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Peritoneal Dialysis International :... 1995
Review
Topics: Biocompatible Materials; Dialysis Solutions; Drug Evaluation; Drug Evaluation, Preclinical; Humans; Peritoneal Dialysis; Peritoneum; Peritonitis
PubMed: 7578495
DOI: No ID Found -
Blood Purification 2023Dialysis therapy is the predominant choice for renal failure in Japan, and almost 30% of the patients with renal failure have been treated for 10 years or more. Dialysis... (Review)
Review
Dialysis therapy is the predominant choice for renal failure in Japan, and almost 30% of the patients with renal failure have been treated for 10 years or more. Dialysis became the standard procedure to treat renal failure nationwide in the 1980s. However, at that time, managing the increased number of patients on maintenance hemodialysis as well as operating and maintaining the newly developed advanced medical technologies at extensive numbers of clinical sites proved problematic. To help address this, the clinical engineer system was established in 1987 and certain aspects of the clinical engineers' role remain unique to Japan today. For the last 30 years, clinical engineers have worked as frontline medical personnel not only operating dialysis-related devices but also placing their hands directly on patients when providing care, routinely performing puncture, and administering drugs through the blood circuit under physicians' instructions. As part of their work, they crucially maintain the use of central dialysis fluid delivery systems (CDDSs) - also unique to Japan - which prepare and deliver a large quantity of dialysis fluid through a central circuit to individual dialysis consoles. CDDSs are widely used because they effectively alleviated the early confusion at clinical sites caused by the rapidly increasing hemodialysis population and the serious shortage in medical personnel. Moreover, clinical engineers alone have the technical ability to provide safe dialysis fluids adjusted to strict standards at clinical sites. In this review article, we focus on the crucial roles that clinical engineers have in maintaining the safety of dialysis-related medical devices and the preparation and delivery of dialysis fluid at many dialysis facilities across the country.
Topics: Humans; Renal Dialysis; Hemodialysis Solutions; Japan; Dialysis Solutions; Renal Insufficiency; Safety Management
PubMed: 33684920
DOI: 10.1159/000512349 -
The Cochrane Database of Systematic... Mar 2014The longevity of peritoneal dialysis (PD) is limited by high rates of technique failure, some of which stem from peritoneal membrane injury. 'Biocompatible' PD solutions... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The longevity of peritoneal dialysis (PD) is limited by high rates of technique failure, some of which stem from peritoneal membrane injury. 'Biocompatible' PD solutions have been developed to reduce damage to the peritoneal membrane.
OBJECTIVES
This review aimed to look at the benefits and harms of biocompatible PD solutions in comparison to standard PD solutions in patients receiving PD.
SEARCH METHODS
We searched the Cochrane Renal Group's Specialised Register (28 February 2013), through contact with the Trials Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE, and handsearching conference proceedings.
SELECTION CRITERIA
All randomised controlled trials (RCTs) and quasi-RCTs in adults and children comparing the effects of biocompatible PD solutions (neutral pH, lactate-buffered, low glucose degradation product (GDP); neutral pH, bicarbonate (± lactate)-buffered, low GDP; glucose polymer (icodextrin)) in PD were included. Studies of amino acid-based PD solutions were excluded.
DATA COLLECTION AND ANALYSIS
Two authors extracted data on study quality and outcomes (including adverse effects). The authors contacted investigators to obtain missing information. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for categorical variables, and mean difference (MD) or standardised mean difference (SMD) and 95% CI for continuous variables.
MAIN RESULTS
Thirty-six eligible studies (2719 patients) were identified: Neutral pH, lactate-buffered/bicarbonate (± lactate)-buffered, low GDP PD solution (24); icodextrin (12). Allocation methods and concealment were generally incompletely reported, and adequate in only ten studies (27.8%). Patients lost to follow-up ranged from 0% to 83.4%. Neutral pH, low GDP versus conventional glucose PD solutionBased on generally sub-optimal quality evidence, the use of neutral pH, low GDP PD solutions was associated with larger urine volumes at the end of the studies, up to three years of therapy duration (7 studies, 520 patients: MD 126.39 mL/d, 95% CI 26.73 to 226.05). Improved preservation of residual renal function was evident in studies with greater than 12 month follow-up (6 studies, 360 patients: SMD 0.31, 95% CI 0.10 to 0.52). There was no significant effect on peritonitis, technique failure or adverse events with the use of neutral pH, low GDP PD solutions. Glucose polymer (icodextrin) versus conventional glucose PD solutionThere was a significant reduction in episodes of uncontrolled fluid overload (2 studies, 100 patients: RR 0.30, 95% CI 0.15 to 0.59) and improvement in peritoneal ultrafiltration (4 studies, 102 patients, MD 448.54 mL/d, 95% CI 289.28 to 607.80) without compromising residual renal function (4 studies, 114 patients: SMD 0.12, 95% CI -0.26 to 0.49) or urine output (3 studies, 69 patients: MD -88.88 mL/d, 95% CI -356.88 to 179.12) with icodextrin use. A comparable incidence of adverse events with the icodextrin (four studies) was reported.
AUTHORS' CONCLUSIONS
Based on generally sub-optimal quality studies, use of neutral pH, low GDP PD solution led to greater urine output and higher residual renal function after use exceeded 12 months. Icodextrin prescription improved peritoneal ultrafiltration and mitigated uncontrolled fluid overload. There were no significant effects on peritonitis, technique survival, patient survival or harms identified with their use. Based on the best available evidence, the use of these 'biocompatible' PD solutions resulted in clinically relevant benefits without added risks of harm.
Topics: Adult; Child; Dialysis Solutions; Glucose; Humans; Hydrogen-Ion Concentration; Kidney; Peritoneal Dialysis; Peritoneum; Randomized Controlled Trials as Topic; Solutions; Urine
PubMed: 24671928
DOI: 10.1002/14651858.CD007554.pub2 -
Seminars in Dialysis 2004Optimization of the peritoneal dialysis (PD) prescription includes attempts to normalize the patient's blood pressure and extracellular volume. To do so, one must... (Review)
Review
Optimization of the peritoneal dialysis (PD) prescription includes attempts to normalize the patient's blood pressure and extracellular volume. To do so, one must utilize crystalloid or colloid osmotic agents to achieve ultrafiltration. These osmotic agents are systemically absorbed and thus have both potential benefits and adverse effects. With glucose-based dialysate solutions, the average patient absorbs 300-450 kcal of glucose per day on either continuous ambulatory peritoneal dialysis (CAPD) or the cycler. The amount of glucose absorbed varies based on peritoneal transport characteristics, prescription, and tonicity of fluids used. Alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and polyglucose (icodextrin) solutions, have a different rate of systemic absorption and thus a different caloric load profile. In addition, there are protein losses that average about 10 g/day with glucose-based solutions and glucose losses with either amino acid or icodextrin dialysate solutions. There are also potential advantages of these alternative solutions with regard to ultrafiltration. Glucose-based solutions require the development of significant crystalloid osmotic forces, which are dissipated as glucose is absorbed systemically. In contrast, macromolecular solutions achieve ultrafiltration via differences in colloid osmotic pressure, and the absorption of these agents is of a lesser magnitude than glucose-based solutions. Further research is needed to determine other potential risks and benefits of these alternative dialysate solutions.
Topics: Amino Acids; Dialysis Solutions; Energy Intake; Glucans; Glucose; Hemofiltration; Humans; Icodextrin; Osmosis; Peritoneal Dialysis; Sweetening Agents
PubMed: 15660581
DOI: 10.1111/j.0894-0959.2004.17610.x -
Peritoneal Dialysis International :... 2000Tidal peritoneal dialysis (TPD) was introduced in 1990 in the hopes of improving dialysis efficiency. Studies comparing low dialysate flow rates show that tidal... (Review)
Review
Tidal peritoneal dialysis (TPD) was introduced in 1990 in the hopes of improving dialysis efficiency. Studies comparing low dialysate flow rates show that tidal peritoneal dialysis has no clearance advantage over intermittent peritoneal dialysis (IPD). With high dialysate flow rates, TPD may be superior or similar to IPD in efficacy, but it is expensive because of the high volumes of dialysis solution used. However, it provides better fluid flow mechanics and more comfort to the patient owing to fewer alarms and less pain during inflow and outflow.
Topics: Automation; Dialysis Solutions; Drainage; Humans; Kidney Failure, Chronic; Metabolic Clearance Rate; Peritoneal Dialysis; Peritoneum
PubMed: 10911652
DOI: No ID Found -
Minerva Urologica E Nefrologica = the... Dec 2015The study aimed to evaluate the impact of glucose-based peritoneal dialysis solutions (GBPDS) on diabetic patients on maintenance peritoneal dialysis.
AIM
The study aimed to evaluate the impact of glucose-based peritoneal dialysis solutions (GBPDS) on diabetic patients on maintenance peritoneal dialysis.
METHODS
In this cross-sectional study we compared the influence of long term use of GBPDS on sixteen parameters related to the peritoneal glucose load, hydration status, inflammation, blood pressure, lipid profile and left ventricular mass in 45 stable PD patients (20 diabetic and 25 non-diabetic) receiving GBPDS.
RESULTS
At 24 months HbA1c, peritoneal glucose load index (PGLI), fluid overload (FO), plasma BNP, hsCRP and IL-6 levels, WBC count, blood pressure, triglycerides, LDL-C and left ventricular mass index (LVMI) were higher in diabetic patients compared to non-diabetic subjects (P ≤ 0.04). Of 16 tested variables, 14 had deteriorated at 24 months in diabetic patients. PGLI values > 3 g/kg/day or FO > 1.0 L were associated with abnormal values of HbA1c, plasma BNP, CRP and plasma IL-6 levels. 60% of diabetic patients had PGLI > 3g/kg/day compared to 32% of non-diabetic patients (P < 0.001). Seventy per cent of diabetic patients had FO > 1.0 L compared to 28% of non-diabetic patients (P < 0.001). Only 12% of diabetic patients had nocturnal blood pressure dipping compared to 45% of non-diabetics (P = 0.03). 57.8% of the studied patients had increased LVMI. Diabetic patients had higher LVMI values compared to non-diabetics (P < 0.001). The presence of DM was found to be the most powerful predictor for the development of LVH (P < 0.001).
CONCLUSION
Utilization of GBPDS in diabetic PD patients may be associated with substantial adverse consequences affecting glycemic control, hydration status, lipid profile, inflammation, blood pressure control and LVM.
Topics: Aged; Blood Glucose; Cardiovascular Diseases; Cross-Sectional Studies; Diabetic Neuropathies; Dialysis Solutions; Female; Glucose; Humans; Hypertrophy, Left Ventricular; Lipids; Male; Middle Aged; Peritoneal Dialysis
PubMed: 26329754
DOI: No ID Found -
International Urology and Nephrology Jul 2014Dialysis-dependent patients are particularly susceptible to the toxic effects of aluminum (Al) because of their impaired ability to eliminate it. Al contamination of... (Review)
Review
PURPOSE
Dialysis-dependent patients are particularly susceptible to the toxic effects of aluminum (Al) because of their impaired ability to eliminate it. Al contamination of dialysis fluid remains a threat in this population. The mechanism for Al diffusion across dialysis membranes is not well established. Our objective is to verify, in AL-exposed patients, the postulate that the direction of Al transfer is predicted by the concentration gradient between free diffusible plasma Al and dialysate Al.
METHODS
A systematic review of the literature was performed. Only papers which included Al plasma concentration ([Al]p), Al dialysate concentration ([Al]d) and direction of Al transfer (positive = from dialysate to plasma, negative = from plasma to dialysate) were selected. We also included four patients from our own cohort. Assuming that [Al]p has an ultrafiltrable fraction between 17 and 23%, cases were considered in keeping with our hypothesis if any of the following scenarios was present: negative Al transfer when [Al]d < [Al]p*23% and positive Al transfer when [Al]d > [Al]p*17%.
RESULTS
The search yielded 409 articles, of which 12 were selected for review. When reviewing individual patients for analysis, 108 out of 115 (94%) patients followed our hypothesis. By further excluding cases in which Al transfer could not be determined, only three out of 111 patients were contrary to out hypothesis.
CONCLUSION
Comparing ultrafiltrable Al to dialysate Al permits to accurately predict the direction of Al transfer. The optimal [Al]d should be <20% of the maximally acceptable [Al]p. In order to follow K/DOQI guidelines ([Al]p < 20 μg/L), the [Al]d should therefore not exceed 4 μg/L. At the level presently supported by K/DOQI ([Al]d < 10 μg/L), [Al]p could realistically reach 50 μg/L and potentially cause toxicity.
Topics: Aluminum; Dialysis Solutions; Humans; Membranes, Artificial; Renal Dialysis; Ultrafiltration
PubMed: 24938693
DOI: 10.1007/s11255-014-0752-8 -
Kidney International Nov 2013The clinical value of biocompatible peritoneal dialysis solutions is uncertain because of inconsistent findings in randomized controlled trials. A systematic review by...
The clinical value of biocompatible peritoneal dialysis solutions is uncertain because of inconsistent findings in randomized controlled trials. A systematic review by Cho et al. examining 20 such trials suggests a beneficial effect on residual renal function. However, the finding is not robust and may relate to decreased ultrafiltration causing hypervolemia. Future prescribing of these biocompatible solutions will probably continue to be driven by opinion, marketing, and cost considerations rather than by evidence-based medicine.
Topics: Dialysis Solutions; Glucose; Humans; Kidney; Kidney Diseases; Peritoneal Dialysis
PubMed: 24172730
DOI: 10.1038/ki.2013.303 -
Peritoneal Dialysis International :... 1999
Review
Topics: Animals; Dialysis Solutions; Humans; Peritoneal Dialysis; Peritoneum
PubMed: 10406529
DOI: No ID Found -
Kidney International Oct 2002The appetite inhibitory effect of glucose-based peritoneal dialysis (PD) solutions may be due to glucose as such, or the hyperosmolality of the PD solution, or an effect...
BACKGROUND
The appetite inhibitory effect of glucose-based peritoneal dialysis (PD) solutions may be due to glucose as such, or the hyperosmolality of the PD solution, or an effect of glucose degradation products (GDPs) formed in the PD solution during heat sterilization. This was studied in an experimental appetite model in rat.
METHODS
The effect of different experimental PD solutions on ingestive behavior was investigated in non-uremic rats equipped with an implanted intraoral (i.o.) cannula through which a 1 mol/L sucrose solution was infused during tests. The amount of intake was recorded at 30 min after rats were infused intraperitoneally (IP) with 30 mL of different solutions. This method allowed an accurate and reproducible analysis of i.o. intake. The experimental PD solutions tested included (1) glucose based PD solutions with different glucose concentrations, sterilized by heat or microbiological filter, (2) glucose- and mannitol-based PD solutions with the same osmolality, sterilized by heat or microbiological filter; and (3) glucose based PD solutions, using different pH values (pH 3.0, pH 5.5 or pH 7.4) during heat sterilization.
RESULTS
Following IP infusion of solutions, (1) the i.o. intake was significantly inhibited by glucose based, heat sterilized PD solutions and the degree of appetite suppression was related to the concentration of dialysate glucose in a dose-dependent way; (2) the i.o. intake was significantly less suppressed by filter sterilized than by heat sterilized glucose-based solutions; (3) the i.o. intake was significantly less following the IP infusion of glucose-based than following the mannitol-based heat sterilized solutions; however, i.o. intake did not differ between the glucose-based and mannitol-based filter sterilized solutions; and (4) furthermore, the degree of suppression of i.o. intake induced by glucose-based PD solutions was influenced by the pH value during heat sterilization. The lower the pH of the PD solution during heat sterilization, the higher the i.o. intake.
CONCLUSIONS
The IP infusion of glucose-based heat-sterilized PD solutions inhibited food intake in this experimental appetite model, and the degree of suppression depended on the concentration of dialysate glucose and the pH of the solution during heat sterilization. The results suggest that GDPs formed during heat sterilization may exert a more adverse effect than glucose itself on ingestive behavior, and that a reduction of the concentration of GDPs in the PD solution using filter sterilization or a low pH value in the PD solution during heat sterilization may improve food intake.
Topics: Animals; Buffers; Dialysis Solutions; Diuretics, Osmotic; Feeding Behavior; Glucose Solution, Hypertonic; Hot Temperature; Hydrogen-Ion Concentration; Infusions, Parenteral; Male; Mannitol; Peritoneal Dialysis; Rats; Rats, Wistar; Sterilization; Uremia
PubMed: 12234318
DOI: 10.1111/j.1523-1755.2002.kid575.x