Metabolic Implications of Peritoneal Dialysis in Patients with Acute Kidney Injury

BackgroundPeritoneal dialysis (PD) is a treatment for selected acute kidney injury patients (AKI), but little is known about its metabolic implications. The aim of the present study was to evaluate the metabolic implications of glucose absorption, sodium removal, protein loss into the dialysate, and catabolism in AKI patients undergoing high-volume PD and to identify risk factors associated with those metabolic effects.MethodsA prospective cohort study over 18 consecutive months evaluated 208 sessions of high-volume PD performed in 31 AKI patients. One session of high-volume PD lasted 24 hours. Repeated-measures analysis was performed, and correlations were calculated using the Spearman test for continuous variables and generalized linear models for categorical variables.ResultsGlucose absorption remained at approximately 35.3% ± 10.5% per session. Protein loss measured 4.2 ± 6.1 g daily, with higher values initially, which declined significantly after 2 sessions. Nitrogen balance (NB) was initially negative, but stabilized at approximately zero after 3 sessions. Glucose uptake was positively correlated with the Acute Tubular Necrosis Individual Severity Score [ATNISS ( r = 0.21, p = 0.0036)], C-reactive protein ( r = 0.26, p = 0.0167), protein loss ( r = 0.36, p < 0.0001), and sodium removal ( r = 0.24, p = 0.002). Protein loss was positively correlated with sodium removal ( r = 0.22, p = 0.0085) and gastrointestinal disease ( p = 0.0004). Sodium removal was positively correlated with serum sodium ( r = 0.21, p = 0.0064), ATNISS ( r = 0.15, p = 0.0411), urea nitrogen appearance [UNA ( r = 0.24, p = 0.0019)], and fluid overload as an indication for dialysis ( p < 0.0001). Urea nitrogen appearance was positively correlated with the indication for dialysis (electrolyte disturbances: p = 0.0287) and negatively correlated with nephrotoxic AKI ( p < 0.0001). Nitrogen balance was negatively correlated with UNA ( r = –0.389, p < 0.0001) and ischemic AKI ( p = 0.0047).ConclusionsHigh-volume PD did not increase hypercatabolism in AKI patients, and protein loss and glucose uptake remained constant during treatment. Those parameters were influenced by the clinical condition of the patients, including the cause of AKI, inflammation, and comorbidities—factors that should be known before the prescription of dialysis and nutrition, thus avoiding metabolic complications such as hyperglycemia, hypernatremia, and worsening catabolism.

Blood Pressure, Volume, and Sodium Control in an Automated Peritoneal Dialysis Population

Objectives To examine the control of blood pressure and volume, and the role of sodium removal in a single, large, contemporary, automated peritoneal dialysis (APD) population where icodextrin is used liberally and there is a policy to avoid long duration glucose-based daytime dwells. Design Observational cross-sectional study. Setting A university hospital. Patients 56 APD patients, with a mean duration on peritoneal dialysis of 1.9 years; 50% were prescribed icodextrin. Main Outcome Measures Blood pressure, extracellular water volume (ECW)-to-intracellular water volume (ICW) ratio, and total (peritoneal and urinary) sodium removal. Results Sodium Removal: Mean total sodium removal, while low at 102.9 ± 64.6 mmol/day, showed a wide range, with 41% having a sodium removal of >120 mmol/day. Total sodium removal correlated with total body water, ECW, and ICW ( p < 0.001, p < 0.001, p < 0.025, respectively), as well as with height and weight ( p < 0.06, p < 0.01 respectively). On multivariate analysis, only ultra-filtration volume and urine volume were significantly associated with total sodium removal ( r2 = 0.67, p < 0.0001 for both). There was also a correlation between sodium removal and urea nitrogen appearance ( r2 = 0.31, p < 0.001), with urea nitrogen appearance in turn being closely correlated with ICW ( p < 0.001). Volume Status: The ECW/ICW ratio was 0.88 ± 0.17, which was not significantly different to that found in hemodialysis patients without clinical evidence of fluid overload, either predialysis (0.96 ± 0.16) or postdialysis (0.92 ± 0.16); p = 0.07 and 0.36 respectively. Blood Pressure: Mean ± standard deviation systolic blood pressure (BP) was 111.9 ± 18.2 mmHg and diastolic BP was 63.3 ± 11.9 mmHg, with only 4 (7%) patients having a systolic BP > 140 mmHg and 1 (2%) having a diastolic BP > 80 mmHg. Median number of antihypertensives was 1 per day. Blood pressure control and ECW/ICW ratio were similar in those with sodium removal >120 mmol/day compared to those with sodium removal ≤120 mmol/day ( p = 0.39 for SBP, p = 0.70 for diastolic B P, p = 0.24 for ECW/ICW). Conclusions We have shown that good blood pressure and volume control is achievable in a large contemporary APD population with liberal use of icodextrin and avoidance of long daytime glucose-based dwells. Neither low nor high sodium removal was associated with more frequent hypertension or volume expansion.

Pengaruh diet rendah protein modifikasi terhadap keseimbangan nitrogen pada pasien penyakit ginjal kronik predialisis di RSU Dr. Soeradji Tirtonegoro

Background: Chronic kidney disease (CKD) is a decreasing function of kidney chronically, progressive, and irreversible. In this condition, one of the symptom found is uremia where gastrointestinal disturbance such as vomiting and anorexia occurred. This causes less nutrition intake, therefore careful diet is needed in attention. One of important aspect of diet procedures for CKD patients is eating management.Objective: To find out the influence of the modification of low protein diet intake towards nitrogen balance in predialysed CKD patients.Method: This was an experimental research using randomized controlled trial design.The subjects were predialysed CKD patients treated who fulfilled the following criteria: adult patients, obtained a low protein diet therapy, treated for at least two days, and willing to be examined. The treatments were a modification of low protein diet compare with a hospital standard of low protein diet.The twenty patients were devided into two groups namely a-ten-people treatment group and a-ten-people control.Result: The statistical test showed that there were no significant difference (p>0.05) in energy and protein intake, urea nitrogen appearance, and nitrogen balance between modification of low protein diet and the hospital standard of low protein diet in predialysed CKD patients.Conclusion: There were no significant difference in nitrogen balance between modification of low protein diet and the hospital standard of low protein diet in predialysed CKD patients.

Nutritional Status and Growth in Children Less than 12 kg Treated with Continuous Ambulatory Peritoneal Dialysis

Various parameters of nutritional status and growth In 13 children with weight less than 12 kg were estimated at the start of continuous ambulatory peritoneal dialysis (CAPD) and 1 year later. A significant Improvement In weight, triceps skinfold, and serum albumin was noticed. Height and midarm muscle circumference did not change significantly. However, a significant Improvement In height occurred In patients with initial abnormal height «- 2 SDS). There was no significant change In protein Intake and urea nitrogen appearance (UNA) during the study period. A significant correlation between protein Intake and UNA was noticed. All patients had normal serum Insulinlike growth factor. In conclusion, there was no significant changein either height velocity or muscle mass despite the improvement in many nutritional parameters.