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Stachowska-Pietka J, Waniewski J, Olszowska A, Garcia-Lopez E, Wankowicz Z, Lindholm B. Modelling of icodextrin hydrolysis and kinetics during peritoneal dialysis. Sci Rep 2023; 13:6526. [PMID: 37085652 PMCID: PMC10121670 DOI: 10.1038/s41598-023-33480-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/13/2023] [Indexed: 04/23/2023] Open
Abstract
In peritoneal dialysis, ultrafiltration is achieved by adding an osmotic agent into the dialysis fluid. During an exchange with icodextrin-based solution, polysaccharide chains are degraded by α-amylase activity in dialysate, influencing its osmotic properties. We modelled water and solute removal taking into account degradation by α-amylase and absorption of icodextrin from the peritoneal cavity. Data from 16 h dwells with icodextrin-based solution in 11 patients (3 icodextrin-exposed, 8 icodextrin-naïve at the start of the study) on dialysate volume, dialysate concentrations of glucose, urea, creatinine and α-amylase, and dialysate and blood concentrations of seven molecular weight fractions of icodextrin were analysed. The three-pore model was extended to describe hydrolysis of icodextrin by α-amylase. The extended model accurately predicted kinetics of ultrafiltration, small solutes and icodextrin fractions in dialysate, indicating differences in degradation kinetics between icodextrin-naïve and icodextrin-exposed patients. In addition, the model provided information on the patterns of icodextrin degradation caused by α-amylase. Modelling of icodextrin kinetics using an extended three-pore model that takes into account absorption of icodextrin and changes in α-amylase activity in the dialysate provided accurate description of peritoneal transport and information on patterns of icodextrin hydrolysis during long icodextrin dwells.
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Affiliation(s)
- Joanna Stachowska-Pietka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, 02-109, Warsaw, Poland.
| | - Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4, 02-109, Warsaw, Poland
| | - Anna Olszowska
- Military Institute of Medicine, Central Hospital of the Ministry of Public Defence, Warsaw, Poland
| | - Elvia Garcia-Lopez
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Zofia Wankowicz
- Military Institute of Medicine, Central Hospital of the Ministry of Public Defence, Warsaw, Poland
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
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Paniagua R, García-López E, Ávila-Díaz M, Ventura MDJ, Orihuela O, Prado-Uribe MDC, Gallardo-Montoya JM, Lindholm B. Sex Modulates Cardiovascular Effects of Icodextrin-Based Peritoneal Dialysis Solutions. Front Physiol 2022; 13:911072. [PMID: 35677090 PMCID: PMC9168216 DOI: 10.3389/fphys.2022.911072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background/Aims: Some previous observations have noted that after six months of peritoneal dialysis (PD) treatment with icodextrin solutions, blood pressure (BP) and NT-proBNP tend to return to baseline values. This may be due to accumulation of icodextrin products that exert a colloid osmotic effect, which drives water into the bloodstream, causing the rise in blood pressure. Since icodextrin is metabolized by α-Amylase and its gene copies are lower in females than in males, we hypothesized icodextrin metabolites reach higher concentrations in females and that cardiovascular effects of icodextrin are influenced by sex. Methods: Secondary analysis of a RCT comparing factors influencing fluid balance control in diabetic PD patients with high or high average peritoneal transport receiving icodextrin (n = 30) or glucose (n = 29) PD solutions. Serum icodextrin metabolites, osmolality, body composition and Inferior Vena Cava (IVC) diameter were measured at baseline, and at 6 and 12 months of follow-up. Results: After six months of treatment, icodextrin metabolites showed higher levels in females than in males, particularly G5-7 and >G7, serum osmolality was lower in females. In spite of reduction in total and extracellular body water, ultrafiltration (UF) was lower and IVC diameter and BP increased in females, suggesting increment of blood volume. Conclusion: Females undergoing PD present with higher levels of icodextrin metabolites in serum that may exert an increased colloid-osmotic pressure followed by less UF volumes and increment in blood volume and blood pressure. Whether this could be due to the lesser number of α-Amylase gene copies described in diabetic females deserves further investigation.
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Affiliation(s)
- Ramón Paniagua
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
- *Correspondence: Ramón Paniagua, ; Marcela Ávila-Díaz,
| | | | - Marcela Ávila-Díaz
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
- *Correspondence: Ramón Paniagua, ; Marcela Ávila-Díaz,
| | - María-de-Jesús Ventura
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
| | - Oscar Orihuela
- Centro Médico Nacional Siglo XXI, Departamento de Cardiología, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
| | - María-del-Carmen Prado-Uribe
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
| | - Juan-Manuel Gallardo-Montoya
- Centro Médico Nacional Siglo XXI, Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Instituto Mexicano del Seguro Social, México, Mexico
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Yamaguchi N, Miyamoto K, Murata T, Ishikawa E, Horiuchi T. Newly Developed Neutralized pH Icodextrin Dialysis Fluid: Nonclinical Evaluation. Artif Organs 2017; 40:E158-66. [PMID: 27530675 DOI: 10.1111/aor.12783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/06/2016] [Accepted: 05/18/2016] [Indexed: 12/01/2022]
Abstract
A two-compartment system (NICOPELIQ; NICO, Terumo Co., Tokyo, Japan) has recently been developed to neutralize icodextrin peritoneal dialysis fluid (PDF). In this study, a nonclinical evaluation of NICO was carried out to evaluate biocompatibility as well as water transport ability. Glucose degradation products (GDPs) in the icodextrin PDFs were analyzed via high-performance liquid chromatography (HPLC). The cell viability of human peritoneal mesothelial cells derived from peritoneal dialysis effluent (PDE-HPMCs) was evaluated as well as the amount of lactate dehydrogenase (LDH) released after exposure to different PDFs (NICO and EXTRANEAL [EX, Baxter Healthcare Corp., Chicago, IL, USA]) and neutralized pH glucose PDF MIDPELIQ 250 (M250, Terumo). The water transport ability of NICO, EX, and M250 was tested using dialysis tube membranes with various pore sizes: 1, 2, 6-8, and 12-16 kDa. Although cell viability decreased by 30% after 30 min exposure to NICO, it was maintained for 6 h while a significant decrease was observed after 6 h exposure to EX. However, following adjustment of the pH to the same pre-exposure pH value, there was no significant difference in cell viability within the same pH group despite a doubling of the difference in the total amount of GDPs (44.6 ± 8.6 µM in NICO and 91.9 ± 9.5 µM in EX, respectively). In contrast, a significant decrease in cell viability was observed when the pH decreased to less than pH 6. Levels of released LDH, a cytotoxic marker, were within 5% after a 6-h exposure of NICO to PDE-HPMCs. There was no significant difference in water transport ability represented as overall osmotic gradients between NICO and EX. In conclusion, neutralization of icodextrin PDF is beneficial for maintaining cell viability and minimizing LDH release while water transport ability is comparable to the conventional icodextrin PDF.
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Affiliation(s)
- Naoya Yamaguchi
- Department of Chemistry for Materials, Faculty of Engineering, Mie University
| | - Keiichi Miyamoto
- Department of Chemistry for Materials, Faculty of Engineering, Mie University
| | - Tomohiro Murata
- Department of Blood Purification Therapy, Mie University Hospital, Mie, Japan
| | - Eiji Ishikawa
- Department of Blood Purification Therapy, Mie University Hospital, Mie, Japan
| | - Takashi Horiuchi
- Department of Chemistry for Materials, Faculty of Engineering, Mie University
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Akonur A, Holmes CJ, Leypoldt JK. Predicting the Peritoneal Absorption of Icodextrin in Rats and Humans Including the Effect of α-Amylase Activity in Dialysate. Perit Dial Int 2014; 35:288-96. [PMID: 24584610 DOI: 10.3747/pdi.2012.00247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 10/21/2013] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Contrary to ultrafiltration, the three-pore model predictions of icodextrin absorption from the peritoneal cavity have not yet been reported likely, in part, due to difficulties in estimating the degradation of glucose-polymer chains by α-amylase activity in dialysate. We incorporated this degradation process in a modified three-pore model of peritoneal transport to predict ultrafiltration and icodextrin absorption simultaneously in rats and humans. METHODS Separate three-pore models were constructed for humans and rats. The model for humans was adapted from PD Adequest 2.0 including a clearance term out of the peritoneal cavity to account for the absorption of large molecules to the peritoneal tissues, and considering patients who routinely used icodextrin by establishing steady-state plasma concentrations. The model for rats employed a standard three-pore model in which human kinetic parameters were scaled for a rat based on differences in body weight. Both models described the icodextrin molecular weight (MW) distribution as five distinct MW fractions. First order kinetics was applied using degradation rate constants obtained from previous in-vitro measurements using gel permeation chromatography. Ultrafiltration and absorption were predicted during a 4-hour exchange in rats, and 9 and 14-hour exchanges in humans with slow to fast transport characteristics with and without the effect of amylase activity. RESULTS In rats, the icodextrin MW profile shifted towards the low MW fractions due to complete disappearance of the MW fractions greater than 27.5 kDa. Including the effect of amylase activity (60 U/L) resulted in 21.1% increase in ultrafiltration (UF) (7.6 mL vs 6.0 mL) and 7.1% increase in icodextrin absorption (CHO) (62.5% with vs 58.1%). In humans, the shift in MW profile was less pronounced. The fast transport (H) patient absorbed more icodextrin than the slow transport (L) patient during both 14-hour (H: 47.9% vs L: 40.2%) and 9-hour (H: 37.4% vs L: 31.7%) exchanges. While the UF was higher during the longer exchange, it varied modestly among the patient types (14-hour range: 460 - 509 mL vs 9-hour range: 382 - 389 mL). When averaged over all patients, the increases in UF and CHO during the 14-hour exchange due to amylase activity (7 U/L) were 15% and 1.5%, respectively. CONCLUSION The icodextrin absorption values predicted by the model agreed with those measured in rats and humans to accurately show the increased absorption in rats. Also, the model confirmed the previous suggestions by predicting an increase in UF specific to amylase activity in dialysate, likely due to the added osmolality by the small molecules generated as a result of the degradation process. As expected, this increase was more pronounced in rats than in humans because of higher dialysate concentrations of amylase in rats.
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Affiliation(s)
- Alp Akonur
- Medical Products R&D (Innovation), Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
| | - Clifford J Holmes
- Medical Products R&D (Renal), Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
| | - John K Leypoldt
- Medical Products R&D (Renal), Baxter Healthcare Corporation, One Baxter Parkway, Deerfield, IL 60015, USA
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Sawa Y, Tatsumi E, Funakubo A, Horiuchi T, Iwasaki K, Kishida A, Masuzawa T, Matsuda K, Nishimura M, Nishimura T, Tomizawa Y, Yamaoka T, Watanabe H. Journal of Artificial Organs 2008: the year in review. J Artif Organs 2009; 12:1-7. [PMID: 19330497 DOI: 10.1007/s10047-009-0451-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
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