Clinical Utility of Potassium-Sparing Diuretics to Maintain Normal Serum Potassium in Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Tibor Fülöp ◽  
Lajos Zsom ◽  
Betzaida Rodríguez ◽  
Sabahat Afshan ◽  
Jamie V. Davidson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Potassium ◽  
Residual Renal Function ◽  
Normal Serum ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Laboratory Variables ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vexing Problem

BackgroundHypokalemia is a vexing problem in end-stage renal disease patients on peritoneal dialysis (PD), and oral potassium supplements (OPS) have limited palatability. Potassium-sparing diuretics (KSD) (spironolactone, amiloride) may be effective in these patients.MethodsWe performed a cross-sectional review of 75 current or past (vintage > 6 months) PD patients with regard to serum potassium (K+), OPS, and KSD utilization. We reviewed charts for multiple clinical and laboratory variables, including dialysis adequacy, residual renal function, nutritional status and co-existing medical therapy.ResultsThe cohort was middle-aged with a mean age of 49.2 years (standard deviation [SD] = 14.7) and overweight with a body mass index of 29.5 (6.7) kg/m2. Of all the participants, 57.3% were female, 73.3% African-American, and 48% diabetic with an overall PD vintage of 28.2 (24.3) months at the time of enrollment. Weekly Kt/V was 2.12 (0.43), creatinine clearance was 73.5 (33.6) L/week/1.73 m2with total daily exchange volume of 10.8 (2.7) L. Residual urine output (RUO) measured at 440 (494) mL (anuric 30.6%). Three-month averaged serum K+measured at 4 (0.5) mmol/L with 36% of the participants receiving K+supplements (median: 20 [0;20] mmol/day) and 41.3% KSD (spironolactone dose: 25 – 200 mg/day; amiloride dose: 5 – 10 mg/day). Serum K+correlated positively with weekly Kt/V (r = 0.239; p = 0.039), PD vintage (r = 0.272; p = 0.018) but not with PD modality, daily exchange volume, RUO, or KSD use. However, KSD use was associated with decreased use of OPS (r = -0.646; p < 0.0001).ConclusionsPotassium-sparing diuretics were effective in this cohort of PD patients and decreased the need for OPS utilization.

scholarly journals The relationship between anemia and Kt/V index in patients undergoing continuous ambulatory peritoneal dialysis and hemodialysis

2019 ◽  
Vol 9 (1) ◽  
pp. 06-06
Author(s):  
Boshra Hasanzamani ◽  
Mahin Ghorban Sabbagh
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hemoglobin Concentration ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Relationship

Introduction: Anemia in end-stage renal disease (ESRD) can cause serious problems for patients. Objectives: The present study was conducted to investigate whether the type or adequacy of dialysis can affect the incidence of anemia in these patients. Patients and Methods: This cross-sectional study was conducted on 57 patients with ESRD, who were referred to Qaem and Imam Reza hospitals, Mashhad, Iran. The patients were divided into two groups of continuous ambulatory peritoneal dialysis (CAPD) (n=37 patients) and hemodialysis (n=20 patients). Patients had no laboratory evidence of iron deficiency or hyperparathyroidism. Enrolled patients were received vitamin B12 and folic acid too. Hemoglobin concentration of under 11 mg/dL was considered as anemia. Adequacy of dialysis was evaluated by Kt/V index (>1.2 for hemodialysis and >1.7 per week for peritoneal dialysis). We compared different factors in these two groups, including anemia and Kt/V, and evaluated their relationship. Results: Around 27% and 65% of the patients on CAPD and hemodialysis were anemic respectively (P=0.005). Adequacy of dialysis in CAPD was acceptable in 81.1% of the cases, while target Kt/V was achieved in 50% of the patients on hemodialysis. Dialysis adequacy was significantly higher in patients receiving CAPD (P=0.014). No significant correlation between the incidence of anemia and Kt/V in both types of dialysis was found (P>0.05). Conclusion: Anemia was mostly observed in patients receiving hemodialysis as compared to CAPD. Regardless of the type of dialysis, adequacy of dialysis did not affect the incidence of anemia in any of the groups.

Dialysis Adequacy in Hypoalbuminemic Continuous Ambulatory Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 221-223 ◽  
Author(s):  
Bruce S. Spinowitz ◽  
Bharat K. Gupta ◽  
Josephine Kulogowski ◽  
Chaim Charytan
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Normal Serum ◽  
Dialysis Therapy ◽  
Dialysis Adequacy ◽  
Significant Difference ◽  
The Face ◽  
Stage Renal Disease ◽  
End Stage

We examined the interrelationship between hypoalbuminemia (HA) and the normalized protein catabolic rate (NPCR; g/kg/day) in the face of adequate Kt/V and weekly creatinine clearances in 40 end-stage renal disease patients on long-term continuous ambulatory peritoneal dialysis (CAPD). We also evaluated serum albumin (SA) levels as an additional marker of nutritional status of the PD patients receiving adequate dialysis therapy in terms of Kt/V greater than 1.5 per week. Twenty-three of 40 patients had normal serum albumin (NSA; ≥3.4 g/dL) and 17 had HA «g/dL). A correlation between NPCR and SA levels was observed. Also, the NPCR values in patients with NSA (0.98±0.31) differ significantly (p<0.0005) from patients with HA (0.80±0.13). Urea kinetic parameters for adequacy of dialysis, that is, Kt/V, blood urea nitrogen (BUN), and weekly creatinine clearance, did not reveal any statistically significant difference between patients with NSA and HA. These data suggest that low values of NPCR may be seen in hypoalbuminemic CAPD patients despite adequate dialysis therapy and indicate further investigation for associated morbid conditions or supplemental nutrition.

scholarly journals Peritoneal Microbiome in End-Stage Renal Disease Patients and the Impact of Peritoneal Dialysis Therapy

2020 ◽  
Vol 8 (2) ◽  
pp. 173
Author(s):  
Liliana Simões-Silva ◽  
Ricardo Araujo ◽  
Manuel Pestana ◽  
Isabel Soares-Silva ◽  
Benedita Sampaio-Maia
Keyword(s):  
Peritoneal Dialysis ◽  
Human Microbiome ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Peritoneal Tissue ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

Factors influencing the occurrence of peritoneal dialysis (PD)-related infections are still far from fully understood. Recent studies described the existence of specific microbiomes in body sites previously considered microbiome-free, unravelling new microbial pathways in the human body. In the present study, we analyzed the peritoneum of end-stage kidney disease (ESKD) patients to determine if they harbored a specific microbiome and if it is altered in patients on PD therapy. We conducted a cross-sectional study where the peritoneal microbiomes from ESKD patients with intact peritoneal cavities (ESKD non-PD, n = 11) and ESKD patients undergoing PD therapy (ESKD PD, n = 9) were analyzed with a 16S rRNA approach. Peritoneal tissue of ESKD patients contained characteristically low-abundance microbiomes dominated by Proteobacteria, Firmicutes, Actinobacteria, and Bacteroidetes. Patients undergoing PD therapy presented lower species richness, with dominance by the Pseudomonadaceae and Prevotelaceae families. This study provides the first characterization of the peritoneal microbiome in ESKD patients, bringing new insight to the human microbiome. Additionally, PD therapy may induce changes in this unique microbiome. The clinical relevance of these observations should be further explored to uncover the role of the peritoneal microbiome as a key element in the onset or aggravation of infection in ESKD patients, especially those undergoing PD.

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.

Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic peritoneal dialysis

2020 ◽  
Vol 40 (4) ◽  
pp. 368-376
Author(s):  
Qian Shen ◽  
XiaoYan Fang ◽  
YiHui Zhai ◽  
Jia Rao ◽  
Jing Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Daily Urine ◽  
Glucose Exposure ◽  
Stage Renal Disease ◽  
End Stage

Background: This study analysed children with end-stage renal disease treated with automated peritoneal dialysis (APD) in our centre to explore the risk factors associated with residual renal function (RRF) loss. Methods: Children treated with APD as the initial renal replacement therapy regimen from January 2008 to December 2016 were included. All the children had a daily urine volume of ≥100 ml/m2 when APD was initiated and a dialysis follow-up time of ≥12 months. A daily urine volume of <100 ml/m2 after 12 months of APD treatment was defined as loss of RRF. Possible risk factors that may be associated with RRF loss were analysed. Results: A total of 66 children were included in the study. After 12 months of APD treatment, the daily urine volume decreased by 377.45 ± 348.80 ml/m2, the residual glomerular filtration rate decreased by 6.39 ± 3.69 ml/min/1.73 m2 and 29 of the patients (43.9%) developed RRF loss. The higher risk of RRF loss after 1 year of APD treatment was most pronounced in patients with daily urine volume of ≤400 ml/m2 before treatment, higher glucose exposure and higher ultrafiltration volume, while the lower risk of RRF loss was in patients with administration of diuretics. Each increase of 1 g/m2/day glucose exposure was associated with a 5% increase in RRF loss (odds ratio (OR) 1.05, p = 0.023) and each increase of 1 ml/m2/day ultrafiltration volume was associated with a 1% increase in RRF loss (OR 1.01, p = 0.013). Conclusion: In children undergoing APD, the risk for loss of RRF is associated with low urine volume at the start of APD, high glucose loading and high peritoneal ultrafiltration volume, while preservation of RRF is associated with the usage of diuretics.

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.

scholarly journals Shortened red blood cell age in patients with end-stage renal disease who were receiving haemodialysis: a cross-sectional study

2020 ◽  
Author(s):  
Koichiro Matsumura ◽  
Toshika Okumiya ◽  
Tetsuro Sugiura ◽  
Nobuyuki Takahashi ◽  
Yoshihiro Yamamoto ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Cell ◽  
Renal Disease ◽  
Red Blood Cell ◽  
End Stage Renal Disease ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background: The causes of anaemia in patients with end-stage renal disease include a relative deficiency in erythropoietin production and complex clinical conditions. We aimed to investigate the underlying mechanisms of anaemia in patients with end-stage renal disease who were undergoing maintenance dialysis by measuring erythrocyte creatine levels.Methods: In a cross-sectional study, we evaluated 69 patients with end-stage renal disease who were receiving haemodialysis (n = 55) or peritoneal dialysis (n = 14). Erythrocyte creatine level, a quantitative marker of mean red blood cell (RBC) age, was measured.Results: The mean RBC age was significantly shorter in the haemodialysis group than in the peritoneal dialysis group (47.7 days vs. 59.8 days, p<0.0001), although the haemoglobin levels were comparable between the groups. A Spearman correlation coefficient analysis revealed that shortened RBC age positively correlated with transferrin saturation (r = 0.54), ferritin level (r= 0.47), and haptoglobin level (r = 0.39) but inversely related with reticulocyte (r = −0.36), weekly doses of erythropoiesis-stimulating agents (ESAs; r = −0.62), erythropoietin resistance index (r = −0.64), and intradialytic ultrafiltration rate (r = −0.32).Conclusions: Shortened RBC age was observed in patients who were receiving maintenance haemodialysis and was associated with iron deficiency, greater haptoglobin consumption, higher ESA requirements, and poor erythropoietin responsiveness, as well as with greater intradialytic fluid extraction.

scholarly journals Neutrophil Gelatinase–Associated Lipocalin in Peritoneal Effluent: Evaluation in Peritoneal Dialysis Patients in Basal Condition

2013 ◽  
Vol 33 (4) ◽  
pp. 379-381 ◽  
Author(s):  
Francesca Martino ◽  
Ilenia Filippi ◽  
Davide Giavarina ◽  
Gianpaolo Amici ◽  
Massimo de Cal ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Cross Sectional Study ◽  
Hydration Status ◽  
Linear Regression Models ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Reactive Protein ◽  
Neutrophil Gelatinase

PurposeIn the present study, we assessed expression of neutrophil gelatinase-associated lipocalin (NGAL) in peritoneal effluent (pNGAL) from peritoneal dialysis (PD) patients, and we evaluated factors that might affect its level in basal conditions.MethodsOur cross-sectional study included all 69 patients on PD at our institution. We evaluated patient history, hydration status, residual renal function, indices of dialysis adequacy, peritoneal transport type, serum C-reactive protein, ferritin, serum NGAL (sNGAL) and pNGAL. Univariate and multivariate linear regression models were used to evaluate predictors of pNGAL.ResultsOf the study patients, 39 (56.5%) were men, and 54 (78.3%) were on continuous ambulatory PD. Median age in the group was 61 years [interquartile range (IQR): 46.5 - 71 years]. Median sNGAL was 487 ng/mL (IQR: 407 - 586 ng/mL), and median pNGAL was 35 ng/mL (IQR: 21 - 46 ng/mL). dNGAL correlated directly with weekly dialytic clearance of creatinine (ρ = 0.291, p = 0.02) and with sNGAL (ρ = 0.269, p = 0.031). The same variables were also independent predictors of pNGAL (β = 0.30 and 0.29 respectively, both p < 0.05) in multivariate analysis.ConclusionsIn our analysis, basal levels of pNGAL were influenced by sNGAL and by dialytic clearance of creatinine.

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