scholarly journals Ultrafiltration and Dialysis Adequacy with Various Daily Schedules of Dialysis Fluids

2012 ◽  
Vol 32 (5) ◽  
pp. 545-551 ◽  
Author(s):  
Ramón Paniagua ◽  
Malgorzata Debowska ◽  
María-De-Jesús Ventura ◽  
Marcela Ávila–Díaz ◽  
Carmen Prado–Uribe ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
High Glucose ◽  
Dialysis Fluid ◽  
Dialysis Adequacy ◽  
Mean Values ◽  
Fluid Removal ◽  
Glucose Exposure ◽  
The Mean ◽  
Dialysis Fluids ◽  
Small Solute

Dialysis regimens for continuous ambulatory peritoneal dialysis (CAPD) patients vary with the need for fluid removal, but also because of concerns about the local and systemic consequences of high glucose exposure. The implications of various regimens for dialysis adequacy—that is, fluid and small-solute removal—are not always clear. We therefore analyzed ultrafiltration (UF) and adequacy indices for 4 different combinations of dialysis fluid.Collections of 24-hour dialysate and urine were carried out in 99 patients on CAPD. On 4 separate occasions, each patient performed 4 exchanges in 24 hours, including 3 daily exchanges with 1.36% glucose and 1 night exchange with either 1.36% glucose (G1 schedule), 2.27% glucose (G2 schedule), 3.86% glucose (G3 schedule), or icodextrin (Ico schedule). Weekly, total, and dialysis Kt/V and KT were calculated for both urea and creatinine.The mean values of urea Kt/V and KT were significantly lower for the G1 schedule than for the G3 and Ico schedules. The adequacy indices for overnight application of 3.86% glucose and icodextrin were similar. Using dialysis fluids with 1.36% and 2.27% glucose overnight reduces glucose exposure, but those schedules may provide inadequate UF and small-solute removal in some patients (UF < 1 L daily, Kt/V < 1.7).

Peritoneal Dialysis Adequacy in Asia—Is Higher Better?

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 65-68 ◽  
Author(s):  
Philip K.T. Li ◽  
Cheuk-chun Szeto
Keyword(s):  
Peritoneal Dialysis ◽  
Mineral Metabolism ◽  
Pressure Control ◽  
Residual Renal Function ◽  
Acid Base Balance ◽  
Dialysis Adequacy ◽  
Fluid Removal ◽  
Base Balance ◽  
Dialysis Outcomes ◽  
Small Solute

Sufficient data are available to support the contention that renal and peritoneal clearances are not equivalent, and that loss of residual renal function (RRF) cannot be completely compensated by an increase in the exchange volume or frequency of peritoneal dialysis. When RRF is minimal (for example, renal Kt/V is 0.1 – 0.3), increasing the peritoneal Kt/V beyond the “conventional” value recommended by the Dialysis Outcomes Quality Initiative yields little additional clinical benefit. The cut-off peritoneal ( not total) Kt/V is possibly 1.6 – 1.7. However, delivery of peritoneal small-solute clearance below that cut-off level has a major detrimental effect on clinical outcome in CAPD patients with little RRF. Measures to preserve RRF therefore become an important goal in the treatment of CAPD patients. In short, with regard to RRF (renal Kt/V), higher is always better, and we should always try to preserve it. For peritoneal Kt/V, higher is better only up to a certain limit. The importance of aspects of adequate dialysis other than small-solute removal—especially fluid removal, blood pressure control, nutrition, acid–base balance, mineral metabolism, and anemia and lipid control—cannot be sufficiently emphasized.

scholarly journals Hydration Status of Patients Dialyzed with Biocompatible Peritoneal Dialysis Fluids

2016 ◽  
Vol 36 (3) ◽  
pp. 257-261 ◽  
Author(s):  
Monika Lichodziejewska-Niemierko ◽  
Michał Chmielewski ◽  
Maria Dudziak ◽  
Alicja Ryta ◽  
Bolesław Rutkowski
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Hydration Status ◽  
Bioimpedance Spectroscopy ◽  
Dialysis Fluid ◽  
Dialysis Adequacy ◽  
Stage Renal Disease ◽  
Dialysis Fluids

Background Biocompatible fluids for peritoneal dialysis (PD) have been introduced to improve dialysis and patient outcome in end-stage renal disease. However, their impact on hydration status (HS), residual renal function (RRF), and dialysis adequacy has been a matter of debate. The aim of the study was to evaluate the influence of a biocompatible dialysis fluid on the HS of prevalent PD patients. Methods The study population consisted of 18 prevalent PD subjects, treated with standard dialysis fluids. At baseline, 9 patients were switched to a biocompatible solution, low in glucose degradation products (GDPs) (Balance; Fresenius Medical Care, Bad Homburg, Germany). Hydration status was assessed through clinical evaluation, laboratory parameters, echocardiography, and bioimpedance spectroscopy over a 24-month observation period. Results During the study period, urine volume decreased similarly in both groups. At the end of the evaluation, there were also no differences in clinical (body weight, edema, blood pressure), laboratory (N-terminal pro-brain natriuretic peptide, NTproBNP), or echocardiography determinants of HS. However, dialysis ultra-filtration decreased in the low-GDP group and, at the end of the study, equaled 929 ± 404 mL, compared with 1,317 ± 363 mL in the standard-fluid subjects ( p = 0.06). Hydration status assessed by bioimpedance spectroscopy was +3.64 ± 2.08 L in the low-GDP patients and +1.47 ± 1.61 L in the controls ( p = 0.03). Conclusions The use of a low-GDP biocompatible dialysis fluid was associated with a tendency to overhydration, probably due to diminished ultrafiltration in prevalent PD patients.

Minoxidil Selectivel Y Improves Peritoneal Ul Trafiltration

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 91-94 ◽  
Author(s):  
Assem K. El-Sherif ◽  
Nader H. Rizkalla ◽  
Mohamed H. Essawy ◽  
Ahmed M. El-Gohary
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Hemodialysis ◽  
Dialysis Session ◽  
Dialysis Fluid ◽  
Endstage Renal Disease ◽  
Urea Nitrogen ◽  
Fluid Removal ◽  
The Mean ◽  
To Receive ◽  
Solute Clearance

This cross-over randomized clinical trial was car-ried out to evaluate the effects of intraperitoneal (IP) administration of minoxidil on fluid removal and solute clearance during peritoneal dialysis. Twenty-one patients with endstage renal disease, awaiting enrollment in chronic hemodialysis therapy, were randomly allocated to receive IP minoxidil either in the first or the last nine cycles of a 24-cycle peritoneal dialysis session. Cycle-to-cycle data on fluid balance, blood pressure, and adverse effects of the drug were obtained. The dialysis fluid recovered in cycles 3,6,9, 18,21, and 24 was analyzed, together with plasma, for creatinine, urea nitrogen, and protein content. The mean excess fluid volume collected in minoxidil cycles was 1123.8±1119 mL versus 145.2±743.6 mL in the minoxidil-free cycles (p = 0.004). The mean creatinine clearance, urea nitrogen clearance, and protein losses were comparable in minoxidil cycles and the minoxidilfree cycles. Six patients developed hypotension during the minoxidil cycles, corrected by normal saline, but no other important side effects were noted. It is concluded that IP minoxidil selectively increases ultrafiltration without influencing solute clearance in peritoneal dialysis.

scholarly journals Peritoneal dialysis fluid inhibition of phagocyte function: effects of osmolality and glucose concentration.

1993 ◽  
Vol 3 (8) ◽  
pp. 1508-1515
Author(s):  
T Liberek ◽  
N Topley ◽  
A Jörres ◽  
G A Coles ◽  
G M Gahl ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lactate Dehydrogenase ◽  
Glucose Concentration ◽  
Lactate Concentration ◽  
Mononuclear Leukocytes ◽  
Dependent Manner ◽  
Dialysis Fluid ◽  
Glucose Content ◽  
Peritoneal Dialysis Fluid ◽  
Dialysis Fluids

Solutions were formulated to examine, independently, the roles of osmolality and glucose in the reduction of viability and inhibition of phagocyte function by dextrose-containing peritoneal dialysis fluids. The exposure of neutrophils (polymorphonuclear leukocytes) to test fluids containing > or = 2.7% (wt/vol) glucose resulted in significant cytotoxicity as assessed by the release of lactate dehydrogenase above control values (7.12 +/- 2.65%). At the highest concentration of glucose (4.5%), lactate dehydrogenase release was 15.83 +/- 0.49% (P < 0.05). These effects were directly related to the presence of D-glucose in the test fluids. In contrast, phagocytosis and the release of leukotriene B4 from PMN stimulated with serum-treated zymosan were significantly inhibited in an osmolality-, but not glucose-, dependent manner. The inhibition of tumor necrosis factor alpha and interleukin-6 release from mononuclear leukocytes was inhibited by a combination of osmolality and monosaccharide concentration. Under the same conditions, PMN respiratory burst activation remained unaffected irrespective of glucose concentration or fluid osmolality. These data indicate that, in addition to the low pH of peritoneal dialysis fluid and its high lactate concentration, its glucose content (either directly or as a consequence of the resulting hyperosmolality of the fluid) inhibits cell functional parameters. These findings suggest clinically significant inhibition of host defense mechanisms because, in high-glucose dialysis fluids, osmolality does not reach physiologic values, even during extended intraperitoneal dwell periods.

scholarly journals Sodium removal in peritoneal dialysis: is there room for a new parameter in dialysis adequacy?

2019 ◽  
Vol 2 (3) ◽  
pp. 151-157
Author(s):  
Anna Lima ◽  
Joana Tavares ◽  
Nicole Pestana ◽  
Maria João Carvalho ◽  
António Cabrita ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Volume Overload ◽  
Residual Renal Function ◽  
Dialysis Adequacy ◽  
Sodium Removal ◽  
Low Sodium ◽  
Major Attention ◽  
New Strategies ◽  
Small Solute ◽  
Solute Clearance

In peritoneal dialysis (PD) (as well as in hemodialysis) small solute clearance measured as Kt/v urea has long been used as a surrogate of dialysis adequacy. A better urea clearance was initially thought to increase survival in dialysis patients (as shown in the CANUSA trial)(1), but  reanalysis of the data showed a superior contribution of residual renal function as a predictor of patient survival. Two randomized controlled trials (RCT)(2, 3)  supported this observation, demonstrating no survival benefit in patients with higher achieved Kt/v. Then guidelines were revised and a minimum Kt/v of 1,7/week was recommended but little emphasis was given to additional parameters of dialysis adequacy. As such, volume overload and sodium removal have gained major attention, since their optimization has been associated with decreased mortality in PD patients(4, 5). Inadequate sodium removal is associated with fluid overload which leads to ventricular hypertrophy and increased cardiovascular mortality(6). Individualized prescription is key for optimal sodium removal as there are differences between PD techniques (CAPD versus APD) and new strategies for sodium removal have emerged (low sodium solutions and adapted PD). In conclusion, future guidelines should address parameters associated with increased survival outcomes (sodium removal playing an important role) and abandon the current one fit all prescription model.

Peritoneal dialysis

2015 ◽  
Author(s):  
Anjali Bhatt Saxena
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Mineral Metabolism ◽  
Pressure Control ◽  
Dialysis Adequacy ◽  
Waste Products ◽  
Stage Renal Disease ◽  
End Stage ◽  
Small Solute

Dialysis adequacy is a term used to describe how well any dialysis therapy effectively mitigates some of the uraemic complications of end-stage renal disease. In the simplest terms, dialysis adequacy measures the dose of dialysis and judges it to be sufficient (adequate) or insufficient (inadequate). In peritoneal dialysis, adequacy refers to the ability of dialysis to perform any or all of myriad tasks including (a) removing metabolic waste products, (b) maintaining proper fluid balance and blood pressure control, (c) removing excess electrolytes, (d) correcting acid–base imbalances, (e) maintaining healthy bone mineral metabolism, and (f) promoting the maintenance of a proper nutritional status. In practice, peritoneal dialysis adequacy is most often measured mono-dimensionally, in terms of small solute (i.e. urea) clearances; however, it is most useful to incorporate a wider view of dialysis adequacy when caring for patients with end-stage renal disease.

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).

Association between Peritoneal Glucose Exposure and Peritonitis in Peritoneal Dialysis Patients: TheBalANZ Trial

2017 ◽  
Vol 37 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Melissa Nataatmadja ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel M. Hawley ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Peritoneal Dialysis ◽  
High Glucose ◽  
Controlled Trial ◽  
Exposure Group ◽  
Peritoneal Membrane ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Low Glucose ◽  
Glucose Exposure

BackgroundGlucose is the primary osmotic medium used in most peritoneal dialysis (PD) solutions, and exposure to glucose has been shown to exert detrimental effects both locally, at the peritoneal membrane, and systemically. Moreover, high dialysate glucose exposure may predispose patients to an increased risk of peritonitis, perhaps as a result of impaired host defences, vascular disease, and damage to the peritoneal membrane.MethodsIn this post-hoc analysis of a multicenter, multinational, open-label randomized controlled trial of neutral pH, low-glucose degradation product (GDP) versus conventional PD solutions ( balANZ trial), the relationship between peritonitis rates of low (< 123.1 g/day) versus high (≥ 123.1 g/day) dialysate glucose exposure was evaluated in 177 incident PD patients over a 2-year study period.ResultsPeritonitis rates were 0.44 episodes per patient-year in the low-glucose exposure group and 0.31 episodes per patient-year in the high-glucose exposure group, (incidence rate ratio [IRR] 0.69, p = 0.09). There was no significant association between dialysate glucose exposure and peritonitis-free survival on univariable analysis (high glucose exposure hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.40 –1.08) or on multivariable analysis (adjusted HR 0.64, 95% CI 0.39 – 1.05). Moreover, there was no relationship between peritoneal glucose exposure and type of organism causing peritonitis. Physician-rated severity of first peritonitis episodes was similar between groups, as was rate and duration of hospital admission.ConclusionsOverall, this study did not identify an association between peritoneal dialysate glucose exposure and peritonitis occurrence, severity, hospitalization, or outcomes. A further large-scale, prospective, randomized controlled trial evaluating patient-level outcomes is merited.

scholarly journals The Association between Glucose Exposure and the Risk of Peritonitis in Peritoneal Dialysis Patients

2016 ◽  
Vol 36 (5) ◽  
pp. 533-539 ◽  
Author(s):  
Anouk T.N. van Diepen ◽  
Sadie van Esch ◽  
Dirk G. Struijk ◽  
Raymond T. Krediet
Keyword(s):  
Peritoneal Dialysis ◽  
Standard Deviation ◽  
Host Defense ◽  
High Glucose ◽  
First Year ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Severe Peritonitis ◽  
Glucose Exposure ◽  
Glucose Group

Background and objective Little or no clinical evidence is available on the association between glucose exposure and peritoneal host defense in peritoneal dialysis (PD) patients. The objective of the present study was to quantify the exposure to glucose during the first year on PD and investigate the association with subsequent peritonitis. Methods We analyzed prospectively collected demographic and peritonitis data from incident adult PD patients between 1990 and 2010. For the present study, we conducted a review of both in- and outpatient medical records of all patients to obtain their day-to-day dialysis schemes during the first year on PD. From these data, the average exposure to glucose was quantified. The exposure was stratified into low- and high-glucose groups based on the median, analyzed per standard deviation and in quartiles. Cox proportional hazard models were used to calculate crude and adjusted hazard ratios (HRs) and 95% confidence intervals for the association between glucose exposure and peritonitis. Adjustments were made for age, sex, primary kidney disease, diabetes mellitus, Davies comorbidity score and the treatment period. Results In total, 230 patients were included in the study of whom 151 (66%) experienced a first peritonitis episode. The median follow-up time was 2.6 years (interquartile range [IQR]: 1.9 – 3.8) in the low-glucose group and 3.1 (IQR: 2.1 – 4.2) in the high-glucose group. After adjustment for confounding factors, no association between high glucose exposure and the risk of peritonitis was found (HR: 0.81; 0.55 – 1.17). No association was present when glucose exposure was analyzed per standard deviation (SD) (HR: 0.98; 0.79 – 1.21) or patient quartiles were applied. No association was identified between glucose exposure and severe peritonitis, Staphylococcus aureus peritonitis, or a peritonitis episode that lasted more than 14 days. Conclusions Exposure to glucose is not associated with an increased risk of peritonitis. The equilibrium between glycemic harm to peritoneal host defense and detrimental effects of glucose on invading microorganisms may determine the susceptibility to peritoneal infection.

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