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Peritoneal Dialysis International :... Sep 2023The peritoneal equilibration test (PET), first described in 1987, is a semiquantitative assessment of peritoneal transfer characteristics in patients undergoing... (Review)
Review
The peritoneal equilibration test (PET), first described in 1987, is a semiquantitative assessment of peritoneal transfer characteristics in patients undergoing peritoneal dialysis. It is typically performed as a 4-h exchange using 2.27/2.5% dextrose dialysate with serial measurements of blood and dialysate creatinine, urea, and glucose concentrations. The percentage absorption of glucose and D/P creatinine ratio are used to determine peritoneal solute transfer rates. It is used to both help guide peritoneal dialysis prescriptions and to prognosticate. There are several derivative tests which have been described in the literature. In this review, we describe the original PET, the various iterations of the PET, the information gleaned, and the use in the setting of poor solute clearance and in the diagnosis of membrane dysfunction, and limitations of the PET.
Topics: Humans; Peritoneal Dialysis; Creatinine; Peritoneum; Dialysis Solutions; Glucose
PubMed: 36350033
DOI: 10.1177/08968608221133629 -
Diagnostic Microbiology and Infectious... May 2017
Topics: Bacteremia; Bicarbonates; Catheter-Related Infections; Dialysis Solutions; Disease Outbreaks; Drug Contamination; Gram-Negative Bacterial Infections; Halomonas; Humans; Renal Dialysis
PubMed: 28274500
DOI: 10.1016/j.diagmicrobio.2017.01.021 -
Journal of Nephrology Feb 2020The major trials in peritoneal dialysis (PD) have demonstrated that increasing peritoneal clearance of small solutes is not associated with any advantage on survival,... (Review)
Review
The major trials in peritoneal dialysis (PD) have demonstrated that increasing peritoneal clearance of small solutes is not associated with any advantage on survival, whereas sodium and fluid overload heralds higher risk of death and technique failure. On the other hand, higher sodium and fluid overload due to loss of residual kidney function (RKF) and higher transport membrane is associated with poor patient and technique survival. Recent experimental studies also show that, independently from fluid overload, sodium accumulation in the peritoneal interstitium exerts direct inflammatory and angiogenetic stimuli, with consequent structural and functional changes of peritoneum, while in patients with Chronic Kidney Disease sodium stored in interstitial skin acts as independent determinant of left ventricular hypertrophy. Noteworthy, this tissue pool of sodium is modifiable being removed by dialysis. Therefore, novel PD strategies to optimize sodium removal, including the use of bimodal and/or low-sodium solutions, are actively tested. Nonetheless, a holistic approach aimed at preserving peritoneal function and the kidney may represent the key of therapy success in the hard task of preserving adequate sodium balance in PD patients. In this review, we describe the available evidence on sodium toxicity in PD, either related or unrelated to fluid overload, and we also discuss about possible "solutions" to preserve or restore sodium balance in PD patients.
Topics: Dialysis Solutions; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Sodium
PubMed: 31734929
DOI: 10.1007/s40620-019-00673-4 -
International Urology and Nephrology Mar 2018The impact of icodextrin (ico) on peritoneal dialysis (PD) extension and patient survival is well established. Predominantly, ico-based solutions were prescribed in... (Review)
Review
The impact of icodextrin (ico) on peritoneal dialysis (PD) extension and patient survival is well established. Predominantly, ico-based solutions were prescribed in high-transporter PD patients. Advantages of the ico-based solutions include increased biocompatibility, avoidance of glucotoxicity, enhanced ultrafiltration failure (UF), sodium removal rates, better metabolic and blood pressure control. Bimodal solutions and twice daily exchanges of ico-based solutions are two newly introduced strategies to avoid glucose exposure and/or enhance UF in PD patients with UF failure. In addition, a simplified schedule of PD using a single nocturnal exchange of ico in patients with refractory congestive heart failure may represent an alternative option to manage fluid removal and azotaemia. The use of a simplified schedule of PD with only two ico exchanges or a single ico exchange is a challenging approach for end-stage renal disease patients with preserved residual function who desire to initiate PD.
Topics: Dialysis Solutions; Glucans; Glucose; Heart Failure; Humans; Icodextrin; Peritoneal Dialysis; Renal Insufficiency, Chronic
PubMed: 28674854
DOI: 10.1007/s11255-017-1647-2 -
Contributions To Nephrology 2017Glucose-based peritoneal dialysis (PD) solutions are the mainstay of therapy for PD patients, yet are accompanied by a number of adverse effects and potential... (Review)
Review
Glucose-based peritoneal dialysis (PD) solutions are the mainstay of therapy for PD patients, yet are accompanied by a number of adverse effects and potential complications. The high glucose content can cause both systemic effects, such as hyperglycaemia, as well as local effects on the peritoneal membrane, which can interfere with its function. In addition, glucose degradation products (GDPs) generated during heat sterilization of the solutions and the acidic pH at which these solutions are kept have been shown to cause peritoneal membrane injury and precipitate inflow pain, respectively. As a result, biocompatible PD solutions, characterized by neutral pH and low GDP concentrations, have been developed. However, the published evidence supporting their use has often been conflicting and of variable methodological quality. This review aims to discuss the relevant literature and up-to-date evidence for the use of biocompatible PD solutions.
Topics: Biocompatible Materials; Dialysis Solutions; Glucose; Humans; Peritoneal Dialysis; Peritoneum; Sterilization
PubMed: 27951555
DOI: 10.1159/000450690 -
Blood Purification 2019Intermittent infusion hemodiafiltration (I-HDF) has been developed to prevent a rapid drop in blood pressure during a dialysis session and to improve peripheral... (Review)
Review
BACKGROUND
Intermittent infusion hemodiafiltration (I-HDF) has been developed to prevent a rapid drop in blood pressure during a dialysis session and to improve peripheral circulation. In Japan, >10,000 dialysis patients underwent treatment with I-HDF in 2017, and the number of dialysis patients is increasing year by year. I-HDF involves the intermittent infusion of ultrapure dialysis fluid or sterile nonpyrogenic substitution fluid, for example, at a volume of 200 mL and a rate of 150 mL/min by backfiltration every 30 min during treatment. The total infusion volume can therefore be estimated at 200 (mL) × 7 (infusions) or 1.4 L/session. I-HDF may be regarded as online HDF with a very small replacement volume.
SUMMARY
Several clinical trials of I-HDF have been conducted in Japan. (1) In a 2007 study, despite there being no differences noted in the volume of water removal between hemodialysis (HD) and I-HDF, a significantly lower rate of reduction in the time-averaged blood volume was seen in I-HDF than in HD, so the plasma refilling rate was greater during I-HDF. (2) In a 2015 study, at 13 weeks after a switch from HD, I-HDF was found to be significantly superior to HD in terms of the incidence of events needing intervention by medical staff. However, significantly lower blood β2-microglobulin (MG) and α1-MG levels were observed in the predilution online HDF (pre-HDF) group than in the I-HDF group, and the amount of albumin leak was lower in the I-HDF group than in the pre-HDF group. (3) In a 2017 study, compared with HD, I-HDF was associated with a reduced number of interventions for intradialytic hypotension and less severe tachycardia, suggesting less sympathetic stimulation during I-HDF. Key messages: I-HDF is a valid treatment option because it is associated with an increased plasma refilling rate and fewer interventions needed by medical staff.
Topics: Blood Pressure; Blood Volume; Dialysis Solutions; Female; Hemodiafiltration; Humans; Hypotension; Male
PubMed: 31752002
DOI: 10.1159/000503891 -
Nefrologia : Publicacion Oficial de La... 2017The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal... (Review)
Review
The measure of intraperitoneal pressure in peritoneal dialysis is easy and provides clear therapeutic benefits. However it is measured only rarely in adult peritoneal dialysis units. This review aims to disseminate the usefulness of measuring intraperitoneal pressure. This measurement is performed in supine before initiating the drain of a manual exchange with "Y" system, by raising the drain bag and measuring from the mid-axillary line the height of the liquid column that rises from the patient. With typical values of 10-16 cmHO, intraperitoneal pressure should never exceed 18 cmHO. With basal values that depend on body mass index, it increases 1-3 cmHO/L of intraperitoneal volume, and varies with posture and physical activity. Its increase causes discomfort, sleep and breathing disturbances, and has been linked to the occurrence of leaks, hernias, hydrothorax, gastro-esophageal reflux and enteric peritonitis. Less known and valued is its ability to decrease the effectiveness of dialysis significantly counteracting ultrafiltration and decreasing solute clearance to a smaller degree. Because of its easy measurement and potential utility, should be monitored in case of ultrafiltration failure to rule out its eventual contribution in some patients. Although not yet mentioned in the clinical practice guidelines for PD, its clear benefits justify its inclusion among the periodic measurements to consider for prescribing and monitoring peritoneal dialysis.
Topics: Adult; Ascitic Fluid; Body Mass Index; Dialysis Solutions; Humans; Hydrostatic Pressure; Kidney Failure, Chronic; Manometry; Peritoneal Dialysis; Pressure; Reference Values; Supine Position; Ultrafiltration
PubMed: 28739249
DOI: 10.1016/j.nefro.2017.05.014 -
Seminars in Dialysis Jan 2023Hemodialysis solutions typically contain a high alkali concentration designed to counter interdialytic acidosis, but this could result in persistent alkalosis in some...
BACKGROUND
Hemodialysis solutions typically contain a high alkali concentration designed to counter interdialytic acidosis, but this could result in persistent alkalosis in some patients. The prevalence and significance of persistent alkalosis were therefore examined at four outpatient centers over a 10-year period.
METHODS
Alkalosis was defined as a pre-dialysis serum [HCO ] ≥ 26 meq/L in >6 months of a 12-month period and was persistent if present in a majority of months thereafter. Control patients had a serum [HCO ] of 19-23 meq/L > 6 of every 12 months. Standard, citrate-containing dialysate was used in all patients without adjustment of bicarbonate concentration.
RESULTS
444 of 1271 patients had alkalosis that persisted in 73. Compared to control patients, persistently alkalotic patients were older, but gender, race, starting weight, comorbidities, and mortality did not differ. Dialysis dose was 7% greater, protein catabolic rate was 11% lower, and interdialytic weight gain was 29% lower, all p < 0.001. Persistently alkalotic patients had double the incidence of cardiac arrhythmias (p = 0.07) and a 20% greater intradialytic blood pressure decrease (p < 0.001).
CONCLUSIONS
Alkalosis is common in hemodialysis patients and can be persistent, likely due to decreased protein catabolic rate and increased dialysis dose, and may have detrimental cardiovascular effects.
Topics: Humans; Renal Dialysis; Prospective Studies; Dialysis Solutions; Hemodialysis Solutions; Alkalosis; Bicarbonates
PubMed: 35384078
DOI: 10.1111/sdi.13068 -
Giornale Italiano Di Nefrologia :... Oct 2021Peritoneal dialysis is an efficient renal replacement therapy for uremic patients but is currently under-prescribed. This is partly due to the unfavorable effects on... (Review)
Review
Peritoneal dialysis is an efficient renal replacement therapy for uremic patients but is currently under-prescribed. This is partly due to the unfavorable effects on peritoneal morphology and function (bioincompatibility) of current glucose-based solutions. Use of standard solutions can cause several peritoneal alterations including inflammation, mesothelial to mesenchymal transition, and neo-angiogenesis. The final step is fibrosis, which reduces the peritoneal filtration capacity and can lead to ultrafiltration failure and transfer of the patient to hemodialysis. Bioincompatibility can be local (peritoneum) but also systemic, due to the excessive absorption of glucose from the dialysate. Several strategies have been adopted to improve the biocompatibility of peritoneal dialysis solutions, based on the alleged causal factors. Some new solutions available on the market contain low glucose degradation products and neutral pH, others contain icodextrin or aminoacids. Clinical benefits have been associated with the use of these solutions, which however have some limitations and a debated biocompatibility profile. More recent strategies include the use of cytoprotective agents or osmo-metabolic agents in the dialysate. In this article, we review the different approaches currently under development to improve the biocompatibility of peritoneal dialysis solution and hence the clinical outcome and the viability of the technique.
Topics: Dialysis Solutions; Glucose; Humans; Icodextrin; Peritoneal Dialysis; Peritoneum
PubMed: 34713640
DOI: No ID Found -
Peritoneal Dialysis International :... Nov 2023To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop... (Review)
Review
To optimise antimicrobial administration in patients with peritoneal dialysis (PD)-related peritonitis, healthcare providers need literature-based information to develop patient-centred pharmacotherapeutic plans. Traditional PD solutions promote osmosis using dextrose or icodextrin with a lactate buffer. Newer PD solutions have modified the osmotic vehicle and buffer. Knowledge of antimicrobial compatibility and stability with newer PD solutions will assist with determining the route of antimicrobial administration as compatible and stable solutions could be delivered directly to the peritoneum using intraperitoneal administration. This review updates the compatibility and stability of antimicrobial additives in newer PD solutions for PD-related peritonitis.
Topics: Humans; Peritoneal Dialysis; Dialysis Solutions; Peritonitis; Anti-Infective Agents; Lactic Acid; Glucose
PubMed: 37728078
DOI: 10.1177/08968608231196034