1
|
Wang T, Heimbürger O, Cheng HH, Bergström J, Lindholm B. Peritoneal Fluid and Solute Transport with Different Polyglucose Formulations. Perit Dial Int 2020. [DOI: 10.1177/089686089801800209] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To study peritoneal fluid and solute transport characteristics using different polyglucose solutions with and without the addition of glucose. Design Thirty-one rats were divided into three groups. A 4-hour dwell study with frequent dialysate and blood samples was performed in each rat using 25 mL of 7.5% polyglucose solution (PG, n = 11),7.5% polyglucose + 0.35% glucose solution (PG1, n = 12), or 3.75% polyglucose + 1.93% glucose solution (PG2, n = 8). Radiolabeled human albumin (RISA) was added to the solutions as an intraperitoneal volume (IPV) marker. In addition, polyglucose degradation was evaluated ex vivo over 24 hours. Experimental Animals Thirty-one male Sprague Dawley rats (300 g) were used. Main Outcome Measures Fluid and solute (glucose, urea, sodium, potassium, and total protein) transport characteristics as well as changes in dialysate osmolality were evaluated. Results The IPV was higher in the PG1 and PG2 groups than in the PG group during the first 2 hours of the dwell. The IPV, in fact, decreased during the first hour of the dwell in the PG group. However, the net ultrafiltration at 4 hours tended to be lower in the PG2 (3.2 ± 1.5 mL) group compared to the PG (5.1 ± 2.3 mL) and the PG1 groups (5.2 ± 2.1 mL) (p = 0.07), and no significant difference was found between the PG and PG1 groups. Adding glucose to the PG solution increased the RISA elimination rate (KE, representing the fluid absorption rate from the peritoneal cavity): 25.5 ± 8.2, 37.5 ± 12.2, and 42.5 ± 8.9 μL/ min for the PG, PG1, and the PG2 group, respectively, p < 0.01. Dialysate osmolality (Dos) increased with the dwell time in the PG and PG1 groups but decreased in the PG2 group. The increase in Dos was partially due to the degradation of glucose polymer, which was supported by the marked increase in osmolality over 24 hours of incubation of PG solution with peritoneal fluid, ex vivo. The diffusive mass transport coefficient for the investigated solutes did not differ among the three groups (except for glucose, which was significantly lower in the PG group). The sieving coefficient for sodium was significantly higher in the PG group compared to the PG1 group (p < 0.05). Conclusion Our results suggest that, although there was an initial decrease in the intraperitoneal dialysate volume, significant amounts of fluid can be removed by polyglucose solution during a single 4-hour dwell in rats, despite the low osmolality of the solution. The positive fluid removal induced by the PG solution is partially due to the lower fluid absorption rate associated with this solution and may, to some extent, also be due to the degradation of glucose polymer within the peritoneal cavity, resulting in increased dialysate osmolality. The addition of glucose to the polyglucose solution does not seem to improve ultrafiltration in a 4-hour dwell in the rat model. However, the peritoneal fluid absorption rate may be increased, and peritoneal transport of glucose and sodium may be altered, by adding glucose to the polyglucose solution.
Collapse
Affiliation(s)
- Tao Wang
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Olof Heimbürger
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Hui-Hong Cheng
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Jonas Bergström
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Fischbach M, Terzic J, Bergère V, Gaugler C, Provot E. The Optimal Approach to Peritoneal Dialysis Prescription in Children. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s76] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To describe the optimal approach to peritoneal dialysis (PO) prescription in children. .Design: Review of the available literature. Results Unlike the situation in adults, the main method used for PO in children is automated peritoneal dialysis (APO). The prone position, while resting, permits the dialysis prescription to use a higher fill volume (IPV), as in continuous ambulatory peritoneal dialysis (CAPO), and is also probably more effective than PO in an upright position. However, because APO is limited to 10 hours, the dialytic effectiveness of nocturnal APO should avoid two potential risks: (1) use of too high an IPV per exchange, inducing lymphatic reabsorption, a factor in unsuitable water and sodium balance [Fischbach M. Peritoneal dialysis prescription for neonates. Perit Diallnt. 1996; 16(Suppl): S52–4]; and (2) use of too short a dwell time per exchange, limiting the purification of creatinine and phosphate despite an apparently adequate urea purification (Malhotra C, Murota GH, Tzamaloukas AH. Creatinine clearance and urea clearance in PO: What to do in case of discrepancy. Perit Diallnt. 1997; 17:532–5).
Collapse
Affiliation(s)
- Michel Fischbach
- Nephrology Dialysis Transplantation, Children's Unit, Strasbourg, France
| | - Joëlle Terzic
- Nephrology Dialysis Transplantation, Children's Unit, Strasbourg, France
| | - Valerie Bergère
- Nephrology Dialysis Transplantation, Children's Unit, Strasbourg, France
| | - Christophe Gaugler
- Nephrology Dialysis Transplantation, Children's Unit, Strasbourg, France
| | - Emmanuel Provot
- Nephrology Dialysis Transplantation, Children's Unit, Strasbourg, France
| |
Collapse
|
3
|
Lameire N, Van Biesen W, Vanholder R. The Role of Peritoneal Dialysis as First Modality in an Integrative Approach to Patients with End-Stage Renal Disease. Perit Dial Int 2020. [DOI: 10.1177/089686080002002s26] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Norbert Lameire
- Renal Division, Department of Internal Medicine, University Hospital, Gent, Belgium
| | - Wim Van Biesen
- Renal Division, Department of Internal Medicine, University Hospital, Gent, Belgium
| | - Raymond Vanholder
- Renal Division, Department of Internal Medicine, University Hospital, Gent, Belgium
| |
Collapse
|
4
|
Jenkins SB, Wilkie ME. An Exploratory Study of a Novel Peritoneal Combination Dialysate (1.36% Glucose/7.5% Icodextrin), Demonstrating Improved Ultrafiltration Compared to Either Component Studied Alone. Perit Dial Int 2020. [DOI: 10.1177/089686080302300513] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective Concerns regarding the impact of ultrafiltration failure on peritoneal dialysis and the effect of hypertonic glucose on the peritoneal membrane have lead to a search for alternative dialysates. Computer simulations based on the three-pore theory suggest that a combination of 1.36% glucose and 7.5% icodextrin (glucose polymer) offers an improved ultrafiltration profile. The aim of the present study was to investigate the ultrafiltration profile of this combination fluid. Design Prospective open study comparing 1.36% glucose, 3.86% glucose, 7.5% icodextrin, and the combination fluid (1.36% glucose/7.5% icodextrin). Setting Sheffield Kidney Institute, Northern General Hospital, Sheffield, UK. Patients 11 patients currently using peritoneal dialysis not previously exposed to icodextrin. Main Outcome Measure Intraperitoneal volume was measured using a radioisotope dilution method. Results The combination fluid showed a biphasic ultrafiltration profile, with a steep initial increase in intraperitoneal volume, then a maintained plateau phase for the duration of the study dwell (7 hours). The final volume was greater than that with the 1.36% glucose dwell and the 7.5% icodextrin dwell. The fluid was well tolerated by the patients. Conclusions These findings are in keeping with computer simulations using the three-pore model. The combination fluid offers an improved ultrafiltration profile, with a final volume similar to 3.86% glucose, while avoiding exposing the peritoneal membrane to high glucose concentrations. It may have a role as a long dwell to optimize ultrafiltration and possibly prolong peritoneal dialysis technique survival.
Collapse
Affiliation(s)
- Sarah B. Jenkins
- Sheffield Kidney Institute, Northern General Hospital, Sheffield University Hospital Trust, Sheffield, South Yorkshire, United Kingdom
| | - Martin E. Wilkie
- Sheffield Kidney Institute, Northern General Hospital, Sheffield University Hospital Trust, Sheffield, South Yorkshire, United Kingdom
| |
Collapse
|
5
|
Shockley TR, Martis L, Tranæus AP. New Solutions for Peritoneal Dialysis in Adult and Pediatric Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s70] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ty R. Shockley
- Renal Division Baxter Healthcare, McGaw Park, Illinois, U.S.A
| | - Leo Martis
- Renal Division Baxter Healthcare, McGaw Park, Illinois, U.S.A
| | | |
Collapse
|
6
|
Krediet RT, Zweers MM, Ho-Dac-Pannekeet MM, Van Der Wal AC, Smit W, Douma CE, Mateijsen MA, Struijk DG. The Effect of Various Dialysis Solutions on Peritoneal Membrane Viability. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s43] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Machteld M. Zweers
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Marja M. Ho-Dac-Pannekeet
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Allard C. Van Der Wal
- Department of Cardiovascular Pathology, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Watske Smit
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Caroline E. Douma
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Maartje A.M. Mateijsen
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| | - Dirk G. Struijk
- Division of Nephrology, Department of Medicine, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Dianet Foundation, Utrecht-Amsterdam, The Netherlands
| |
Collapse
|
7
|
The contribution of combined crystalloid and colloid osmosis to fluid and sodium management in peritoneal dialysis. Kidney Int 2008:S102-11. [PMID: 18379532 DOI: 10.1038/sj.ki.5002610] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The achievement of euvolemia is essential to the successful management of peritoneal dialysis patients. However, the concern that hypertonic glucose exchanges may have a role in long-term changes to the peritoneal membrane has lead to an alternative strategy to enhance ultrafiltration (UF) over the long dwell by combining crystalloid and colloid osmosis. This review summarizes the experience of mixing glucose or amino acids with polyglucose (icodextrin), with particular focus given to data from studies using glucose/icodextrin in combinations of 1.36%/7.5% and 2.61%/6.8%. Both combinations demonstrate a significant increment of UF volume and sodium removal compared with the component osmotic agents used individually over long dwells, with the 2.61%/6.8% mixture having an effect over dwells extending to 15 h. Hypothetically, the mechanism of the enhanced UF is the attenuation by the colloid osmotic force of the backflow of water through small pores from dialysate to the peritoneal capillary circulation once the crystalloid osmotic force has dissipated. This experience provides promising data that deserves further examination in longer term clinical studies.
Collapse
|
8
|
Johnson DW, Agar J, Collins J, Disney A, Harris DCH, Ibels L, Irish A, Saltissi D, Suranyi M. Recommendations for the use of icodextrin in peritoneal dialysis patients. Nephrology (Carlton) 2004; 8:1-7. [PMID: 15012742 DOI: 10.1046/j.1440-1797.2003.00117.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Icodextrin is a starch-derived, high molecular weight glucose polymer, which has been shown to promote sustained ultrafiltration equivalent to that achieved with hypertonic (3.86%/4.25%) glucose exchanges during prolonged intraperitoneal dwells (up to 16 h). Patients with impaired ultrafiltration, particularly in the settings of acute peritonitis, high transporter status and diabetes mellitus, appear to derive the greatest benefit from icodextrin with respect to augmentation of dialytic fluid removal, amelioration of symptomatic fluid retention and possible prolongation of technique survival. Glycaemic control is also improved by substituting icodextrin for hypertonic glucose exchanges in diabetic patients. Preliminary in vitro and ex vivo studies suggest that icodextrin demonstrates greater peritoneal membrane biocompatibility than glucose-based dialysates, but these findings need to be confirmed by long-term clinical studies. This paper reviews the available clinical evidence pertaining to the safety and efficacy of icodextrin and makes recommendations for its use in peritonal dialysis.
Collapse
Affiliation(s)
- David W Johnson
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Fischbach M, Stefanidis CJ, Watson AR. Guidelines by an ad hoc European committee on adequacy of the paediatric peritoneal dialysis prescription. Nephrol Dial Transplant 2002; 17:380-5. [PMID: 11865081 DOI: 10.1093/ndt/17.3.380] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michel Fischbach
- Centre Hospitalier Regional et Universitaire, Hopital de Hautepierre, Strasbourg, France
| | | | | |
Collapse
|
10
|
Lilaj T, Dittrich E, Puttinger H, Schneider B, Haag-Weber M, Hörl WH, Vychytil A. A preceding exchange with polyglucose versus glucose solution modifies peritoneal equilibration test results. Am J Kidney Dis 2001; 38:118-26. [PMID: 11431191 DOI: 10.1053/ajkd.2001.25204] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The peritoneal equilibration test (PET) is an important tool for evaluating peritoneal membrane characteristics. The polyglucose icodextrin induces ultrafiltration caused by colloid osmosis through the small pores of the peritoneal membrane and therefore is especially effective during long dwell times. The main indications for polyglucose solutions are daytime dwells in patients on automated peritoneal dialysis and nighttime exchanges in continuous ambulatory peritoneal dialysis (CAPD) patients. In CAPD patients, PET is started immediately after the icodextrin exchange. Therefore, we performed two PETs in each of 15 CAPD patients. PET post-1.36% glucose was performed immediately after a preceding exchange with 2 L of 1.36% glucose dialysate solution (dwell time, 10 hours). PET postpolyglucose was started immediately after a preceding exchange with 2 L of 7.5% icodextrin solution (dwell time, 10 hours). The dialysate to plasma (D/P) ratio of creatinine, phosphate, and sodium during PET postpolyglucose was significantly greater than during PET post-1.36% glucose at 1, 2, 3, and 4 hours of dwell time. The quotient of dialysate glucose at 1, 2, and 4 hours of dwell time to dialysate glucose at 0 dwell time was significantly lower in PET postpolyglucose compared with PET post-1.36% glucose. In the case of creatinine, phosphate, and glucose, PET postpolyglucose curves tended to be steeper than those of PET post-1.36% glucose during the first hour of dwell time, whereas both curves were parallel between 1 and 4 hours of dwell time. The course of D/P ratio curves of urea nitrogen, protein, and albumin was nearly identical between PET postpolyglucose and PET post-1.36% glucose. In a subgroup of 5 patients, D/P ratios of creatinine and phosphate were also greater in PET postpolyglucose compared with PET performed after a long dwell with 2.27% glucose solution. Before a scheduled PET, CAPD patients using icodextrin solution during the nighttime should perform their nighttime exchange with conventional glucose solution.
Collapse
Affiliation(s)
- T Lilaj
- Department of Medicine III, Division of Nephrology, University Hospital of Vienna
| | | | | | | | | | | | | |
Collapse
|
11
|
Wang T, Cheng HH, Heimbürger O, Waniewski J, Bergström J, Lindholm B. Effect of peritonitis on peritoneal transport characteristics: glucose solution versus polyglucose solution. Kidney Int 2000; 57:1704-12. [PMID: 10760106 DOI: 10.1046/j.1523-1755.2000.00015.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Peritonitis is a common clinical problem and contributes to the high rate of technique failure in continuous ambulatory peritoneal dialysis treatment. The present study investigated the effect of peritonitis on peritoneal fluid and solute transport characteristics using glucose and polyglucose (icodextrin) solutions. METHODS A four-hour dwell was performed in 32 Sprague-Dawley rats (8 rats in each group), with 131I albumin as an intraperitoneal volume marker. Peritonitis was induced by an intraperitoneal injection of 2 mL lipopolysaccharide (100 microg/mL phosphate-buffered saline) four hours before the dwell. Each rat was intraperitoneally infused with 25 mL of 3.86% glucose [glucose solution control group (Gcon) and glucose solution peritonitis group (Gpts)] or 7.5% icodextrin solution [icodextrin solution control group (Pgcon) and icodextrin peritonitis group (PGpts)]. RESULTS Net ultrafiltration was significantly lower (by 44%) in the Gpts as compared with the Gcon group, but was significantly higher (by 138%) in the PGpts as compared with the PGcon group. The peritoneal fluid absorption rate, including the direct lymphatic absorption rate, was significantly increased (by 78%) in the Gpts group as compared with the Gcon group. However, the total fluid absorption did not differ between the PGpts and the PGcon groups. The dialysate osmolality decreased much faster in the Gpts group as compared with the Gcon group, resulting in significantly lower (by 9%) transcapillary ultrafiltration in the Gpts group. In contrast, the dialysate osmolality increased faster in the PGpts group as compared with the PGcon group, resulting in higher (by 40%) transcapillary ultrafiltration in the PGpts group. The in vitro increase in dialysate osmolality was also higher in the PGpts group as compared with the PGcon group. The solute diffusive transport rates were, in general, increased in the two peritonitis groups as compared with their respective control groups. CONCLUSIONS Our results suggest the following: (1) Peritonitis results in decreased net ultrafiltration using glucose solution caused by (a) decreased transcapillary ultrafiltration and (b) increased peritoneal fluid absorption. (2) Ultrafiltration induced by the icodextrin solution appears to be related to the increase in dialysate osmolality (mainly because of the degradation of icodextrin). (3) Peritonitis results in increased degradation of icodextrin and a faster increase in dialysate osmolality and therefore better ultrafiltration, whereas the fluid absorption rate does not change. (4) Peritonitis results in increased peritoneal diffusive permeability.
Collapse
Affiliation(s)
- T Wang
- Divisions of Baxter Novum and Renal Medicine, Huddinge University Hospital, Karolinska Institute, Huddinge, Sweden
| | | | | | | | | | | |
Collapse
|
12
|
Van Biesen W, Vanholder R, Lameire N. Recent developments in osmotic agents for peritoneal dialysis. ADVANCES IN RENAL REPLACEMENT THERAPY 1998; 5:218-31. [PMID: 9686633 DOI: 10.1016/s1073-4449(98)70035-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although glucose is still the most widely used osmotic agent for peritoneal dialysis, it has several disadvantages that challenge its long-term use. During the past years several nonglucose molecules have been tested as osmotic agents for peritoneal dialysis. Most of these molecules have some advantages over glucose, but they also have drawbacks. Every new agent should be carefully tested for performance and long-term safety. In the following review, alternative osmotic agents are discussed, including their potential indications and drawbacks. Major issues include the improvement of biocompatibility and preservation of peritoneal membrane integrity by using dialysate with more physiologic pH, the effect on nutritional status by using dialysate with amino acids, and maintenance of peritoneal ultrafiltration in the long-term by using dialysate with polyglucose. It is believed that in the near future, mixtures of osmotic agents will become most appropriate to obtain the best performance.
Collapse
Affiliation(s)
- W Van Biesen
- Department of Internal Medicine, University Hospital, Gent, Belgium
| | | | | |
Collapse
|