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Xiao X, Ye H, Yi C, Lin J, Peng Y, Huang X, Wu M, Wu H, Mao H, Yu X, Yang X. Roles of peritoneal clearance and residual kidney removal in control of uric acid in patients on peritoneal dialysis. BMC Nephrol 2020; 21:148. [PMID: 32334567 PMCID: PMC7183606 DOI: 10.1186/s12882-020-01800-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/07/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There have been few systematic studies regarding clearance of uric acid (UA) in patients undergoing peritoneal dialysis (PD). This study investigated peritoneal UA removal and its influencing factors in patients undergoing PD. METHODS This cross-sectional study enrolled patients who underwent peritoneal equilibration test and assessment of Kt/V from April 1, 2018 to August 31, 2019. Demographic data and clinical and laboratory parameters were collected, including UA levels in dialysate, blood, and urine. RESULTS In total, 180 prevalent patients undergoing PD (52.8% men) were included. Compared with the normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1 ± 6.2 vs. 42.0 ± 8.0 L/week/1.73m2; P = 0.008). Furthermore, higher transporters (high or high-average) exhibited greater peritoneal UA clearance, compared with lower transporters (low or low-average) (42.0 ± 7.0 vs. 36.4 ± 5.6 L/week/1.73 m2; P < 0.001). Among widely used solute removal indicators, peritoneal creatinine clearance showed the best performance for prediction of higher peritoneal UA clearance in receiver operating characteristic curve analysis [area under curve (AUC) 0.96; 95% confidence interval [CI], 0.93-0.99]. Peritoneal UA clearance was independently associated with continuous SUA [standardized coefficient (β), - 0.32; 95% CI, - 6.42 to - 0.75] and hyperuricemia [odds ratio (OR), 0.86; 95% CI, 0.76-0.98] status, only in patients with lower (≤2.74 mL/min/1.73 m2) measured glomerular filtration rate (mGFR). In those patients with lower mGFR, lower albumin level (β - 0.24; 95%CI - 7.26 to - 0.99), lower body mass index (β - 0.29; 95%CI - 0.98 to - 0.24), higher transporter status (β 0.24; 95%CI 0.72-5.88) and greater dialysis dose (β 0.24; 95%CI 0.26-3.12) were independently associated with continuous peritoneal UA clearance. Furthermore, each 1 kg/m2 decrease in body mass index (OR 0.79; 95% CI 0.63-0.99), each 1 g/dL decrease in albumin level (OR 0.08; 95%CI 0.01-0.47), and each 0.1% increase in average glucose concentration in dialysate (OR 1.56; 95%CI 1.11-2.19) were associated with greater peritoneal UA clearance (> 39.8 L/week/1.73m2). CONCLUSIONS For patients undergoing PD who exhibited worse residual kidney function, peritoneal clearance dominated in SUA balance. Increasing dialysis dose or average glucose concentration may aid in controlling hyperuricemia in lower transporters.
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Affiliation(s)
- Xi Xiao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Xuan Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Meiju Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China. .,Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China.
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Hills BA, Birch S, Burke JR, LaMont AC. Spatial Distribution of Dialysate in Patients and its Implications to Intradialysate Diffusion. Perit Dial Int 2020. [DOI: 10.1177/089686080202200609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To visualize and quantify the spatial distribution of dialysate in patients on continuous ambulatory peritoneal dialysis (CAPD) and, hence, estimate diffusion times for fluid “pockets” wherever intradialysate concentration gradients may not be dissipated by convective currents. Design Contrast medium was added to the dialysate of three supine CAPD patients before an exchange prior to computed tomographic (CT) scanning. Spatial information in the CT scanner was then downloaded to other computers and processed to produce impressive three-dimensional models of dialysate distribution using “wire frame technology.” Results Models differed between patients but all demonstrated pooling of dialysate in the paracolic gutters, subphrenic space, and, especially, in the pelvic cavity. Some pockets of fluid were almost isolated. Quantitatively, the models can account for over 80% of the volume of the exchange (2.5 L), displaying an effective area of contact of 913 – 1450 cm2 between parietal peritoneum and dialysate. This amounts to only 11% – 21% of the anatomic area, again emphasizing the uneven distribution of dialysate. Ignoring very thin (< 0.1 mm) films of dialysate, the bulk (80%) had mean thicknesses ranging from 1.6 to 1.9 cm. Transcendental equations for bulk diffusion were then applied to these findings to determine a theoretical time for urea of about 2 – 3 hours to half-saturation, or 5 – 7 hours to 80% saturation, in the absence of convective currents. Conclusions The distribution of dialysate within the peritoneal cavity is very uneven, resulting in long diffusion times in fluid pockets wherever convective currents may be minimal. Hence, intradialysate diffusion should not be ignored when modeling peritoneal dialysis.
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Affiliation(s)
- Brian A. Hills
- Paediatric Respiratory Research Centre, Mater Children's Hospital, Brisbane, Australia
- Mater Children's Hospital; Department of Medicine, Mater Children's Hospital, Brisbane, Australia
| | - Seamus Birch
- Department of Mechanical Engineering, Mater Children's Hospital, Brisbane, Australia
| | - John R. Burke
- University of Queensland; Princess Alexandra Hospital Mater Children's Hospital, Brisbane, Australia
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Lal SM, Moore HL, Nolph KD. Effects of Intraperitoneal Captopril on Peritoneal Transport in Rats. Perit Dial Int 2020. [DOI: 10.1177/089686088700700206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We studied the effects of various doses of intraperitoneal (I.P.) captopril, (an angiotensin-converting enzyme inhibitor) during peritoneal dialysis, on urea dialysate/plasma (DIP) ratios, dialysate protein (Dpo), dialysate glucose (DG), and drainage volume (VD) in 19 Sprague-Dawley male rats with normal renal function. Similarly, these parameters were measured in five control rats. Among the study group, 14 rats received 20 to 100 mg/kg of intraperitoneal captopril without effect. Following a larger intraperitoneal dose (75 mg/exchange (ex)) five rats had delayed increases in urea D/P ratios and dialysate protein losses by 30% (p < 0.05) and by 286% (p < 0.025), respectively. During and following intraperitoneal captopril the rats showed enhanced glucose absorption and consequently significant decreases in dialysate glucose concentration. The rats receiving IP captopril, 75 mg/ex remained hypotensive throughout the drug exchanges and three subsequent exchanges. Increases in dialysate protein concentration and decreases in the dialysate glucose concentration seen with captopril (75 mg/ex) returned to near baseline values only after four to five hours of drug-free exchanges. These changes, despite systemic hypotension, may reflect an increase in blood flow, capillary permeability and/or surface area subsequent to blockade of the renin-angiotensin system, suggesting some angiotensin II modulation of the peritoneal microcirculation and solute transport during peritoneal dialysis.
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Affiliation(s)
- Sunder M. Lal
- From the Department of Medicine, University of Missouri and Dalton Research Center, Columbia, MO
| | - Harold L. Moore
- From the Department of Medicine, University of Missouri and Dalton Research Center, Columbia, MO
| | - Karl D. Nolph
- From the Department of Medicine, University of Missouri and Dalton Research Center, Columbia, MO
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4
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Indraprasit S, Taramas W, Panpakde O. Complete Dialysate Drainage: An Unnecessary Step in Intermittent Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686088500500408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peritoneal dialysis was performed in 16 renal-failure patients to study the necessity of complete drainage during the outflow period. Comparison between complete drainage (CD) and the accelerated inflow and limited outflow (AILO) showed no difference of drainage volume despite the accelerated outflow during the AILO period. It is postulated that the higher level of dialysate in the fluid line during the AILO period resulted in a relative increase availability of the outflow through the catheter perforations. In the CD period the peritoneal clearances of urea, creatinine and inulin were lower because of inefficient transport of these solutes during the outflow phase. The authors concluded that complete drainage is not necessary in intermittent peritoneal dialysis. During intermittent peritoneal dialysis, dialysate drainage volume usually is a major concern among medical and nursing staffs. Particularly during the initial exchange, dialysate frequently is retained because of a pocket of fluid in an inaccessible area of the peritoneal cavity (1). Thus, in subsequent exchanges considerable effort is made to stimulate drainage so as to avoid further accumulation. This prolongs outflow time and takes up the time and attention of paramedical personnel. The present study was done to evaluate the necessity of complete dialysate drainage in term of mechanics and efficiency of dialysis.
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Affiliation(s)
- Suchati Indraprasit
- From the Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Wandee Taramas
- From the Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Orasa Panpakde
- From the Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Sandoz P, Walls J. Protein Losses in Con Tinuous Ambulatory and Continuous Cyclic Peritoneal Dialysis (CAPD and CCPD). Perit Dial Int 2020. [DOI: 10.1177/089686088400400220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- P. Sandoz
- Area Renal Unit Leicester General Hospital Gwendolen Road Leicester
| | - J. Walls
- Area Renal Unit Leicester General Hospital Gwendolen Road Leicester
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Perez RA, Blake PG, McMurray S, Mupas L, Oreopoulos DG. What is the Optimal Frequency of Cycling in Automated Peritoneal Dialysis? Perit Dial Int 2020. [DOI: 10.1177/089686080002000510] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveThe recent increase in the use of automated peritoneal dialysis (APD) has led to concerns about the adequacy of clearances delivered by this modality. Few clinical studies looking at the effects of varying the individual components of the APD prescription on delivered clearance have been done, and most published data are derived from computer modeling. Most controversial is the optimal frequency of exchanges per APD session. Many centers prescribe 4 to 6 cycles per night but it is unclear if this is optimal. The purpose of this study was to address at what point the beneficial effect of more frequent cycles is outweighed by the concomitant increase in the proportion of the total cycling time spent draining and filling.MethodsA comparison was made between the urea and creatinine clearances (CCrs) achieved by 4 different APD prescriptions, used for 7 days each, in 18 patients. The prescriptions were for 9 hours each and were all based on 2-L dwell volumes, but differed in the frequency of exchanges. They were 5 x 2 L, 7 x 2 L, and 9 x 2 L, as well as a 50% tidal peritoneal dialysis (TPD) prescription using 14 L. Ultrafiltration, dwell time, glucose absorption, sodium and potassium removal, protein excretion, and relative cost were also compared. Clearances due to day dwells and residual renal function were not included in the calculation.ResultsMean urea clearances were 7.5, 8.6, 9.1, and 8.3 L/night for the four prescriptions respectively. Urea clearance with 9 x 2 L was significantly greater than with the other three prescriptions ( p < 0 0.05). Urea clearance with 7 x 2 L and TPD were superior to 5 x 2 L ( p < 0.05). Mean CCr was 5.1, 6.1, 6.4, and 5.6 L/night, respectively. Compared to 5 x 2-L, the 7 x 2-L, 9 x 2-L, and TPD prescriptions achieved greater CCr ( p < 0.05). Taking both urea and CCr into account, 9 x 2 L was the optimal prescription in 12 of the 18 patients. Ultrafiltration and sodium and potassium removals were all significantly greater with the higher frequency prescriptions.ConclusionThe 5 x 2-L prescription significantly underutilizes the potential of APD to deliver high clearances, and 7 x 2 L is a consistently superior prescription if 2-L dwells are being used. Although more costly, 9 x 2 L should be considered if higher clearances are required.
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Affiliation(s)
- Rafael A. Perez
- Optimal Dialysis Research Unit, London Health Sciences Centre and University of Western Ontario
| | - Peter G. Blake
- Optimal Dialysis Research Unit, London Health Sciences Centre and University of Western Ontario
| | - Susan McMurray
- Optimal Dialysis Research Unit, London Health Sciences Centre and University of Western Ontario
| | - Lou Mupas
- Toronto Hospital, University of Toronto, Ontario, Canada
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7
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Chang W, Uchida S, Qi P, Zhang W, Wang X, Liu Y, Han Y, Li J, Xu H, Hao J. Decline in serum uric acid predicts higher risk for mortality in peritoneal dialysis patients-a propensity score analysis. J Nephrol 2019; 33:591-599. [PMID: 31321744 DOI: 10.1007/s40620-019-00632-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The level of serum uric acid (SUA) in treatment follow-up is associated with mortality in peritoneal dialysis (PD) patients, but it remains unknown if the longitudinal change in SUA affects mortality. METHODS 309 PD patients who were not using UA-lowering agents were enrolled. The longitudinal change in SUA was estimated by comparing the values between the run-in and follow-up periods. Based the calculated values, the patients were divided into SUA decliner and SUA non-decliner. A propensity score (PS) was calculated using the parameters measured in run-in period. After PS matching, the time-to-event analysis was performed for all-cause death. RESULTS After PS matching, 86 patients of each group were left. A higher mortality of 19/86 existed in SUA decliner compared with SUA non-decliner which is 3/86 (p < 0.001). Kaplan-Meier analysis in sub-cohort showed worse survival in the SUA decliner. Standard and stratified Cox regression analysis both showed SUA decline to be an independent risk factor for all-cause death in PD patients. CONCLUSIONS The decline in SUA in the follow-up may predict the all-cause mortality of PD patients, the reason of which may result from reducing scavenging effects of SUA or may reflect general condition. More studies need to be done.
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Affiliation(s)
- Wenxiu Chang
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
| | - Shunya Uchida
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - PingPing Qi
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Wenyu Zhang
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Xichao Wang
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Ying Liu
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Yingying Han
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Jinping Li
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Haiyan Xu
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
| | - Jie Hao
- Department of Nephrology, Tianjin First Center Hospital, No. 24 Fukang Road, Nankai District, Tianjin, 300192, China
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Murea M, Tucker BM. The physiology of uric acid and the impact of end-stage kidney disease and dialysis. Semin Dial 2018; 32:47-57. [DOI: 10.1111/sdi.12735] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mariana Murea
- Department of Internal Medicine; Section on Nephrology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Bryan M. Tucker
- Department of Internal Medicine; Section on Nephrology; Wake Forest School of Medicine; Winston-Salem NC USA
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9
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Blouin RA, Bauer LA, Piecoro JJ, Holland NH. Decreased Gentamicin Half-Life during Peritoneal Dialysis. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/106002808001400313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Bouchard J, Roberts DM, Roy L, Ouellet G, Decker BS, Mueller BA, Desmeules S, Ghannoum M. Principles and operational parameters to optimize poison removal with extracorporeal treatments. Semin Dial 2014; 27:371-80. [PMID: 24824059 DOI: 10.1111/sdi.12247] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A role for nephrologists in the management of a poisoned patient involves evaluating the indications for, and methods of, enhancing the elimination of a poison. Nephrologists are familiar with the various extracorporeal treatments (ECTRs) used in the management of impaired kidney function, and their respective advantages and disadvantages. However, these same skills and knowledge may not always be considered, or applicable, when prescribing ECTR for the treatment of a poisoned patient. Maximizing solute elimination is a key aim of such treatments, perhaps more so than in the treatment of uremia, because ECTR has the potential to reverse clinical toxicity and shorten the duration of poisoning. This manuscript reviews the various principles that govern poison elimination by ECTR (diffusion, convection, adsorption, and centrifugation) and how components of the ECTR can be adjusted to maximize clearance. Data supporting these recommendations will be presented, whenever available.
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Affiliation(s)
- Josée Bouchard
- Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Quebec, Canada
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Dell'Aquila R, Rodighiero MP, Bordoni V, D'Intini V, Ronco C. APD prescription: achieving the adequacy goals. Semin Dial 2002; 15:397-402. [PMID: 12437533 DOI: 10.1046/j.1525-139x.2002.00099.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last few years, automated peritoneal dialysis (APD) has undergone considerable improvements due to technological developments. The definition of a minimal dose of peritoneal dialysis (PD) has not yet been completely assessed. Appropriate use of APD requires an evaluation of dialytic efficiency in terms of dialytic indexes and their targets. Many dialytic treatment modalities have been performed in order to achieve adequacy targets. Some aspects have to be taken into consideration to reach the optimal dialytic dose: optimizing mass transfer in correlation with intraperitoneal volumes, prescribing tailored treatment modalities according to different characteristics of peritoneal membranes and individual patient needs, and performing more biocompatible treatments using different glucose profiling and alternative physiologic PD fluids. New high-flow techniques such as continuous flow PD can ensure better urea and creatinine clearances and ultrafiltration rates, leading to a higher utilization of the APD modality.
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13
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Kagan A, Bar-Khayim Y, Schafer Z, Fainaru M. Kinetics of peritoneal protein loss during CAPD: I. Different characteristics for low and high molecular weight proteins. Kidney Int 1990; 37:971-9. [PMID: 2313984 DOI: 10.1038/ki.1990.73] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We studied the peritoneal protein loss in 13 patients during CAPD using 2 liters of 1.5% dextrose dialysis solutions. We compared the kinetic characteristics of the peritoneal mass transfer and clearance of proteins over a wide range of molecular size, to those of small molecular weight solutes. The peritoneal clearance of all studied proteins and solutes correlated strongly and negatively with their molecular mass. No changes were observed in these clearances during 58 months of dialysis. Unlike the peritoneal mass transfer and clearance of small molecular weight solutes (less than 200) which revealed a remarkable progressive drop after the first hour of an eight-hour dialysis cycle, the mass transfer and clearance of proteins of large molecular weight (greater than 68,000) was continuous throughout the eight hours. The clearance of proteins of small molecular weight (less than 15,000) showed similar kinetics to small solutes (less than 200). These results indicate that long dwell times (6 or 8 hr) of peritoneal dialysis are detrimental for the loss of large molecular weight proteins (such as albumin and immunoglobulins) in view of the negligible dialysance of both small solutes (creatinine and potassium) and "intermediate molecules" (represented by the small molecular weight proteins) during the latter hours of long dwell cycles. Thus we suggest that substituting CAPD (3 x 8 hr or 4 x 6 hr) with CCPD (6 x 1 hr) may limit protein loss in these patients.
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Affiliation(s)
- A Kagan
- Department of Medicine A, Kaplan Hospital, Rehovot, Israel
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14
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Ilker NY, Ozgür S, Cetin S. Effect of papaverine on solute transport in peritoneal dialysis. Int Urol Nephrol 1989; 21:119-23. [PMID: 2714946 DOI: 10.1007/bf02549910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Since vasodilators enhance the peritoneal solute transport, the influence of intraperitoneal papaverine was studied. To verify the action of papaverine on peritoneal transport we selected 33 patients on acute peritoneal dialysis and performed two 2-hour cycles with 2000 cc of a 1.5% solution, adding 40 mg of papaverine to the fourth cycle. At the end of the third and fourth cycles blood and dialysate were drawn for urea, creatinine, glucose and protein levels, using peritoneal clearances of urea and creatinine, glucose absorption and net protein loss to compare the two cycles. We found no significant change in solute transport (urea clearance p greater than 0.0.5; creatinine clearance, protein loss and glucose absorption p greater than 0.1).
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Affiliation(s)
- N Y Ilker
- Department of Nephrology, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey
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15
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von Lilien T, Salusky IB, Little RJ, Alliapolous JC, Leichter HE, Hall TL, Fine RN. Peritoneal kinetics in children undergoing continuous ambulatory/cycling peritoneal dialysis. Am J Kidney Dis 1987; 10:431-8. [PMID: 3120579 DOI: 10.1016/s0272-6386(87)80189-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We present a report on peritoneal kinetics in children undergoing continuous ambulatory/cycling peritoneal dialysis (CAPD/CCPD). The effect of long-term treatment with CAPD/CCPD, peritonitis episodes, and dialysate inflow volume on peritoneal kinetics in children was evaluated. Peritoneal kinetic studies (PKSs) were performed in 47 pediatric patients at different times following initiation of CAPD/CCPD. In 18 of these patients, PKSs were repeated up to four times with an unchanged dialysate inflow volume after up to 55 months of CAPD/CCPD treatment. The PKS consisted of a 120-minute dwell with a 1.5% dextrose dialysate solution. Peritoneal clearance, dialysance, and dialysate to plasma (D/P) concentration ratios were calculated after 30, 60, and 120 minutes. The results of the serial PKSs demonstrate stable peritoneal creatinine and urea-N clearance, dialysance or D/P concentration ratios. Furthermore, there was no adverse effect of 32 peritonitis episodes. Finally, inflow volumes correlated directly with clearances of creatinine (P less than .01), urea-N (P less than .001), and potassium (P less than .001), and there was an inverse relationship to the D/P concentration ratios of creatinine (P less than .01), urea-N (P less than .01), potassium (P less than .01), and uric acid (P less than .01). Thus, CAPD/CCPD is a useful and effective long-term treatment modality for pediatric patients. Maximal dialysate inflow volumes should be provided to enhance peritoneal kinetics.
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Affiliation(s)
- T von Lilien
- Department of Pediatrics, UCLA School of Medicine
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16
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Hoenich NA. Membranes and their removal of uremic toxins. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1987; 223:253-62. [PMID: 3447443 DOI: 10.1007/978-1-4684-5445-1_40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- N A Hoenich
- Department of Medicine, Medical School, University of Newcastle upon Tyne, UK
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17
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Rasio EA, Goresky CA. Passage of ions and dextran molecules across the rete mirabile of the eel. The effects of charge. Circ Res 1985; 57:74-83. [PMID: 2408782 DOI: 10.1161/01.res.57.1.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The countercurrent-perfused rete mirabile of the eel is a preparation in which capillary permeability values can be determined accurately in broadscale fashion. To provide insight into charge effects on transendothelial passage, the permeability values of small inorganic cations (labeled sodium and rubidium, and stable potassium) and anions (labeled chloride, iodide, sulfate, and ferrocyanide) were compared to those expected for neutral solutes with approximately matched diffusion coefficients, and that of a neutral dextran fraction was compared to that of a negatively charged dextran sulfate with a similar diffusion coefficient. In the small ion experiments, the labeled iodide values were unexpectedly high, apparently due to the contamination of the labeled iodide solution with I-3. The permeabilities of the rest of the ions clustered at a level about 0.5 of the values which would have been expected for neutral solutes with similar diffusion coefficients. The decrement was interpreted to reflect the presence of both positive and negative charges along the transendothelial pathway, which effectively decrease the dimensions of the limiting part of the pathway for the charged microions relative to that accessible to comparable nonelectrolytes. The larger negatively charged dextran sulfate was also reduced in its passage, in comparison with its matching neutral dextran; this was taken to indicate the presence of a larger scale average net negative charge along its pathway. The data indicate the presence of a staggering of positive and negative charges along the transendothelial pathway accessible to the microions, and a net negative charge in the more restricted part of the pathway available to the dextrans.
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Abstract
We evaluated the influence of dialysate flow rates upon peritoneal clearance of urea, creatine, protein losses into dialysate, glucose disappearance from dialysate, sodium removal from the patient during dialysis, and ultrafiltration rate in 64 patients undergoing intermittent peritoneal dialysis. We evaluated three dialysate flow rates: 2 L/h, 3 L/h, and 4 L/h. All dialysate contained 1.5% glucose. The clearance of urea in milliliters per minute (2-L series 14.0, 3-L series 15.1, 4-L series 17.6) and creatinine in milliliters per minute (2-L series 9.3, 3-L series 10.6, 4-L series 11.6) determined at a dialysate flow rate of 4 L/h was significantly greater than the clearances determined at 3 and 2 L/h of dialysate flow (P less than 0.05). The clearance of glucose from the peritoneal cavity in milliliters per minute (2-L series 6.9, 3-L series 7.9, 4-L series 8.9) was significantly greater for the 4-L series as compared with the 2-L series (P less than 0.05). There were no other significant differences. Neither sex, race, previous episodes of peritonitis, nor etiology of renal failure influenced the results. Given the high cost of dialysate, we recommend dialysate flows of 2 L/h if a patient has a residual renal clearance of 2.5 mL/min. Although increasing dialysate flow rate may compensate for renal clearances significantly less than this, we believe the patient should be offered hemodialysis, continuous cyclic peritoneal dialysis (CCPD), or continuous ambulatory peritoneal dialysis (CAPD).
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Doody PT, Goldberg M. Evaluation of low flow long dwell chronic intermittent peritoneal dialysis. CLINICAL AND EXPERIMENTAL DIALYSIS AND APHERESIS 1982; 6:45-51. [PMID: 7094414 DOI: 10.3109/08860228209050812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
TWelve patients on chronic intermittent peritoneal dialysis for end-state renal disease were followed a total of eight months on high dialysate flow rate (four liters/hour) and low dialysate flow rate (two liters/hour). Creatine, blood urea nitrogen, serum electrolytes, albumin, calcium and phosphorous were recorded weekly. Interdialytic weight gain and intradialytic weight loss were recorded with each dialysis. No significant differences were noted when the mean values were compared for the two trail periods. The two liter/hour dialytic flow rate is less expensive, more convenient for the patients, and could result in a decreased risk for peritonitis when compared to the four liter/hour flow rate. For chronic intermittent peritoneal dialysis, the two liter/hour flow rate should be the preferred mode of therapy.
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Dunham CB, Hak LJ, Hull JH, Mattocks AM. Enhancement of peritoneal dialysis clearance with docusate sodium. Kidney Int 1981; 20:563-8. [PMID: 7343706 DOI: 10.1038/ki.1981.177] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A study was done in rabbits to determine the effect of docusate sodium (DSS) on the peritoneal clearance of creatinine and urea. Following a series of control exchanges with a commercially available peritoneal dialysis solution, three animals in each of four groups received DSS (0.005%, 0.01%, 0.02%, or 0.04%) in a single exchange, followed by 10 subsequent exchanges of control fluid. Creatinine and urea clearances were measured for each exchange. Comparison of post-DSS clearances (exchanges 5 through 15) with pre-DSS baseline values (exchanges 1 through 4) showed a mean percent increase in creatinine clearance that was proportional to the concentration and ranged from 74% to 244% above baseline. Similarly, urea clearance increased by 79 to 166%. The effect on both creatinine and urea clearance persisted through the completion of the dialysis procedure. No animals showed signs of toxicity from DSS. The mechanism of the DSS effect on clearance is unknown. Although studies are needed to delineate the mechanism of the effect and to identify potential toxic effects, the results of this study indicate that DSS has a significant effect on clearance of both creatinine and urea.
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