Cardiovascular risk in peritoneal dialysis

All patients with CKD have multiple risk factors for CVD and CAD in particular. Some of these risk factors such as age and gender cannot be modified. Others such as diabetes and hypertension are not only CVD risk factors but are also the cause of the patient's CKD. Finally there are a group of risk factors such as disturbances of mineral metabolism and oxidative stress which are present either uniquely in or are exaggerated by renal failure. PD gives patients a more atherogenic lipid and lipoprotein profile, puts them at greater risk for AGE formation and usually causes hyperinsulinemia. All of these contribute to CVD risk. However, they can also achieve excellent blood pressure control, usually easily reach targets for anemia management and have continuous ultrafiltration allowing for the maintenance of good volume status, all of which will reduce risk for CVD. All treatable risk factors should be treated early in the development of CKD and should continue through their time on dialysis and after transplantation.

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

This paper reviews the most recent clinical data on the volume status of long-term peritoneal dialysis (PD) patients. It appears that many PD patients are volume overloaded, associated with a high prevalence of hypertension and left ventricular hypertrophy. In the presence of the poor results in patients with peritoneal ultrafiltration, the introduction of the polyglucose solution, icodextrin, has ameliorated volume control in some of these patients. In a second part of the review, some of the structural and functional alterations in the peritoneal membrane and the role of glucose degradation products (GDP) in the commonly used dialysates as well as the resulting formation of advanced glycation end products are described. The introduction of low GDP-containing solutions at normal pH has at least in experimental models of PD attenuated the hemodynamic changes observed with the classical solutions. The solutions at normal pH containing either bicarbonate or a mixture of bicarbonate/lactate were clinically associated with less inflow pain.

Glucose degradation products in peritoneal dialysis: from bench to bedside

In continuous ambulatory peritoneal dialysis patients, treatment success is inextricably linked to the functional and morphological integrity of the peritoneal membrane. This membrane, however, is repeatedly exposed to peritoneal dialysis fluids (PDFs) with unphysiological composition (e.g., acidic pH, high glucose content, hyperosmolarity). More recently, attention of researchers and clinicians has been focused on the presence of glucose degradation products (GDPs) that are generated during heat sterilization of PDF. These GDPs were found to adversely affect peritoneal cell function both acutely and chronically. Recently, a new family of multi-chambered PDFs has been introduced into clinical practice. By keeping the glucose in a separate compartment at very low pH, the generation of GDPs during heat sterilization is markedly reduced. Initial clinical studies indicate that treatment with these novel PDFs may lead to improved clinical outcomes. The current article reviews recent experimental and clinical experience with both conventional and multi-chambered PDFs.

What is new in peritoneal dialysis in the years 2003-2004

This review paper describes new data on the role of aquaporins in peritoneal function, peritoneal membrane permeability, peritoneal dialysis (PD) adequacy and peritoneal membrane histology, new aspects of the use of PD solutions alternative to glucose ones and indications for use of peritoneal catheters with different configurations. Results of main studies, published predominantly in 2003-2004, are presented and discussed. Clinically important news, although preliminary in some cases, are also included.