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Peritoneal Dialysis International :... 2001To provide guidelines on choosing dialysis solutions for children on chronic peritoneal dialysis (PD). (Review)
Review
OBJECTIVE
To provide guidelines on choosing dialysis solutions for children on chronic peritoneal dialysis (PD).
SETTING
European Paediatric Peritoneal Dialysis Working Group.
DATA SOURCE
Literature on the application of PD solutions in children (Evidence), and discussions within the group (Opinion).
CONCLUSIONS
Glucose is the standard osmotic agent for PD in children (Evidence). The lowest glucose concentration needed should be used (Opinion). Low calcium solution (1.25 mmol/L) should be applied, wherever possible, with careful monitoring of parathyroid hormone levels (Opinion). The use of amino acid-containing dialysis fluids can be considered in malnourished children, although aggressive enteral nutrition is preferred (Opinion). There is insufficient evidence documenting the efficacy of intraperitoneally administered amino acids (Evidence). When ultrafiltration and/or solute removal are insufficient, polyglucose solutions are a welcome addition to the treatment of children on nocturnal intermittent PD (Evidence). However, in the absence of any reported long-term experience with children, their use must be closely monitored (Opinion). Bicarbonate would appear to be the preferred buffer for PD in children, but more in vivo studies are required before it replaces the present lactate-containing solutions (Evidence/Opinion).
Topics: Acetates; Amino Acids; Bicarbonates; Buffers; Child; Dialysis Solutions; Glucans; Glucose; Humans; Lactic Acid; Osmosis; Peritoneal Dialysis; Peritoneum
PubMed: 11783765
DOI: No ID Found -
American Journal of Kidney Diseases :... May 1996
Review
Topics: Biocompatible Materials; Dialysis Solutions; Drug Evaluation; Humans; Peritoneal Dialysis, Continuous Ambulatory; Peritoneum
PubMed: 8629638
DOI: 10.1016/s0272-6386(96)90114-6 -
Clinical Journal of the American... Aug 2015Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A... (Meta-Analysis)
Meta-Analysis Review
Effect of Neutral-pH, Low-Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis.
BACKGROUND AND OBJECTIVES
Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers.
RESULTS
Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including >1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =-110; 95% confidence interval, -312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06).
CONCLUSIONS
The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.
Topics: Biomarkers; Chi-Square Distribution; Creatinine; Dialysis Solutions; Glucose; Humans; Hydrogen-Ion Concentration; Kidney; Kidney Diseases; Peritoneal Dialysis; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome; Urination; Urodynamics
PubMed: 26048890
DOI: 10.2215/CJN.05410514 -
Kidney International. Supplement Nov 1996
Review
Topics: Amino Acids; Dialysis Solutions; Humans; Nutritional Status; Peritoneal Dialysis
PubMed: 8914059
DOI: No ID Found -
Peritoneal Dialysis International :... Jun 2007Compelling data underscore the bioincompatible nature of glucose-based peritoneal dialysis (PD) solutions and their detrimental effects on peritoneal physiology and... (Review)
Review
BACKGROUND
Compelling data underscore the bioincompatible nature of glucose-based peritoneal dialysis (PD) solutions and their detrimental effects on peritoneal physiology and morphology. New PD solutions have been formulated to tackle common clinical problems such as inadequate ultrafiltration or malnutrition, and to improve biocompatibility-the latter aimed at preserving the structural and functional integrity of the peritoneum and reducing adverse systemic effects on the patient.
METHODS
This article reviews the factors in PD fluids that alter normal peritoneal anatomy and physiology, and the data that illustrate approaches to investigating the local and systemic biocompatibility of new PD solutions.
RESULTS
Chronic exposure of the peritoneal membrane to glucose-based PD solutions results in denudation of the mesothelium, thickened submesothelium, and hyalinization of the vasculature, often resulting in reduced or lost solute and water clearance. Data from in vitro or animal experiments and clinical studies have shown improved biocompatibility profiles with new PD solutions that are glucose-free (that is, dialysates with amino acids or icodextrin), bicarbonate-buffered, or compartmentalized during heat sterilization to reduce levels of glucose degradation products. Improved biocompatibility is denoted by reduced induction of proinflammatory, profibrotic, or angiogenic growth factors in mesothelial cells and macrophages, or by less perturbation of leukocyte phagocytic function.
CONCLUSIONS
Data from in vitro and animal experiments show more favorable biocompatibility profiles with new PD fluids than with glucose-based dialysates. Clinical studies are ongoing to assess the impact of the new PD fluids on peritoneal function, morbidity, and mortality.
Topics: Amino Acids; Animals; Bicarbonates; Biocompatible Materials; Buffers; Dialysis Solutions; Glucans; Glucose; Humans; Icodextrin; Peritoneal Dialysis; Peritoneum
PubMed: 17556337
DOI: No ID Found -
Blood Purification 1989The ideal components of peritoneal dialysate and their ideal concentrations have yet to be defined. This article reviews the hazards inherent in present solutions and... (Review)
Review
The ideal components of peritoneal dialysate and their ideal concentrations have yet to be defined. This article reviews the hazards inherent in present solutions and emphasises the dual needs for uniformity of approach to composition and for agreement on minimal international standards for solution quality control.
Topics: Buffers; Dialysis Solutions; Drug Contamination; Electrolytes; Humans; Osmosis; Peritoneal Dialysis, Continuous Ambulatory
PubMed: 2663039
DOI: 10.1159/000169581 -
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 -
ASAIO Journal (American Society For... 2003We used the thermodynamic principles governing bound solute dialysis, commonly referred to as "albumin dialysis" or "sorbent dialysis" and practiced clinically with the... (Comparative Study)
Comparative Study
We used the thermodynamic principles governing bound solute dialysis, commonly referred to as "albumin dialysis" or "sorbent dialysis" and practiced clinically with the Molecular Adsorbent Recirculating System (MARS) and Biologic-DT approaches, respectively, to develop a comprehensive understanding of the process. Dimensionless parameters emerging from the thermodynamic analysis that govern bound solute dialysis are as follows: (1) lambda, the binding power of the solute binding moiety; (2) kappa, the dialyzer mass transfer/blood flow rate ratio; (3) alpha, the dialysate/blood flow rate ratio; (4) beta, the dialysate/blood binding moiety concentration ratio, and (5) psi, the solute/binding moiety concentration ratio in the blood. Results from a mathematical model of countercurrent bound solute dialysis for phi = 0.9 indicate that for a given binding moiety (fixed lambda), the most important parameter for achieving high removal rates is the dialyzer mass transfer ratio for free (unbound) solute. The results also show solute removal approaching an asymptote with increasing beta that is dependent on kappa and independent of alpha. More importantly, results indicate that once a dialysis membrane is chosen, solute removal is virtually independent of blood flow rate, dialysate flow rate, and amount of binding moiety in the dialysate, provided the amount is greater than approximately 90% of that required to reach the asymptote. Experimental observations over a range of blood flow rates (100-400 ml/ minute), dialysate flow rates (50-400 ml/minute), and dialysate/blood albumin concentration ratios (beta = 0-0.3) corroborate the model predictions and indicate that < 4 g/L albumin in the dialysate solution is required for effective bound solute dialysis. The experimental results also show evidence of enhanced mass transfer once the dialysis membrane pore structure surface saturates with albumin.
Topics: Albumins; Charcoal; Dialysis; Dialysis Solutions; Diffusion; Filtration; Membranes, Artificial; Models, Theoretical; Thermodynamics
PubMed: 12790375
DOI: 10.1097/01.mat.0000065378.73558.83 -
American Journal of Kidney Diseases :... May 2015Biocompatible solutions may lower peritonitis rates, but are more costly than conventional solutions. The aim of the present study was to assess the additional costs and... (Comparative Study)
Comparative Study Randomized Controlled Trial
Economic evaluation of neutral-pH, low-glucose degradation product peritoneal dialysis solutions compared with standard solutions: a secondary analysis of the balANZ Trial.
BACKGROUND
Biocompatible solutions may lower peritonitis rates, but are more costly than conventional solutions. The aim of the present study was to assess the additional costs and health outcomes of biocompatible over conventional solutions in incident peritoneal dialysis patients to guide practice decisions.
STUDY DESIGN
Secondary economic evaluation of a randomized controlled trial.
SETTING & POPULATION
185 participants in the balANZ trial.
MODEL, PERSPECTIVE, & TIMEFRAME
Cost-effectiveness of biocompatible compared to standard solution over the 2 years using an Australian health care funder perspective.
INTERVENTION
Intervention group received biocompatible solutions and control group received standard solutions over 2 years.
OUTCOMES
Costs included dialysis charges, costs of treating peritonitis, non-peritonitis-related hospital stays, and medication. Peritonitis was the health outcome of interest; incremental cost-effectiveness ratios were reported in terms of the additional cost per additional patient avoiding peritonitis at 2 years.
RESULTS
Mean total per-patient costs were A$57,451 and A$53,930 for the biocompatible and standard-solution groups, respectively. The base-case analysis indicated an incremental cost of A$17,804 per additional patient avoiding peritonitis at 2 years for biocompatible compared to standard solution. In a sensitivity analysis excluding extreme outliers for non-peritonitis-related hospitalizations, mean per-patient costs were A$49,159 and A$52,009 for the biocompatible and standard-solution groups, respectively. Consequently, the incremental cost-effectiveness ratio also was reduced significantly: biocompatible solution became both less costly and more effective than standard solution and, in economic terms, was dominant over standard solution.
LIMITATIONS
Peritonitis was a secondary outcome of the balANZ trial. Health outcomes measured only in terms of patients avoiding peritonitis over 2 years may underestimate the longer term benefits (eg, prolonged technique survival).
CONCLUSIONS
Biocompatible dialysis solutions may offer a cost-effective alternative to standard solutions for peritoneal dialysis patients. Reductions in peritonitis-related hospital costs may offset the higher costs of biocompatible solution.
Topics: Adult; Aged; Biocompatible Materials; Cost-Benefit Analysis; Dialysis Solutions; Female; Humans; Hydrogen-Ion Concentration; Kidney Failure, Chronic; Male; Middle Aged; Quality-Adjusted Life Years
PubMed: 25746151
DOI: 10.1053/j.ajkd.2014.12.017 -
Kidney International. Supplement Dec 2003The application of animal models to study the biocompatibility of bicarbonate-buffered peritoneal dialysis solutions. Patients treated with peritoneal dialysis (PD) are... (Review)
Review
The application of animal models to study the biocompatibility of bicarbonate-buffered peritoneal dialysis solutions. Patients treated with peritoneal dialysis (PD) are at risk for development of ultrafiltration failure and peritonitis. These two significant complications can result in the termination of PD treatment. The relative unphysiologic composition of the currently used standard peritoneal dialysis fluids (PDF) is considered to be a major cause for the development of morphologic changes of the peritoneal membrane, ultimately resulting in ultrafiltration failure and probably contributing to changes in local defense mechanisms with the associated increased risk of peritonitis. In recent years, a major research focus has become the development of new and improved PD solutions. This has resulted in the development of an amino-acid-based PDF, a glucose polymer-based PDF, and several bicarbonate-buffered PDF. Typically, the first phase of biocompatibility testing of new PD solutions involves in vitro testing, employing isolated cells such as peritoneal macrophages or cell culture systems using human peritoneal mesothelial cells. The results of such evaluations are useful in providing insights into the biocompatibility performance of any given formulation, but suffer from several disadvantages, which can be better addressed using animal models. In vivo studies using animals permit the analysis of biocompatibility under conditions that allow for cell-to-cell interactions and dynamic changes in solution composition that more closely mimic the clinical situation. In this paper, we will review the use of animal models for the study of PDF biocompatibility and their application to the assessment of bicarbonate-buffered PDF.
Topics: Animals; Bicarbonates; Buffers; Dialysis Solutions; Materials Testing; Models, Animal; Peritoneal Dialysis; Peritoneum
PubMed: 14870880
DOI: 10.1046/j.1523-1755.2003.08808.x