-
Kidney International. Supplement Dec 2003Buffer transport in peritoneal dialysis. The success of peritoneal dialysis as a robust modality of renal replacement therapy has invited a quest for ameliorations in... (Review)
Review
Buffer transport in peritoneal dialysis. The success of peritoneal dialysis as a robust modality of renal replacement therapy has invited a quest for ameliorations in its underlying technology aimed at enhancing patient satisfaction and preserving the central instrument of the therapy, namely the peritoneal membrane. The health and longevity of the membrane have motivated and continue to drive a series of iterative innovations in the composition, methods of production, and delivery of dialysis solutions. It is the purpose of this article to review aspects of these innovations pertaining to buffer composition in dialysis solutions and the peritoneal mechanisms of buffer transport.
Topics: Biological Transport; Buffers; Dialysis Solutions; Humans; Peritoneal Dialysis
PubMed: 14870876
DOI: 10.1046/j.1523-1755.2003.08804.x -
Pediatric Nephrology (Berlin, Germany) Jul 2011The purpose of this article is to provide recommendations on the choice of peritoneal dialysis (PD) fluids in children by the European Pediatric Dialysis Working Group....
The purpose of this article is to provide recommendations on the choice of peritoneal dialysis (PD) fluids in children by the European Pediatric Dialysis Working Group. The literature on experimental and clinical studies with PD solutions in children and adults was analyzed together with consensus discussions within the group. A grading was performed based on the international KDIGO nomenclature and methods. The lowest glucose concentration possible should be used. Icodextrin may be applied once daily during the long dwell, in particular in children with insufficient ultrafiltration. Infants on PD are at risk of ultrafiltration-associated sodium depletion, while anuric adolescents may have water and salt overload. Hence, the sodium chloride balance needs to be closely monitored. In growing children, the calcium balance should be positive and dialysate calcium adapted according to individual needs. Limited clinical experience with amino acid-based PD fluids in children suggests good tolerability. The anabolic effect, however, is small; adequate enteral nutrition is preferred. CPD fluids with reduced glucose degradation products (GDP) content reduce local and systemic toxicity and should be preferred whenever possible. Correction of metabolic acidosis is superior with pH neutral bicarbonate-based fluids compared with single-chamber, acidic, lactate-based solutions. Prospective comparisons of low GDP solutions with different buffer compositions are still few, and firm recommendations cannot yet be given, except when hepatic lactate metabolism is severely compromised.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Dialysis Solutions; Europe; Humans; Infant; Patient Selection; Peritoneal Dialysis; Risk Assessment; Risk Factors
PubMed: 21448787
DOI: 10.1007/s00467-011-1863-4 -
Blood Purification 2003This paper reviews some important recent findings on the molecular biology of the peritoneal membrane. It attempts to correlate in vitro and in vivo experimental results... (Review)
Review
This paper reviews some important recent findings on the molecular biology of the peritoneal membrane. It attempts to correlate in vitro and in vivo experimental results with the possible clinical consequences. The most common functional alteration during long-term CAPD is increased peritoneal small-solute transport rate, resulting in impaired ultrafiltration and decreased dialysis efficiency. This contribution first discusses the most relevant advances in the biochemistry and molecular biology of the peritoneal membrane following peritonitis and as consequence of the continuous exposure to unphysiological dialysis fluids. In a second part the preliminary experimental and clinical experience with more biocompatible fluids is summarized. The most relevant structural and functional alterations of the membrane following repeated peritonitis is the consequence of the response of the peritoneum to infective organisms involving the inflammatory cytokines and the interaction between membrane resident cell populations: macrophages, mesothelial cells and fibroblasts. In this setting, human biopsy studies and animal experiments have identified an increase in the peritoneal-associated vasculature, which seems to be the primary cause of increased solute transport. The structural and functional alterations in the membrane in long-term peritoneal dialysis are thought to be the consequence of the toxicity of glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end-products. In particular, an important role for vascular endothelial growth factor and nitric oxide as downstream mediators of the alterations has been suggested. Finally, the last part of this paper reviews the actual and future research aimed at an amelioration of the biocompatibility of the dialysis fluids. Replacing glucose by other osmotic agents, changing the sterilization process, replacing the lactate buffer by bicarbonate, blocking the formation of reactive carbonyl products and of the neoangiogenesis are the most promising changes to enhance the biocompatibility. Finally, gene therapy may in the future have an important contribution. Ex vivo gene therapy involves harvesting peritoneum samples to isolate mesothelial cells that will be genetically modified before re-implantation into the peritoneal cavity.
Topics: Animals; Biocompatible Materials; Dialysis Solutions; Humans; Peritoneal Dialysis; Peritoneum; Peritonitis; Uremia
PubMed: 12566656
DOI: 10.1159/000067867 -
The International Journal of Artificial... Oct 1993
Topics: Dialysis Solutions; Humans; Lactates; Lactic Acid; Peritoneal Dialysis
PubMed: 8125613
DOI: No ID Found -
Kidney360 May 2022
Topics: Dialysis Solutions; Icodextrin; Peritoneal Dialysis
PubMed: 36128486
DOI: 10.34067/KID.0001902022 -
Journal of Nephrology 2013
Review
Topics: Amino Acids; Bicarbonates; Body Weight; Buffers; Creatinine; Dialysis Solutions; Glucans; Glucose; Hemodiafiltration; Humans; Hydrogen-Ion Concentration; Icodextrin; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Phthalic Acids; Prescriptions; Renal Dialysis; Software
PubMed: 24307441
DOI: 10.5301/JN.2013.11635 -
Peritoneal Dialysis International :... 2011
Topics: Anti-Bacterial Agents; Daptomycin; Dialysis Solutions; Drug Stability; Humans; Peritoneal Dialysis
PubMed: 21799057
DOI: 10.3747/pdi.2010.00183 -
Seminars in Dialysis Sep 2019During the last two decades, oxidative stress (OS) has emerged as a novel risk factor for a variety of adverse events, including atherosclerosis and mortality in chronic... (Review)
Review
During the last two decades, oxidative stress (OS) has emerged as a novel risk factor for a variety of adverse events, including atherosclerosis and mortality in chronic kidney disease (CKD) patients. Increased OS occurs even in early stages of the disease, progresses with deterioration of renal function and is further aggravated by hemodialysis (HD), due to the bioincompatibility of the method. Compared to HD, peritoneal dialysis (PD) is a more biocompatible dialysis modality, characterized by a significantly reduced, but still high, OS status. The culprit for OS in PD is mainly the composition of PD solutions (low pH, lactate buffer, increased osmolarity and high glucose concentration). After heat sterilization of PD solutions, formation of glucose degradation products (GDPs) and advanced glycation end-products (AGEs) trigger inflammation and enhance OS. Chronic exposure of the peritoneum to this toxic, hyperglycemic environment leads to OS-derived morphologic damage of peritoneal cells, loss of ultrafiltration capacity and decreased technique survival. Moreover, OS is linked with peritonitis, loss of residual renal function, inflammation, atherosclerosis, cardiovascular (CV) disease, and increased mortality. To ameliorate OS status in PD, a multitargeted approach is necessary that includes use of neutral pH, low GDP, low lactate and iso-ismolar PD solutions, strict glycemic control, optimal volume management and, probably supplementation with antioxidants, N-acetylcysteine being the most promising among them.
Topics: Dialysis Solutions; Humans; Oxidative Stress; Peritoneal Dialysis; Renal Insufficiency, Chronic
PubMed: 31044475
DOI: 10.1111/sdi.12818 -
Seminars in Dialysis Jul 2016Despite advances in peritoneal dialysis (PD) technique and therapy over the last 40 years, PD therapy for end-stage renal disease (ESRD) in the United States remains...
Despite advances in peritoneal dialysis (PD) technique and therapy over the last 40 years, PD therapy for end-stage renal disease (ESRD) in the United States remains underutilized. One of the major factors contributing to this underutilization involves concerns about technique failure. More physiologic PD solutions, with a lower concentration of glucose degradation products and a neutral pH, exist and are readily available in Europe, Asia, and Australia. Several benefits of these biocompatible solutions exist over the conventional solutions including a slower decline in residual renal function and better maintenance of urine volumes. There may also be a beneficial effect of the biocompatible solutions in limiting the increase in peritoneal transport that is characteristic of patients maintained on conventional solutions. It should be of concern to the US nephrology community that biocompatible PD solutions are unavailable in the United States.
Topics: Biocompatible Materials; Dialysis Solutions; Humans; Kidney Failure, Chronic; Nephrology; Peritoneal Dialysis
PubMed: 27061506
DOI: 10.1111/sdi.12490 -
Peritoneal Dialysis International :... 2000
Review
Topics: Dialysis Solutions; Drug Storage; Glucose; Glycation End Products, Advanced; Hot Temperature; Humans; Peritoneal Dialysis; Sterilization; Time Factors
PubMed: 10911643
DOI: No ID Found