1
|
Verger C, Dratwa M. Traduction des Recommandations de l'ISPD pour l'évaluation du dysfonctionnement de la membrane péritonéale chez l'adulte. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i3.62673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Informations concernant cette traductionDans le cadre d’un accord de partenariat entre l’ISPD et le RDPLF, le RDPLF est le traducteur français officiel des recommandations de l’ISPD. La traduction ne donne lieu à aucune compensation financière de la part de chaque société et le RDPLF s’est engagé à traduire fidèlement le texte original sous la responsabilité de deux néphrologues connus pour leur expertise dans le domaine. Avant publication le texte a été soumis à l’accord de l’ISPD. La traduction est disponible sur le site de l’ISPD et dans le Bulletin de la Dialyse à Domicile.Le texte est, comme l’original, libremement téléchargeable sous licence copyright CC By 4.0https://creativecommons.org/licenses/by/4.0/Cette traduction est destinée à aider les professionnels de la communauté francophone à prendre connaissance des recommandations de l’ISPD dans leur langue maternelle.
Toute référence dans un article doit se faire au texte original en accès libre :Peritoneal Dialysis International https://doi.org/10.1177/0896860820982218
Dans les articles rédigés pour des revues françaises, conserver la référence à la version originale anglaise ci dessus, mais ajouter «version française https://doi.org/10.25796/bdd.v4i3.62673"»TraducteursDr Christian Verger, néphrologue, président du RDPLFRDPLF, 30 rue Sere Depoin, 95300 Pontoise – FranceProfesseur Max Dratwa, néphrologueHôpital Universitaire Brugmann – Bruxelles – Belgique
Collapse
|
2
|
Morelle J, Stachowska-Pietka J, Öberg C, Gadola L, La Milia V, Yu Z, Lambie M, Mehrotra R, de Arteaga J, Davies S. ISPD recommendations for the evaluation of peritoneal membrane dysfunction in adults: Classification, measurement, interpretation and rationale for intervention. Perit Dial Int 2021; 41:352-372. [DOI: 10.1177/0896860820982218] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lay summary Peritoneal dialysis (PD) uses the peritoneal membrane for dialysis. The peritoneal membrane is a thin layer of tissue that lines the abdomen. The lining is used as a filter to help remove extra fluid and poisonous waste from the blood. Everybody is unique. What is normal for one person’s membrane may be very different from another person’s. The kidney care team wants to provide each person with the best dialysis prescription for them and to do this they must evaluate the person’s peritoneal lining. Sometimes dialysis treatment itself can cause the membrane to change after some years. This means more assessments (evaluations) will be needed to determine whether the person’s peritoneal membrane has changed. Changes in the membrane may require changes to the dialysis prescription. This is needed to achieve the best dialysis outcomes. A key tool for these assessments is the peritoneal equilibration test (PET). It is a simple, standardized and reproducible tool. This tool is used to measure the peritoneal function soon after the start of dialysis. The goal is to understand how well the peritoneal membrane works at the start of dialysis. Later on in treatment, the PET helps to monitor changes in peritoneal function. If there are changes between assessments causing problems, the PET data may explain the cause of the dysfunction. This may be used to change the dialysis prescription to achieve the best outcomes. The most common problem with the peritoneal membrane occurs when fluid is not removed as well as it should be. This happens when toxins (poisons) in the blood cross the membrane more quickly than they should. This is referred to as a fast peritoneal solute transfer rate (PSTR). Since more efficient fluid removal is associated with better outcomes, developing a personal PD prescription based on the person’s PSTR is critically important. A less common problem happens when the membrane fails to work properly (also called membrane dysfunction) because the peritoneal membrane is less efficient, either at the start of treatment or developing after some years. If membrane dysfunction gets worse over time, then this is associated with progressive damage, scarring and thickening of the membrane. This problem can be identified through another change of the PET. It is called reduced ‘sodium dip’. Membrane dysfunction of this type is more difficult to treat and has many implications for the individual. If the damage is major, the person may need to stop PD. They would need to begin haemodialysis treatment (also spelled hemodialysis). This is a very important and emotional decision for individuals with kidney failure. Any decision that involves stopping PD therapy or transitioning to haemodialysis therapy should be made jointly between the clinical team, the person on dialysis and a caregiver, if requested. Although evidence is lacking about how often tests should be performed to determine peritoneal function, it seems reasonable to repeat them whenever there is difficulty in removing the amount of fluid necessary for maintaining the health and well-being of the individual. Whether routine evaluation of membrane function is associated with better outcomes has not been studied. Further research is needed to answer this important question as national policies in many parts of the world and the COVID-19 has placed a greater emphasis and new incentives encouraging the greater adoption of home dialysis therapies, especially PD. For Chinese and Spanish Translation of the Lay Summary, see Online Supplement Appendix 1. Key recommendations Guideline 1: A pathophysiological taxonomy: A pathophysiological classification of membrane dysfunction, which provides mechanistic links to functional characteristics, should be used when prescribing individualized dialysis or when planning modality transfer (e.g. to automated peritoneal dialysis (PD) or haemodialysis) in the context of shared and informed decision-making with the person on PD, taking individual circumstances and treatment goals into account. (practice point) Guideline 2a: Identification of fast peritoneal solute transfer rate (PSTR): It is recommended that the PSTR is determined from a 4-h peritoneal equilibration test (PET), using either 2.5%/2.27% or 4.25%/3.86% dextrose/glucose concentration and creatinine as the index solute. (practice point) This should be done early in the course dialysis treatment (between 6 weeks and 12 weeks) (GRADE 1A) and subsequently when clinically indicated. (practice point) Guideline 2b: Clinical implications and mitigation of fast solute transfer: A faster PSTR is associated with lower survival on PD. (GRADE 1A) This risk is in part due to the lower ultrafiltration (UF) and increased net fluid reabsorption that occurs when the PSTR is above the average value. The resulting lower net UF can be avoided by shortening glucose-based exchanges, using a polyglucose solution (icodextrin), and/or prescribing higher glucose concentrations. (GRADE 1A) Compared to glucose, use of icodextrin can translate into improved fluid status and fewer episodes of fluid overload. (GRADE 1A) Use of automated PD and icodextrin may mitigate the mortality risk associated with fast PSTR. (practice point) Guideline 3: Recognizing low UF capacity: This is easy to measure and a valuable screening test. Insufficient UF should be suspected when either (a) the net UF from a 4-h PET is <400 ml (3.86% glucose/4.25% dextrose) or <100 ml (2.27% glucose /2.5% dextrose), (GRADE 1B) and/or (b) the daily UF is insufficient to maintain adequate fluid status. (practice point) Besides membrane dysfunction, low UF capacity can also result from mechanical problems, leaks or increased fluid absorption across the peritoneal membrane not explained by fast PSTR. Guideline 4a: Diagnosing intrinsic membrane dysfunction (manifesting as low osmotic conductance to glucose) as a cause of UF insufficiency: When insufficient UF is suspected, the 4-h PET should be supplemented by measurement of the sodium dip at 1 h using a 3.86% glucose/4.25% dextrose exchange for diagnostic purposes. A sodium dip ≤5 mmol/L and/or a sodium sieving ratio ≤0.03 at 1 h indicates UF insufficiency. (GRADE 2B) Guideline 4b: Clinical implications of intrinsic membrane dysfunction (de novo or acquired): in the absence of residual kidney function, this is likely to necessitate the use of hypertonic glucose exchanges and possible transfer to haemodialysis. Acquired membrane injury, especially in the context of prolonged time on treatment, should prompt discussions about the risk of encapsulating peritoneal sclerosis. (practice point) Guideline 5: Additional membrane function tests: measures of peritoneal protein loss, intraperitoneal pressure and more complex tests that estimate osmotic conductance and ‘lymphatic’ reabsorption are not recommended for routine clinical practice but remain valuable research methods. (practice point) Guideline 6: Socioeconomic considerations: When resource constraints prevent the use of routine tests, consideration of membrane function should still be part of the clinical management and may be inferred from the daily UF in response to the prescription. (practice point)
Collapse
Affiliation(s)
- Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, and Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| | - Joanna Stachowska-Pietka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - Carl Öberg
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Liliana Gadola
- Centro de Nefrología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | | | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mark Lambie
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Rajnish Mehrotra
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington DC, USA
| | - Javier de Arteaga
- Servicio de Nefrología, Hospital Privado Universitario de Córdoba, Universidad Católica de Córdoba, Córdoba, Argentina
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| |
Collapse
|
3
|
Wang K, Nguyen M, Chen Y, Hoofnagle AN, Becker JO, Zelnick LR, Kundzins J, Goodling A, Himmelfarb J, Kestenbaum B. Association of Tubular Solute Clearance with Symptom Burden in Incident Peritoneal Dialysis. Clin J Am Soc Nephrol 2020; 15:530-538. [PMID: 32152064 PMCID: PMC7133131 DOI: 10.2215/cjn.11120919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 02/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Residual kidney function is important to the health and wellbeing of patients with ESKD. We tested whether the kidney clearances of proximal tubular secretory solutes are associated with burden of uremic and heart failure symptoms among patients on peritoneal dialysis with residual kidney function. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We enrolled 29 patients on incident peritoneal dialysis with residual urine output >250 ml daily. We used targeted liquid chromatography-mass spectrometry to quantify plasma, 24-hour urine, and peritoneal dialysate concentrations of ten tubular secretory solutes. We calculated the kidney and peritoneal dialysis clearances of each secretory solute, creatinine, and urea, and we estimated a composite kidney and peritoneal secretion score. We assessed for uremic symptoms using the Dialysis Symptom Index and heart failure-related symptoms using the Kansas City Cardiomyopathy Questionnaire. We used linear regression to determine associations of composite secretory solute clearances and GFRurea+Cr with Dialysis Symptom Index symptom score and Kansas City Cardiomyopathy Questionnaire summary score. RESULTS Mean residual kidney clearances of creatinine and urea were 8±5 and 9±6 ml/min per 1.73 m2, respectively, and mean GFRurea+Cr was 8±5 ml/min per 1.73 m2. The residual kidney clearances of most secretory solutes were considerably higher than creatinine and urea clearance, and also, they were higher than their respective peritoneal dialysis clearances. After adjustments for age and sex, each SD higher composite kidney secretion score was associated with an 11-point lower Dialysis Symptom Index score (95% confidence interval, -20 to -1; P=0.03) and a 12-point higher Kansas City Cardiomyopathy Questionnaire score (95% confidence interval, 0.5- to 23-point higher score; P=0.04). Composite peritoneal dialysis secretion score was not associated with either symptom assessment. CONCLUSIONS Residual kidney clearances of secretory solutes are higher than peritoneal dialysis clearances. Kidney clearances of secretory solutes are associated with patient-reported uremic and heart failure-related symptoms.
Collapse
Affiliation(s)
- Ke Wang
- Division of Nephrology, Department of Medicine, University of Washington, Seattle Washington; .,Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington
| | - Michelle Nguyen
- Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington
| | - Yan Chen
- Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle Washington; and
| | - Andrew N Hoofnagle
- Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington.,Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Jessica O Becker
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Leila R Zelnick
- Division of Nephrology, Department of Medicine, University of Washington, Seattle Washington.,Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington
| | - John Kundzins
- Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington.,Department of Epidemiology, University of Washington, Seattle Washington; and
| | - Anne Goodling
- Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington
| | - Jonathan Himmelfarb
- Division of Nephrology, Department of Medicine, University of Washington, Seattle Washington.,Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington
| | - Bryan Kestenbaum
- Division of Nephrology, Department of Medicine, University of Washington, Seattle Washington.,Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington
| |
Collapse
|
4
|
Sarfarazi A, Lee G, Mirjalili SA, Phillips ARJ, Windsor JA, Trevaskis NL. Therapeutic delivery to the peritoneal lymphatics: Current understanding, potential treatment benefits and future prospects. Int J Pharm 2019; 567:118456. [PMID: 31238102 DOI: 10.1016/j.ijpharm.2019.118456] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/21/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022]
Abstract
The interest in approaches to deliver therapeutics to the lymphatic system has increased in recent years as the lymphatics have been discovered to play an important role in a range of disease states such as cancer metastases, inflammatory and metabolic disease, and acute and critical illness. Therapeutic delivery to lymph has the potential to enhance treatment of these conditions. Currently much of the existing data explores therapeutic delivery to the lymphatic vessels and nodes that drain peripheral tissues and the intestine. Relatively little focus has been given to understanding the anatomy, function and therapeutic delivery to the peritoneal lymphatics. Gaining a better understanding of peritoneal lymphatic structure and function would contribute to the understanding of disease processes involving these lymphatics and facilitate the development of delivery systems to target therapeutics to the peritoneal lymphatics. This review explores the basic anatomy and ultrastructure of the peritoneal lymphatics system, the lymphatic drainage pathways from the peritoneum, and therapeutic and delivery system characteristics (size, lipophilicity and surface properties) that favour lymph uptake and retention after intraperitoneal delivery. Finally, techniques that can be used to quantify uptake into peritoneal lymph are outlined, providing a platform for future studies.
Collapse
Affiliation(s)
- Ali Sarfarazi
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Given Lee
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony R J Phillips
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - John A Windsor
- Surgical and Translational Research Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Sciences, University of Auckland, Auckland, New Zealand; HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Natalie L Trevaskis
- Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia.
| |
Collapse
|
5
|
Voinova M, Repin N, Sokol E, Tkachuk B, Gorelik L. Physical Processes in Polymeric Filters Used for Dialysis. Polymers (Basel) 2019; 11:E389. [PMID: 30960373 PMCID: PMC6473866 DOI: 10.3390/polym11030389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/06/2019] [Accepted: 02/12/2019] [Indexed: 01/03/2023] Open
Abstract
The key physical processes in polymeric filters used for the blood purification include transport across the capillary wall and the interaction of blood cells with the polymer membrane surface. Theoretical modeling of membrane transport is an important tool which provides researchers with a quantification of the complex phenomena involved in dialysis. In the paper, we present a dense review of the most successful theoretical approaches to the description of transport across the polymeric membrane wall as well as the cell⁻polymer surface interaction, and refer to the corresponding experimental methods while studying these phenomena in dialyzing filters.
Collapse
Affiliation(s)
- Marina Voinova
- Department of Physics, Chalmers University of Technology, 41296 Gothenburg, Sweden.
- Department of Industrial and Biomedical Electronics, Kharkiv Polytechnical Institute, National Technical University, 61002 Kharkov, Ukraine.
| | - Nikolay Repin
- Department of Cryomorphology, Institute for Problems of Cryobiology and Cryomedicine, 61015 Kharkov, Ukraine.
| | - Evgen Sokol
- Department of Industrial and Biomedical Electronics, Kharkiv Polytechnical Institute, National Technical University, 61002 Kharkov, Ukraine.
| | - Bogdan Tkachuk
- Department of Hemodialysis, Municipal Noncommercial Enterprise of Kharkiv Regional Council "Regional Medical Clinical Center of Urology and Nephrology n.a. V.I. Shapoval", 61037 Kharkov, Ukraine.
| | - Leonid Gorelik
- Department of Physics, Chalmers University of Technology, 41296 Gothenburg, Sweden.
| |
Collapse
|
6
|
Rodríguez-Esparragón F, Marrero-Robayna S, González-Cabrera F, Hernández-Trujillo Y, Buset-Ríos N, Carlos Rodríguez-Pérez J, Vega-Díaz N. Peritoneal dialysis fluid biocompatibility impact on human peritoneal membrane permeability. Clin Kidney J 2018; 11:881-888. [PMID: 30524724 PMCID: PMC6275447 DOI: 10.1093/ckj/sfy043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/02/2018] [Indexed: 11/12/2022] Open
Abstract
Background We have compared the effects of conventional lactate-based peritoneal dialysis fluid (CPDF) with respect to bicarbonate/lactate-based fluid on peritoneal ultrafiltration (UF) and peritoneal permeability, and on variations on gene expression in cells isolated from effluents of patients' peritoneal bags. Methods This was a non-randomized sequential prospective study including all incident peritoneal dialysis (PD) patients (n = 40) recruited in our centre. Peritoneal equilibration tests (PETs) were performed using CPDF or BPDF both containing 2.27% glucose during a 48-h interval in four different sequences. Gene expression variation of selected genes was measured by reverse transcription polymerase chain reaction in mesothelial cells obtained from the total drained fluid during the PET. Results In the overall study, the use of BPDF was associated with significantly lower mass transfer area coefficient for urea and creatinine, longer accelerated peritoneal examination test times for urea and creatinine, lower total pore area available for exchange over diffusion distance and lower UF. There were no differences in the gene expression of aquaporins 1-3, endothelial and inducible nitric oxide synthase (NOS3 and NOS2), or interleukin-6. The SNAIL and E-CADHERIN gene expression normalized ratio was evaluated in peritoneal effluents of cells obtained from CPDF and BPDF. We observed that the SNAIL/E-CADHERIN mRNA ratio decreased when the dialysis sequence started with BPDF and went on to CPDF, but not when the sequence was the opposite. Conclusion This study shows that those patients who started PD treatment with BPDF were characterized by a better biocompatibility profile. BPDF associates with lower peritoneal permeability to small molecules and lower UF.
Collapse
Affiliation(s)
- Francisco Rodríguez-Esparragón
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Silvia Marrero-Robayna
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Fayna González-Cabrera
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Yaridé Hernández-Trujillo
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Nisa Buset-Ríos
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - José Carlos Rodríguez-Pérez
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Gran Canaria, Spain.,Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| | - Nicanor Vega-Díaz
- Unidad de Investigación, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain.,Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria, Gran Canaria, Spain.,Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Gran Canaria, Spain
| |
Collapse
|
7
|
Lu W, Pang WF, Jin L, Li H, Chow KM, Kwan BCH, Leung CB, Li PKT, Szeto CC. Peritoneal protein clearance predicts mortality in peritoneal dialysis patients. Clin Exp Nephrol 2018; 23:551-560. [PMID: 30506285 DOI: 10.1007/s10157-018-1677-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Peritoneal protein clearance has been suggested to be a marker of peritoneal inflammation and systemic endothelial dysfunction. METHODS We enrolled 711 consecutive incident PD patients. Baseline peritoneal protein clearance and other clinical information were reviewed. All patients were followed for at least 1 year for all-cause and cardiovascular mortality. RESULTS The average PD effluent protein loss was 6.41 ± 2.16 g/day; peritoneal protein clearance was 97.15 ± 41.55 mL/day. The average duration of follow-up was 50.8 ± 36.2 months. Multivariate linear regression analysis showed that serum albumin, C-reactive protein, and mass transfer area coefficients of creatinine were independently associated with peritoneal protein clearance. By multivariate Cox regression analysis, age, Charlson comorbidity score, volume of overhydration and peritoneal protein clearance were independent predictors of all-cause mortality. Every 10 mL/day increase in peritoneal protein clearance confers 10.4% increase in risk of all-cause mortality (95% confidence interval 2.6-18.7%, p = 0.008). Peritoneal protein clearance was also associated with cardiovascular mortality by univariate analysis, but the association became insignificant after adjusting for confounding factors Cox regression analysis. CONCLUSIONS Baseline peritoneal protein clearance is an independent predictor of all-cause mortality in incident PD patients. Routine measurement of peritoneal protein clearance may facilitate patient risk stratification.
Collapse
Affiliation(s)
- Wanhong Lu
- Nephrology Department, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wing-Fai Pang
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Li Jin
- Nephrology Department, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Huixian Li
- Nephrology Department, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Kai Ming Chow
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Bonnie Ching-Ha Kwan
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Chi Bon Leung
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| |
Collapse
|
8
|
Morelle J, Sow A, Fustin CA, Fillée C, Garcia-Lopez E, Lindholm B, Goffin E, Vandemaele F, Rippe B, Öberg CM, Devuyst O. Mechanisms of Crystalloid versus Colloid Osmosis across the Peritoneal Membrane. J Am Soc Nephrol 2018; 29:1875-1886. [PMID: 29844208 DOI: 10.1681/asn.2017080828] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 04/25/2018] [Indexed: 12/27/2022] Open
Abstract
Background Osmosis drives transcapillary ultrafiltration and water removal in patients treated with peritoneal dialysis. Crystalloid osmosis, typically induced by glucose, relies on dialysate tonicity and occurs through endothelial aquaporin-1 water channels and interendothelial clefts. In contrast, the mechanisms mediating water flow driven by colloidal agents, such as icodextrin, and combinations of osmotic agents have not been evaluated.Methods We used experimental models of peritoneal dialysis in mouse and biophysical studies combined with mathematical modeling to evaluate the mechanisms of colloid versus crystalloid osmosis across the peritoneal membrane and to investigate the pathways mediating water flow generated by the glucose polymer icodextrin.ResultsIn silico modeling and in vivo studies showed that deletion of aquaporin-1 did not influence osmotic water transport induced by icodextrin but did affect that induced by crystalloid agents. Water flow induced by icodextrin was dependent upon the presence of large, colloidal fractions, with a reflection coefficient close to unity, a low diffusion capacity, and a minimal effect on dialysate osmolality. Combining crystalloid and colloid osmotic agents in the same dialysis solution strikingly enhanced water and sodium transport across the peritoneal membrane, improving ultrafiltration efficiency over that obtained with either type of agent alone.Conclusions These data cast light on the molecular mechanisms involved in colloid versus crystalloid osmosis and characterize novel osmotic agents. Dialysis solutions combining crystalloid and colloid particles may help restore fluid balance in patients treated with peritoneal dialysis.
Collapse
Affiliation(s)
- Johann Morelle
- Division of Nephrology and .,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Amadou Sow
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Charles-André Fustin
- Bio and Soft Matter Division (BSMA), Institute of Condensed Mater and Nanosciences, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Catherine Fillée
- Department of Clinical Biochemistry, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Elvia Garcia-Lopez
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Eric Goffin
- Division of Nephrology and.,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | | | - Bengt Rippe
- Department of Nephrology, Lund University, Skane University Hospital, Lund, Sweden; and
| | - Carl M Öberg
- Department of Nephrology, Lund University, Skane University Hospital, Lund, Sweden; and
| | - Olivier Devuyst
- Division of Nephrology and .,Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Institute of Physiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Öberg CM, Rippe B. Optimizing Automated Peritoneal Dialysis Using an Extended 3-Pore Model. Kidney Int Rep 2017; 2:943-951. [PMID: 29270500 PMCID: PMC5733752 DOI: 10.1016/j.ekir.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/04/2017] [Accepted: 04/21/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction In the current study, an extended 3-pore model (TPM) is presented and applied to the problem of optimizing automated peritoneal dialysis (APD) with regard to osmotic water transport (UF), small/middle-molecule clearance, and glucose absorption. Methods Simulations were performed for either intermittent APD (IPD) or tidal APD (TPD). IPD was simulated for fill and drain volumes of 2 L, whereas TPD was simulated using a tidal volume of 0.5 L, 1 L, or 1.5 L with full drains and subsequent fills (2 L) occurring after every fifth dwell. A total of 25 cycles for a large number of different dialysate flow rates (DFR) were simulated using 3 different glucose concentrations (1.36%, 2.27%, and 3.86%) and 3 different peritoneal transport types: slow (peritoneal equilibrium test D/Pcrea < 0.6), fast (peritoneal equilibrium test D/Pcrea > 0.8), and average. Solute clearance and UF were simulated to occur during the entire dwell, including both fill and drain periods. Results It is demonstrated that DFRs exceeding ∼ 3 L/h are of little benefit both for UF and small-solute transport, whereas middle-molecule clearance is enhanced at higher DFRs. The simulations predict that large reductions (> 20%) in glucose absorption are possible by using moderately higher DFRs than a standard 6 × 2 L prescription and by using shorter optimized “bi-modal” APD regimens that alternate between a glucose-free solution and a glucose-containing solution. Discussion Reductions in glucose absorption appear to be significant with the proposed regimens for APD; however, further research is needed to assess the feasibility and safety of these regimens.
Collapse
Affiliation(s)
- Carl M. Öberg
- Lund University, Skåne University Hospital, Clinical Sciences Lund, Department of Nephrology, Lund, Sweden
- Correspondence: Carl M. Öberg, Department of Nephrology, Skåne University Hospital, S-211 85 Lund, Sweden.Department of Nephrology, Skåne University HospitalS-211 85 LundSweden
| | | |
Collapse
|
10
|
Affiliation(s)
- Bengt Rippe
- Department of Nephrology; Faculty of Medicine; Lund University; Clinical Sciences Lund; Lund Sweden
| | - Carl M. Öberg
- Department of Nephrology; Faculty of Medicine; Lund University; Clinical Sciences Lund; Lund Sweden
| |
Collapse
|
11
|
Schrader M, Treff B, Sandholtet T, Maassen N, Shushakov V, Kaesebieter J, Maassen M. Carbohydrate supplementation stabilises plasma sodium during training with high intensity. Eur J Appl Physiol 2016; 116:1841-53. [PMID: 27465126 DOI: 10.1007/s00421-016-3429-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 07/05/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Investigations of the effect of beverages containing carbohydrates, only, on the sodium and fluid balance during intermittent exercise of high intensity are rare. Therefore, we compared the effects of water and carbohydrate supplementation on plasma, blood volume, and electrolyte shifts during intermittent exercise. METHODS Ten male subjects performed an intermittent exercise test twice. In one trial, tap water (4 ml/kg/15 min) was consumed (Plac trial). In the other trial, the same amount of water supplemented with maltodextrin to achieve a 9.1 % carbohydrate solution (CHO trial) was ingested. Training schedule: warm-up at 50 % for 15 min. Afterwards, power changed between 100 % of the maximum power from a previous incremental test minus 10 and 10 W for each 30 s. Venous blood was sampled to measure electrolytes, osmolality, [protein], hct, [Lactate], [glucose], [Hb] and catecholamines. Hydration status was evaluated by BIA before and after exercise. RESULTS After beverage ingestion [glucose] was significantly higher in CHO until the end of the trial. Starting with similar resting values, osmolality increased significantly more during CHO (p = 0.002). PV decreased by 5 % under both conditions, but recovered partly during exercise under Plac (p = 0.002). [Na+] and [Cl(-)] decreased with Plac during exercise (both p < 0.001) but remained constant during exercise with CHO. CONCLUSIONS Sole carbohydrate supplementation seems to stabilise plasma [Na+]. This cannot be explained simply by a cotransport of glucose and [Na+], because that should lead to a recovery of the blood and plasma volume under CHO. In contrast, this was found during exercise with Plac.
Collapse
Affiliation(s)
- M Schrader
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - B Treff
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - T Sandholtet
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - N Maassen
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Institute of Sports Science, Leibniz University Hannover, Am Moritzwinkel 6, 30167, Hannover, Germany
| | - V Shushakov
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Institute of Sports Science, Leibniz University Hannover, Am Moritzwinkel 6, 30167, Hannover, Germany
| | | | - M Maassen
- Institute of Sports Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Institute of Sports Science, Leibniz University Hannover, Am Moritzwinkel 6, 30167, Hannover, Germany
| |
Collapse
|
12
|
Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:8204294. [PMID: 26989432 PMCID: PMC4771885 DOI: 10.1155/2016/8204294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/13/2016] [Indexed: 11/18/2022]
Abstract
During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (αu), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.
Collapse
|
13
|
Teixidó-Planas J, Troya-Saborido MI, Pedreira-Robles G, Del-Rio-Lafuente M, Romero-Gonzalez R, Bonet-Sol J. Measuring peritoneal absorption with the prolonged peritoneal equilibration test from 4 to 8 hours using various glucose concentrations. Perit Dial Int 2015; 34:605-11. [PMID: 25228213 DOI: 10.3747/pdi.2013.00235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal fluid flows such as small-pore ultrafiltration and free water transport can now be calculated by means of the modified peritoneal equilibration test (PET). To calculate peritoneal fluid absorption, volume markers have been used, but that method is not easily applicable in clinical practice. Alternatively, absorption can be estimated using the personal dialysis capacity test. However, a method of measuring overall peritoneal absorption together with the PET is lacking. The aim of the present study was to assess whether overall peritoneal absorption was different when measured from the 4th to 8th hour in a prolonged PET using three different glucose solutions. METHODS The study enrolled 32 stable peritoneal dialysis (PD) patients from a tertiary university hospital, who underwent three 8-hour prolonged PETs with 1.36%, 2.27%, and 3.86% glucose solution. The PETs were performed in random order over a period of less than 1 month. During the prolonged PET, the peritoneal volume was emptied and reinfused at 60 and 240 minutes and drained at 480 minutes. Peritoneal absorption was calculated as the volume difference between the 4th and the 8th hour. RESULTS The dialysate-to-plasma ratio (D/P) of urea, the D/P creatinine, and the mass transfer area coefficient (MTC) of creatinine at 240 minutes were not significantly different with the three glucose solutions. The end-to-initial (D/D0) glucose, MTC urea, and MTC glucose were significantly different. All water transport parameters were significantly different, except for the 4- to 8-hour absorption volumes and rates. The peritoneal absorption rates were, for 1.36% solution, 1.03 ± 0.58 mL/min [95% confidence interval (CI): 0.83 to 1.24 mL/min]; for 2.27% solution, 0.86 ± 0.71 mL/min (95% CI: 0.61 to 1.11 mL/min); and for 3.86% solution, 1.05 ± 0.78 mL/min (95% CI: 0.77 to 1.33 mL/min). Peritoneal absorption volumes and rates from the 4th to the 8th hour showed good correlations for the various solutions. CONCLUSIONS Using any glucose solution, the prolonged PET with voiding and reinfusion at the 4th hour could be a practical method for calculating overall peritoneal absorption from the 4th to the 8th hour in PD patients.
Collapse
Affiliation(s)
- Josep Teixidó-Planas
- Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain
| | - Maria Isabel Troya-Saborido
- Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain
| | - Guillermo Pedreira-Robles
- Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain
| | - Milagros Del-Rio-Lafuente
- Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain
| | - Ramon Romero-Gonzalez
- Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain
| | - Josep Bonet-Sol
- Nephrology Department, Hospital Universitari, and Fundació Institut d'Investigació en Ciències de la Salut, Germans Trias i Pujol, Barcelona, Spain
| |
Collapse
|
14
|
|
15
|
Yu Z, Lambie M, Davies SJ. Longitudinal study of small solute transport and peritoneal protein clearance in peritoneal dialysis patients. Clin J Am Soc Nephrol 2013; 9:326-34. [PMID: 24262505 DOI: 10.2215/cjn.04420413] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Peritoneal protein clearance (Pcl) is determined by both effective (small pores) membrane area and relative capillary leakiness (large pores). It is not known how these two components change with duration of peritoneal dialysis (PD) in the context of progressive membrane injury and differential attrition of patients with higher Pcl, which has been associated with increased mortality risk in several studies. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients treated continuously from 2000 to 2011 for a minimum of 4 years were selected from the longitudinal prospective Stoke PD Study. Pcl, membrane area (peritoneal solute transport rate [PSTR]), dialysis prescription, and residual renal function were measured every 6 months, along with comorbidity and peritonitis events. Multilevel multivariate analysis was used to determine associations with Pcl over time, taking into account within-subject correlations. RESULTS From 280 incident patients, 335 datasets were analyzed from 49 patients receiving treatment for 4 years. Pcl correlated with PSTR at baseline (R=0.61; P<0.01), but over time there was progressive uncoupling of this relationship (year 4, R=0.28; P=0.05) with increasing PSTR (0.66-0.74; P<0.01) and stable Pcl (78.4-81.9 ml/d; P=0.7). Multivariate analysis found that age, PSTR, daily ultrafiltration, and sodium removal were significant predictors of Pcl when adjusted for sex, comorbidity, glucose exposure, and residual renal function. Peritonitis was associated with increased PSTR but a similar pattern of uncoupling. CONCLUSION There is a progressive dissociation of the small- and large-pore pathways with time on PD, which would be in keeping with a switch from local inflammation early on to progressive fibrosis, combined with increased vascular surface area. Measuring longitudinal changes in Pcl may complement membrane function tests used to monitor progressive injury.
Collapse
Affiliation(s)
- Zanzhe Yu
- Institute for Science and Technology in Medicine, Keele University, United Kingdom;, †Department of Nephrology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China, ‡Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent, United Kingdom
| | | | | |
Collapse
|
16
|
Waniewski J. Peritoneal fluid transport: mechanisms, pathways, methods of assessment. Arch Med Res 2013; 44:576-83. [PMID: 24215786 DOI: 10.1016/j.arcmed.2013.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 10/15/2013] [Indexed: 11/26/2022]
Abstract
Fluid removal during peritoneal dialysis is controlled by many mutually dependent factors and therefore its analysis is more complex than that of the removal of small solutes used as markers of dialysis adequacy. Many new tests have been proposed to assess quantitatively different components of fluid transport (transcapillary ultrafiltration, peritoneal absorption, free water, etc.) and to estimate the factors that influence the rate of fluid transport (osmotic conductance). These tests provide detailed information about indices and parameters that describe fluid transport, especially those concerning the problem of the permanent loss of ultrafiltration capacity (ultrafiltration failure). Different theories and respective mathematical models of mechanisms and pathways of fluid transport are presently discussed and applied, and some fluid transport issues are still debated.
Collapse
Affiliation(s)
- Jacek Waniewski
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland.
| |
Collapse
|
17
|
Affiliation(s)
- James G Heaf
- Department of Nephrology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark.
| |
Collapse
|
18
|
Aubertin G, Choquet P, Dheu C, Constantinesco A, Ratomponirina C, Zaloszyc A, Passlick-Deetjen J, Fischbach M. The impact of dialysis solution biocompatibility on ultrafiltration and on free water transport in rats. Pediatr Nephrol 2012; 27:131-8. [PMID: 21744055 DOI: 10.1007/s00467-011-1945-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 05/11/2011] [Accepted: 05/24/2011] [Indexed: 11/24/2022]
Abstract
This study compares different peritoneal dialysis fluids (PDF) in rats over a short contact time. For greater accuracy, net ultrafiltration (UF) and peritoneal transport indices, mass transfer area coefficient (MTAC) were scaled for the in vivo peritoneal surface area recruited (ivPSA) measured by microcomputerized tomography. Wistar rats underwent nephrectomy (5/6ths), were randomized into two groups and given 1.5% glucose PDF, either conventional acidic lactate (n = 14) or pH neutral bicarbonate (BicaVera) (n = 13); MTAC and UF were measured using a 90-min peritoneal equilibrium test (PET), fill volume (IPV) of 10 ml/100 g; small pore fluid transport was determined from sodium balance and used to calculate free water transport (FWT). Each ivPSA value was significantly correlated with the actual IPV, which varied from one rat to another. At 90 min of contact, there was no difference in recruited ivPSA in relation to PDFs. There was a difference (p < 0.01) in net UF/ivPSA 0.45 vs. 1.41 cm(2)/ml for bicarbonate versus lactate, as there was in the proportion of FWT with bicarbonate (42 ± 5% of net UF) compared to lactate (29 ± 4% of net UF). Net UF for individual values of ivPSA differs between conventional PDF and more biocompatible solutions, such as bicarbonate PDF. This observed change in UF cannot be fully explained by differences in glucose transport. The changes in FWT may be explained by the impact of the PDF biocompatibility on aquaporin function.
Collapse
Affiliation(s)
- Gaëlle Aubertin
- Service de biophysique et médecine nucléaire - Institut de Mécanique des fluides et des Solides CNRS Université de Strasbourg, CHU Hautepierre, Avenue Molière, 67098 Strasbourg Cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Golembiewska E, Kabat–Koperska J, Safranow K, Ciechanowski K. Free Water Transport is Associated with Phosphorus Control in Patients at Initiation of Peritoneal Dialysis. Perit Dial Int 2011; 31:685-7. [DOI: 10.3747/pdi.2010.00244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Krzysztof Safranow
- Department of Chemistry and Biochemistry Pomeranian Medical University Szczecin, Poland
| | | |
Collapse
|
20
|
Gomes AM, Fontan MP, Rodriguez-Carmona A, Sastre A, Cambre HD, Muniz AL, Falcon TG. Categorization of sodium sieving by 2.27% and 3.86% peritoneal equilibration tests--a comparative analysis in the clinical setting. Nephrol Dial Transplant 2009; 24:3513-20. [DOI: 10.1093/ndt/gfp319] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
21
|
Coester AM, Smit W, Struijk DG, Krediet RT. Peritoneal function in clinical practice: the importance of follow-up and its measurement in patients. Recommendations for patient information and measurement of peritoneal function. NDT Plus 2009; 2:104-110. [PMID: 19461865 PMCID: PMC2655762 DOI: 10.1093/ndtplus/sfn203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 12/15/2008] [Indexed: 11/15/2022] Open
Abstract
A review is given on peritoneal function, especially ultrafiltration and ultrafiltration failure followed by recommendations on how to translate pathophysiology into clinical practice. The subsequent consequences for management of peritoneal membrane function and for patient information are also included.
Collapse
Affiliation(s)
- Annemieke M. Coester
- Division of Nephrology, Department of Medicine, Academic Medical Centre University of Amsterdam
| | | | | | - Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Centre University of Amsterdam
| |
Collapse
|
22
|
Abstract
The general principles for assessing solute and fluid transport across the peritoneum in animal models are not different from those in human studies. Animal models allow for extensive standardization of experimental conditions and also for sampling of peritoneal tissues for analysis. The present review will focus on ( 1 ) the scaling issue between various species, ( 2 ) how to measure intraperitoneal volume in animal models, ( 3 ) the impact of an indwelling catheter, ( 4 ) the difference between acute and chronic experiments, and ( 5 ) the particular problems associated with transport measurements in mice. If done correctly and after proper scaling, mass transfer area coefficients and clearance measurements show marked similarity among different species. Although animal models only partly mimic human peritoneal dialysis, they are valuable tools for understanding the basic physiology and biology of peritoneal dialysis.
Collapse
Affiliation(s)
- Bengt Rippe
- Department of Nephrology, University Hospital of Lund, Sweden
| |
Collapse
|
23
|
Devuyst O, Goffin E. Water and solute transport in peritoneal dialysis: models and clinical applications. Nephrol Dial Transplant 2008; 23:2120-3. [DOI: 10.1093/ndt/gfn298] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|