues to be a major complication of peritoneal dialysis (PD), particularly long-term PD. Continuous exposure to bioincompatible PD solutions causes inflammation of the peritoneal membrane, which progressively undergoes fibrosis and angiogenesis and, ultimately, UFF. There is emerging evidence that epithelial–mesenchymal transition (EMT) of peritoneal mesothelial cells (MCs) may play an important role in the failure of peritoneal membrane function. Submesothelial myofibroblasts originating from MCs through EMT and from activated resident fibroblasts participate in inflammatory responses, extracellular matrix accumulation, and angiogenesis. High glucose and glucose degradation products from PD solutions are responsible for production of transforming growth factor β (TGFβ) and vascular endothelial growth factor (VEGF) by MCs, which induce EMT. Leptin and receptor for advanced glycation end-products (AGEs) augment myofibroblastic conversion through the TGFβ signaling system. A reduction in osmotic conductance in addition to increased solute transport causes UFF. This situation may be caused by loss of aquaporin (AQP) function and formation of the submesothelial fibrotic layer. During PD, AQP1 plays an essential role in water permeability and ultrafiltration (UF), modulating processes such as endothelial permeability and angiogenesis. During a hypertonic dwell, AQP1 mediates 50% of UF. Insufficient AQP1 function may be causative for inadequate UFF. A significant amount of evidence from animal studies now exists to show that mast cells communicate with fibroblasts and are implicated in fibrogenesis, angiogenesis, and UFF. However, it is not confirmed in human studies that mast cells contribute to the fibrosis seen in the peritoneum of PD patients. The patterns of UFF in PD patients depend on duration of treatment. Inherently high small-solute transport status is associated with hypoalbuminemia and a greater comorbidity index. However, most of the variability in peritoneal transport remains unexplained, pointing to the potential role of genetic factors. Gene polymorphisms associated with peritoneal membrane transport have been identified. Recent studies have shown that VEGF, interleukin-6, endothelial NO synthase, AGE receptor, and RAS gene polymorphisms are associated with transport properties in PD patients. Current insights into the mechanisms of UFF will provide rationales for new therapeutic strategies.

Impact of Peritoneal Membrane Function on Long Term Clinical Outcome in Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 91-94 ◽  
Author(s):  
Simon J. Davies ◽  
Louise Phillips ◽  
Anne M. Griffiths ◽  
Lesley H. Russell ◽  
Patrick F. Naish ◽  
...  
Keyword(s):  
Renal Function ◽  
Solute Transport ◽  
Residual Renal Function ◽  
Clinical Implications ◽  
Water Removal ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Membrane Function

It is increasingly clear that peritoneal membrane transport status has clinical implications. The role of the peritoneum in dialysis delivery becomes para mount once residual renal function is lost, particularly as the membrane characteristics may change for the worse with time on treatment. These findings have several important implications: Clinicians need to take solute transport character istics into account as they assess their patients. Adverse effects of high solute transport include reduced ultrafiltration, solute removal (in particular, sodium), and increased peritoneal protein losses. A need exists to replace lost residual renal function, not just with enhanced solute removal, but also with adequate salt and water removal. The interpretation of urea and creatinine clear ances in anuric PD patients needs further consideration and validation. Hypoalbuminemia in PD patients will result from the combined effects of high protein losses, over hydration, comorbidity, and malnutrition.

scholarly journals Prominent Levels of the Profibrotic Chemokine CCL18 during Peritonitis: In Vitro Downregulation by Vitamin D Receptor Agonists

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Marta Ossorio ◽  
Virginia Martínez ◽  
Maria-Auxiliadora Bajo ◽  
Gloria Del Peso ◽  
Maria-José Castro ◽  
...  
Keyword(s):  
Vitamin D ◽  
Risk Factor ◽  
Vitamin D Receptor ◽  
Peritoneal Macrophages ◽  
Peritoneal Membrane ◽  
Pharmacological Interventions ◽  
Membrane Function ◽  
Bacterial Peritonitis ◽  
Ultrafiltration Failure

Peritoneal dialysis (PD) is used as a renal replacement therapy, which can be limited by peritoneal membrane ultrafiltration failure (UFF) secondary to fibrotic processes. Peritonitis, a frequent complication of PD, is a major risk factor for peritoneal membrane fibrosis and UFF. Low peritoneal levels of the chemokine CCL18 are associated with preservation of peritoneal membrane function in PD. Given that CCL18 is involved in fibrotic processes and recurrent peritonitis, it is a risk factor for peritoneal membrane failure; thus, we evaluated CCL18 concentrations in peritoneal effluents from patients undergoing peritonitis episodes. Pharmacological interventions aimed at diminishing the production of CCL18 were also explored. Fivefold higher CCL18 peritoneal concentrations were found during acute bacterial peritonitis, in parallel with the increased infiltration of macrophages. Unexpectedly, CCL18 was also highly (50-fold) increased during sterile eosinophilic peritonitis, and peritoneal eosinophils were found to express CCL18. In vitro treatment of peritoneal macrophages with the vitamin D receptor agonist paricalcitol was able to reduce the secretion and the expression of CCL18 in isolated peritoneal macrophages. In conclusion, our study suggests that the chemokine CCL18 can be a mediator of peritoneal membrane failure associated with peritonitis episodes as well as providing a new potential therapeutic target.

New Insights into the Physiology of Peritoneal Fluid Transport

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 144-149
Author(s):  
Raymond T. Krediet ◽  
Annemieke M. Coester ◽  
Alena Parikova ◽  
Watske Smit ◽  
Dirk G. Struijk
Keyword(s):  
Water Transport ◽  
Fluid Transport ◽  
Free Water ◽  
Osmotic Gradient ◽  
Ultrafiltration Failure ◽  
Ultra Filtration ◽  
Relationship Of ◽  
The Relationship

A review is given on the mechanisms of free water transport, the various methodologies for its measurement, its dependency on the osmotic gradient, and the assessment of osmotic conductance in individual patients. The importance of impaired free water transport in long-term ultra-filtration failure is discussed, relative to peritoneal solute transport status. Furthermore, the relationship of free water transport with locally released potassium is considered, together with a potential role of impaired K+ channel function with peritoneal alterations. Finally, the role of impaired osmotic conductance to glucose and its effects on free water transport in long-term patients with ultrafiltration failure is reviewed.

scholarly journals Genetic Polymorphisms and Peritoneal Membrane Function

2015 ◽  
Vol 35 (5) ◽  
pp. 517-529 ◽  
Author(s):  
Imad Siddique ◽  
K. Scott Brimble ◽  
Louise Walkin ◽  
Angela Summers ◽  
Paul Brenchley ◽  
...  
Keyword(s):  
Solute Transport ◽  
Clinical Outcomes ◽  
Genetic Polymorphisms ◽  
Gene Polymorphisms ◽  
Candidate Gene Approach ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Technique Survival ◽  
Endothelial Growth Factor ◽  
Endothelial Nitric Oxide

BackgroundOutcomes for peritoneal dialysis (PD) patients are affected by the characteristics of the peritoneal membrane, which may be determined by genetic variants. We carried out a systematic review of the literature to identify studies which assessed the association between genetic polymorphisms, peritoneal membrane solute transport, and clinical outcomes for PD patients.MethodsThe National Library of Medicine was searched using a variety of strategies. Studies which met our inclusion criteria were reviewed and data abstracted. Our outcomes of interest included: high transport status peritoneal membrane, risk for peritonitis, encapsulating peritoneal sclerosis (EPS), patient and technique survival. We combined data from studies which evaluated the same genetic polymorphism and the same outcome.ResultsWe evaluated 18 relevant studies. All studies used a candidate gene approach. Gene polymorphisms in the interleukin (IL)-6 gene were associated with peritoneal membrane solute transport in several studies in different ethnic populations. Associations with solute transport and polymorphisms in endothelial nitric oxide synthase and receptor for advanced glycation end product genes were also identified. There was evidence of a genetic predisposition for peritonitis found in 2 studies, and for EPS in 1 study. Survival was found to be associated with a polymorphism in vascular endothelial growth factor and technique failure was associated with a polymorphism in the IL-1 receptor antagonist.ConclusionsThere is evidence that characteristics of the peritoneal membrane and clinical outcomes for PD patients have genetic determinants. The most consistent association was between IL-6 gene polymorphisms and peritoneal membrane solute transport.

scholarly journals Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

2017 ◽  
Vol 46 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Ana Fernandes ◽  
Roi Ribera-Sanchez ◽  
Ana Rodríguez-Carmona ◽  
Antía López-Iglesias ◽  
Natacha Leite-Costa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water ◽  
Volume Overload ◽  
Diabetic Patients ◽  
Longitudinal Analyses ◽  
Cross Sectional ◽  
Sodium Removal ◽  
Essential Stability ◽  
Stability Of Water

Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently. Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes. Main Results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics. Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.

Glycated Albumin in Serum and Dialysate of Patients on Continuous Ambulatory Peritoneal Dialysis

1993 ◽  
Vol 84 (6) ◽  
pp. 619-626 ◽  
Author(s):  
E. Lamb ◽  
W. R. Cattell ◽  
A. Dawnay
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Glycated Albumin ◽  
Protein Glycation ◽  
Structural Proteins ◽  
Diabetic Patients ◽  
Peritoneal Membrane ◽  
Membrane Function ◽  
Ultrafiltration Failure

1. Chronic use of hyperosmolar glucose solutions in continuous ambulatory peritoneal dialysis may cause glycation of peritoneal structural proteins which could contribute to membrane dysfunction and ultrafiltration failure. To determine whether glycation can occur in the environment of the dialysate, we have carried out studies using albumin as a model protein. 2. Glycated albumin was measured in the serum and dialysate of 46 patients on continuous ambulatory peritoneal dialysis (31 non-diabetic patients, 15 diabetic patients). Dialysate and serum glycated albumin (ranges 1.0-12.7% and 0.9-10.2%, respectively) were related to each other (r = 0.988, P <0.001), but dialysate glycated albumin was significantly higher than serum glycated albumin (P <0.0001), with the dialysate to serum glycated albumin ratio being greater than unity in 76% of patients (mean ratio 1.14). This implies either preferential transfer of glycated albumin across the peritoneal membrane or intraperitoneal glycation during the dwell period. 3. In vitro, significant glycation occurred in dialysate during a 6 h incubation period (P <0.01) at a rate related to the glucose concentration in the dialysate (rs = 0.63, P <0.05). The glycation rate was not significantly affected (P = 0.05) by factors other than the glucose concentration. 4. Our results demonstrate that protein glycation occurs within the peritoneum during continuous ambulatory peritoneal dialysis. Further studies are required to establish the relationship of glycation of structural proteins in the peritoneal membrane to membrane function.

scholarly journals Effectiveness of Renin-Angiotensin-Aldosterone System Blockade on Residual Kidney Function and Peritoneal Membrane Function in Peritoneal Dialysis Patients: A Network Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Sirayut Phatthanasobhon ◽  
Surapon Nochaiwong ◽  
Kednapa Thavorn ◽  
Kajohnsak Noppakun ◽  
Setthapon Panyathong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Active Control ◽  
Meta Analysis ◽  
Urine Volume ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Membrane Function ◽  
Raas Blockade ◽  
Residual Kidney Function

AbstractWe performed a network meta-analysis of randomised controlled trials (RCTs) and non-randomised studies in adult peritoneal dialysis patients to evaluate the effects of specific renin-angiotensin aldosterone systems (RAAS) blockade classes on residual kidney function and peritoneal membrane function. Key outcome parameters included the following: residual glomerular filtration rate (rGFR), urine volume, anuria, dialysate-to-plasma creatinine ratio (D/P Cr), and acceptability of treatment. Indirect treatment effects were compared using random-effects model. Pooled standardised mean differences (SMDs) and odd ratios (ORs) were estimated with 95% confidence intervals (CIs). We identified 10 RCTs (n = 484) and 10 non-randomised studies (n = 3,305). Regarding changes in rGFR, RAAS blockade with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were more efficacious than active control (SMD 0.55 [0.06–1.04] and 0.62 [0.19–1.04], respectively) with the protective effect on rGFR observed only after usage ≥12 months, and no differences among ACEIs and ARBs. Compared with active control, only ACEIs showed a significantly decreased risk of anuria (OR 0.62 [0.41–0.95]). No difference among treatments for urine volume and acceptability of treatment were observed, whereas evidence for D/P Cr is inconclusive. The small number of randomised studies and differences in outcome definitions used may limit the quality of the evidence.

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