Faculty Opinions recommendation of Benefit of glucose-free dialysis solutions on glucose and lipid metabolism in peritoneal dialysis patients.

The widespread use of calcium carbonate as a phosphate binder is limited by its tendency to develop hypercalcemia in some patients using effective dosages needed to control hyperphosphatemia. Most common continuous ambulatory peritoneal dialysis (CAPD) regimens using dialysis solutions containing 3.5 mEqlL of calcium result in net absorption of calcium from the dialysis solution and, hence limit the amount of oral calcium that can be administered. Peritoneal dialysis solutions with reduced calcium levels are needed for effective use of CaCO3 to control hyperphosphatemia in some dialysis patients.

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Icodextrin Metabolism and Alpha-Amylase Activity in Nonuremic Rats Undergoing Chronic Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080702700409 ◽

2007 ◽

Vol 27 (4) ◽

pp. 415-423 ◽

Cited By ~ 19

Author(s):

Elvia García–López ◽

Krzysztof Pawlaczyk ◽

Björn Anderstam ◽

A. Rashid Qureshi ◽

Malgorzata Kuzlan–Pawlaczyk ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Wistar Rats ◽

Amylase Activity ◽

Dialysis Fluid ◽

Dialysis Patients ◽

Peritoneal Dialysis Fluid ◽

Male Wistar Rats ◽

Osmotic Agent ◽

Dialysis Solutions

Objective To study the metabolism of icodextrin and α–amylase activity following daily exposure to dialysis solutions containing either glucose or icodextrin as osmotic agent in rats. Methods Male Wistar rats with implanted peritoneal catheters were infused twice daily for 3 weeks with 20 mL 7.5% icodextrin-based peritoneal dialysis fluid (IPDF; ICO group, n = 12) or 3.86% glucose-based peritoneal dialysis fluid (GLU group, n = 11). A 4-hour dwell study using 30 mL IPDF was performed on day 10 (D1) and day 21 (D2) in both the ICO and the GLU groups. Radiolabeled serum albumin (RISA) was used as a macromolecular volume marker. Dialysate samples were collected at 3, 15, 30, 60, 90, 120, and 240 minutes. Blood samples were drawn before the start and at the end of the dwell. Results During all dwell studies, the dialysate concentrations of total icodextrin decreased due to decrease in high molecular weight (MW) fractions, whereas there was a marked increase in icodextrin low MW metabolites. α–Amylase activity increased in dialysate and decreased in plasma. About 60% of the total icodextrin was absorbed from the peritoneal cavity during the 4-hour dwells. Low MW icodextrin metabolites were present in the dialysate already at 3 minutes, and maltose (G2), maltotriose (G3), maltotetraose (G4), and maltopentaose (G5) increased progressively, reaching maximum concentrations at 60 minutes. Maltohexaose (G6) and maltoheptaose (G7) were also detected already at 3 minutes but did not change significantly during the dwells. During the two 4-hour dwell studies (D1 and D2), the concentrations of total icodextrin and icodextrin metabolites and α–amylase activity in dialysate did not differ between the ICO and GLU groups, during either D1 or D2. No icodextrin metabolites were detected in plasma at the end of the dwells. α–Amylase activity in the dialysate increased six- to eightfold whereas plasma α–amylase activity decreased by 21% – 26% during the two 4-hour dwells in both the ICO and the GLU groups; there were no significant differences between the ICO and the GLU groups during either D1 or D2. α–Amylase activity in the dialysate correlated strongly with the disappearance rate of icodextrin from the peritoneal cavity during the 4-hour dwells, and with the concentrations of G2, G3, G6, and G7 in dialysate. Conclusions The decline in the dialysate concentrations of high MW fractions and the increase in low MW metabolites of icodextrin suggest intraperitoneal α–amylase mediated the metabolism of icodextrin and the transport of predominantly the smaller icodextrin metabolites from dialysate. However, no icodextrin could be detected in plasma, suggesting that it was metabolized and excreted by the kidney in these nonuremic rats. In contrast to uremic peritoneal dialysis patients, chronic exposure to IPDF did not seem to further affect α–amylase activity or icodextrin metabolism. The much higher α–amylase activity in plasma and dialysate in rats than in humans explains the much more rapid metabolism of icodextrin in rats compared with peritoneal dialysis patients.

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Relationship between glucose exposure via peritoneal dialysis solutions and coronary artery calcification in non-diabetic peritoneal dialysis patients

International Urology and Nephrology ◽

10.1007/s11255-012-0138-8 ◽

2012 ◽

Vol 44 (6) ◽

pp. 1847-1853 ◽

Cited By ~ 8

Author(s):

Ebru Sevinc Ok ◽

Gulay Asci ◽

Fatih Kircelli ◽

Soner Duman ◽

Hamad Dheir ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Coronary Artery ◽

Coronary Artery Calcification ◽

Dialysis Patients ◽

Glucose Exposure ◽

Dialysis Solutions ◽

Peritoneal Dialysis Solutions

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Future Approaches to the Treatment of Malnutrition Malnutrition in Peritoneal Dialysis Patients: Etiologic Factors and Treatment Options

Peritoneal Dialysis International ◽

10.1177/089686089501505s09 ◽

1995 ◽

Vol 15 (5_suppl) ◽

pp. 63-66 ◽

Cited By ~ 11

Author(s):

T. Alp Ikizler ◽

Rebecca L. Wingard ◽

Raymond M. Hakim

Keyword(s):

Peritoneal Dialysis ◽

Nutritional Status ◽

Treatment Options ◽

Nutritional Supplements ◽

Chronic Dialysis ◽

Dialysis Patients ◽

Nutritional Counseling ◽

Dialysis Dose ◽

Early Start ◽

Dialysis Solutions

It is clear that malnutrition is common in chronic dialysis patients and is associated with increased morbidity and mortality. Evidence is accumulating that several measures can be taken to improve the nutritional status of these patients. An early start of dialysis, an increase in dialysis dose, the use of biocompatible membranes or dialysis solutions, and intensive nutritional counseling should be applied when necessary. If these measures fail, additional interventions, such as parenteral or enteral nutritional supplements, rhGH, and rhIGF -1, alone or in combination, should be tried.

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Pharmacokinetics of Calcitriol and Maxacalcitol Administered into Peritoneal Dialysate Bags in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080502500613 ◽

2005 ◽

Vol 25 (6) ◽

pp. 570-575 ◽

Cited By ~ 5

Author(s):

Chieko Hamada ◽

Kayo Hayashi ◽

Ichiyu Shou ◽

Masanori Inaba ◽

Yuuki Ro ◽

...

Keyword(s):

Vitamin D ◽

Peritoneal Dialysis ◽

Acidic Solution ◽

Time Lag ◽

Dialysis Patients ◽

Maximum Serum ◽

Vitamin D Analog ◽

Maximum Serum Concentration ◽

The Stability ◽

Dialysis Solutions

Objectives It is well known that injection of calcitriol (CT) or maxacalcitol (OCT) is very effective in hemodialysis patients with secondary hyperparathyroidism (2HPT). However, it is difficult to use these drugs with peritoneal dialysis (PD) patients with 2HPT because these drugs must be injected two or three times per week. The objective of the present study was to evaluate the stability of physiological activities of CT and OCT in PD bags and to determine the CT or OCT dosage for intraperitoneal (IP) administration. Materials and Methods We added CT 1.5 μg or OCT 10 μg to Dianeal PD-2 (approximate pH = 5.0, calcium = 0.87 mmol/L; Baxter, Tokyo, Japan), Midpeliq 250 (approximate pH = 7.0, Ca = 1.0 mmol/L; Terumo Corporation, Tokyo, Japan), and Peritoliq 250 (approximate pH = 5.5, Ca = 1.0 mmol/L; Terumo Corp.). Dialysis solutions were collected from the PD bags at 0, 1, 4, 8, 12, 24, 48, and 72 hours after addition of CT and OCT. The activities of CT and OCT in the dialysis effluent were measured by radioimmunoassay. The levels of serum and effluent OCT after a single IP administration of 10 μg OCT were examined in 4 PD patients with advanced 2HPT. Results Although the levels of CT and OCT in PD bags made of polyvinyl resins decreased by 70% – 75% immediately after injection, levels in PD bags made of polypropylene resins decreased only slightly. The concentration of CT mixed into the acidic solution in glass containers was stable; the decreased concentration of CT in the PD solution might be due to adsorption onto polyvinyl resins. The maximum serum concentration after IP administration of 10 μg OCT was 750 pg/mL after 5 minutes, and remained at 500 pg/mL at 60 minutes. These results show good peritoneal transport of OCT but not rapid disappearance, unlike intravenous administration. Conclusions If peritoneal administration of vitamin D derivatives is contemplated, it is important to select the composition of PD bag resins, type of vitamin D analog, and time lag to use when deciding the dosage of injectable vitamin D preparations, such as OCT or CT, for IP administration to PD patients. It appears that IP administration in overnight dwells might be useful for PD patients as a complementary vitamin D preparation.

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Volume Control in Peritoneal Dialysis Patients: Role of New Dialysis Solutions

Blood Purification ◽

10.1159/000074923 ◽

2004 ◽

Vol 22 (1) ◽

pp. 44-54 ◽

Cited By ~ 7

Author(s):

Norbert Lameire

Keyword(s):

Peritoneal Dialysis ◽

Volume Control ◽

Dialysis Patients ◽

Dialysis Solutions

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Beta-Blockers May Cause Ultrafiltration Failure in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686089701700604 ◽

1997 ◽

Vol 17 (6) ◽

pp. 541-545 ◽

Cited By ~ 13

Author(s):

Bernd G. Stegmayr

Keyword(s):

Peritoneal Dialysis ◽

Beta Blockers ◽

Serum Levels ◽

Dialysis Patients ◽

Serum Triglycerides ◽

Exact Test ◽

Glucose And Lipid Metabolism ◽

Multivariate Correlation ◽

Ultrafiltration Failure ◽

Continuous Cycling

Objective To elucidate mechanisms of ultrafiltration failure (UFF) in patients on continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective analysis of patients with UFF during CAPD compared with cross-sectionally selected controls. Setting University peritoneal dialysis center. Patients Thirteen patients with UFF during CAPD necessitating change to hemodialysis (n = 6) or continuous cycling peritoneal dialysis (n = 1), or causing greatly increased need for high glucose-containing solutes, were compared with 18 CAPD patients without such problems. Statistics Fisher's exact test, Student's independent t-test, univariate and multivariate correlation analyses. Main Outcome Measures Data were collected prior to analyses. Results Systolic blood pressure and total cholesterol and triglyceride levels were higher in the UFF patients than in the controls (p = 0.006, p = 0.028, p = 0.013). Betablockers were used by 12 of the UFF patients, but only 2/ 18 controls (p < 0.0001). There was no intergroup difference in number of women, patient age or weight, incidence of diabetes or previous peritonitis, duration of PD, serum levels of albumin, creatinine, iron, or ferritin, or dosage of erythropoietin. Correlation was found between the daily amount of glucose instilled into the abdomen and serum triglycerides (r = +0.72, p < 0.001), total choles terol (r = +0.56, p = 0.008), and HbA1C(r =-0.41, p =0.039). Many patients were high absorbers of dialysis glucose. Conclusion The study indicates that beta-blockers may cause UFF, and that glucose and lipid metabolism differed between these patients and controls without UFF.

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Taming Apoptosis in Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080902902s08 ◽

2009 ◽

Vol 29 (2_suppl) ◽

pp. 45-48 ◽

Cited By ~ 2

Author(s):

Beatriz Santamaria ◽

Alvaro Conrado Ucero ◽

Alberto Benito–Martin ◽

Rafael Selgas ◽

Marta Ruiz–Ortega ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Degradation Products ◽

Cell Number ◽

Mesothelial Cells ◽

Neutrophil Apoptosis ◽

Dialysis Patients ◽

Short Term ◽

Cell Numbers ◽

Caspase Inhibition ◽

Dialysis Solutions

Excessive, insufficient, or untimely apoptosis may result in disorders of cell numbers. Peritoneal demesothelization is an example of disease by decreased cell number; untimely leukocyte apoptosis impairs peritoneal defense. Conventional peritoneal dialysis solutions accelerate neutrophil apoptosis. Glucose degradation products such as 3,4-dideoxyglucosone-3-ene (3,4-DGE) decisively contribute to apoptosis induced by these solutions, in both leukocytes and mesothelial cells and in both culture and peritoneal dialysis patients. Pan-caspase inhibition retards neutrophil apoptosis and improves peritoneal clearance of Staphylococcus aureus in animal models. However, regulation of apoptosis in mesothelial cells is more complex than in leukocytes, and caspase inhibitors may not be the optimal drugs to modulate apoptosis in these cells. In this regard, Bax antagonistic peptides protect mesothelial cells from 3,4-DGE. In addition, novel molecular targets have been identified. Short-term modulation of apoptosis may be useful to accelerate recovery and to prevent irreversible peritoneal injury following peritonitis.

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