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Journal of Nephrology 2013
Review
Topics: Biomarkers; Biopsy; CA-125 Antigen; Dialysis Solutions; Humans; Interleukin-6; Kidney; Membrane Proteins; Pain; Peritoneal Dialysis; Peritoneum; Peritonitis; Renal Dialysis; Vascular Endothelial Growth Factor A
PubMed: 24307440
DOI: 10.5301/JN.2013.11634 -
Blood Purification 2012Novel low-glucose degradation products (GDP) peritoneal dialysis (PD) fluids have an improved biocompatibility profile as compared to standard fluids. Clinical studies...
Novel low-glucose degradation products (GDP) peritoneal dialysis (PD) fluids have an improved biocompatibility profile as compared to standard fluids. Clinical studies suggest that their use may be associated with favorable clinical outcomes; however, large prospective randomized studies addressing clinical endpoints such as patient and technique survival are presently lacking. Nevertheless, as their only disadvantage is their cost, they are already being used as the standard treatment by many adult PD centers. This policy is also in line with the latest recommendations from the European Pediatric Dialysis Working Group which advises that conventional, single-chamber PD solutions should be replaced by PD solutions with reduced GDP content. The use of icodextrin, the glucose polymer PD solution, is recommended for patients with high or high-average peritoneal transport and/or ultrafiltration problems who otherwise would resort to hypertonic (3.86% glucose) exchanges.
Topics: Dialysis Solutions; Glucans; Glucose; Humans; Icodextrin; Incidence; Peritoneal Dialysis; Peritonitis
PubMed: 22269466
DOI: 10.1159/000334151 -
Kidney International Dec 2001Standard peritoneal dialysis (PD) solutions may contribute to anorexia in PD patients due to the peritoneal absorption of glucose from the dialysate, abdominal...
BACKGROUND
Standard peritoneal dialysis (PD) solutions may contribute to anorexia in PD patients due to the peritoneal absorption of glucose from the dialysate, abdominal discomfort and other factors. New PD solutions containing alternative osmotic agents, neutral pH and bicarbonate as buffer were recently developed. To test the effect of these solutions on appetite, we investigated how intraoral (IO) intake of sucrose via an IO cannula was influenced by intraperitoneal (IP) infusion of different PD solutions in an appetite model in rats.
METHODS
The IO intake was measured in male Wistar rats after an IP dwell of 30 and 120 minutes with the following PD solutions: 1.36%, 2.27% and 3.86% glucose based and lactate buffered solutions (D); 1.36%, 2.27% and 3.86% glucose based and bicarbonate/lactate buffered solutions (P); 7.5% icodextrin based solution (E); 1.1% amino acid-based solution (N); and, 2.5% glucose-based lactate-buffered solution (GB), using sham injection (injection without infusion) as control. Prior to the tests, rats were provided with an IO cannula, and were trained for two weeks until the rate of IO intake had stabilized.
RESULTS
The D and N solutions inhibited IO intake. For the D solutions, the degree of appetite suppression was higher with the higher concentration of glucose. P 3.86%, but not P 1.36% and P 2.27% solutions, inhibited the IO intake. However, a comparison of the degree of appetite inhibition between D and P showed less inhibition with P 1.36%, 2.27% and 3.86% solutions than with corresponding D solutions. The E solution did not seem to suppress appetite. Finally, no significant difference in IO intake was found between rats given GB 2.5% and D 2.27%.
CONCLUSIONS
In this appetite model in rats, the measurement of IO intake after the IP infusion of different dialysis solutions showed that (1) N and D solutions may reduce appetite, and for the D solutions the degree of appetite inhibition was related to the dialysate concentrations of glucose; (2) the P solutions had less impact on appetite than the D solutions; (3) the E solution had no impact on appetite during the short dwells of 30 and 120 minutes. The demonstrated differences between the different solutions appear to be due to different concentrations, and type, of nutrients used as osmotic agent (glucose, amino acids, icodextrin) or buffer (lactate), although differences in dialysate pH, tonicity and concentration of glucose degradation products also may be important. The present studies suggest a possible positive effect on appetite by using bicarbonate/lactate buffered solutions instead of lactate buffered solutions.
Topics: Administration, Oral; Animals; Appetite; Dialysis Solutions; Drinking; Injections, Intraperitoneal; Male; Peritoneal Dialysis; Rats; Rats, Wistar; Reference Values; Solutions; Sucrose; Time Factors
PubMed: 11737615
DOI: 10.1046/j.1523-1755.2001.00075.x -
The Western Journal of Emergency... May 2018Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack... (Review)
Review
Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD. PD in austere environments is not without challenges, including catheter placement, availability of dialysate, and medical complications related to the procedure itself. However, when hemodialysis is unavailable, PD can be performed using generally available medical supplies including sterile tubing and intravenous fluids. Amidst the ever-increasing global burden of ESRD and AKI, the ability to perform PD is essential for many medical facilities.
Topics: Acute Kidney Injury; Armed Conflicts; Dialysis Solutions; Disasters; Humans; Kidney Failure, Chronic; Peritoneal Dialysis
PubMed: 29760854
DOI: 10.5811/westjem.2018.3.36762 -
Seminars in Dialysis 2008In addition to the maintenance of normal extracellular electrolyte composition, the prescription of continuous peritoneal dialysis (CPD) should address four other... (Review)
Review
In addition to the maintenance of normal extracellular electrolyte composition, the prescription of continuous peritoneal dialysis (CPD) should address four other specific issues: (i) prevention of uremia by achievement of adequate clearance of azotemic substances, (ii) prevention of progressive expansion of the extracellular volume by adequate peritoneal ultrafiltration, (iii) prevention of loss of residual renal function, and (iv) prevention of deterioration of the peritoneal membrane structure and function. Urea clearance, in the form of Kt/V(Urea), is the index of removal of azotemic substances proposed by current guidelines. The target total (renal plus peritoneal) Kt/V(Urea) is >or=1.7 weekly. To provide the desired peritoneal Kt/V(Urea) (K(p)t/V(Urea)), the prescription of peritoneal dialysis must provide a daily drain volume (Dv) defined by the clearance equations as Dv = V x (K(p)t/V(Urea))/(D/P(Urea)), where V is body water obtained from published anthropometric formulas, K(p)t/V(Urea) = (1.7 - renal Kt/V(Urea))/7 and D/P(Urea) is the dialysate-to-plasma urea concentration ratio at the dwell time prescribed. Computer programs obtain the relevant D/P(Urea) values from formal studies of peritoneal transport. In the absence of these studies (for example, at initiation of CPD), D/P(Urea) values can be obtained from published studies with similar dwell times. Body size, indicated by V, is the major determinant of the K(p)t/V(Urea) limit provided by a given CPD schedule. Other obstacles to achievement of adequate urea clearance are created by poor patient compliance, inaccuracies of the anthropometric formulas estimating V, and mechanical complications of CPD that lead to retention of dialysate in the body. The main requirements for the prescription of adequate ultrafiltration are knowledge of the individual peritoneal transport characteristics, monitoring of urinary volume, and restriction of dietary sodium intake. Excessive dietary sodium intake is the major cause of extracellular volume expansion in CPD. Ideally, sodium intake should be kept at the level of total (peritoneal plus renal) sodium removal. Preventing the loss of residual renal function involves avoidance of nephrotoxic influences in the form of medications, radiocontrast agents, urinary obstruction and infection, and possibly other influences, such an elevated calcium-phosphorus product and anemia. Use of the lowest dialysate dextrose concentration that will allow adequate ultrafiltration is currently the most widespread practical measure of prevention of peritoneal membrane deterioration. Formulation of biocompatible dialysate is a major ongoing research effort and may greatly enhance the success of CPD in the future.
Topics: Decision Making, Computer-Assisted; Dialysis Solutions; Humans; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Urea; Uremia
PubMed: 18248525
DOI: 10.1111/j.1525-139X.2007.00412.x -
Clinical Journal of the American... May 2007In recent years, there have been some interesting advances in the science and practice of peritoneal dialysis (PD). This review focuses on selected technological... (Review)
Review
In recent years, there have been some interesting advances in the science and practice of peritoneal dialysis (PD). This review focuses on selected technological advances and the impact that these changes may have on this modality. New, so-called "biocompatible" fluids have more physiologic pH and reduced glucose degradation products. These new fluids may reduce the deleterious effects of chronic exposure to the peritoneal membrane. However, enthusiasm for these new fluids is outstripping rigorous evidence that they change patient outcome. Continuous-flow PD offers a way to increase dramatically small solute clearance. However, there are significant technological barriers to the implementation of this kind of dialysis. Furthermore, there is little evidence that augmented small solute clearance will improve survival in PD patients. Finally, new catheter insertion techniques provide perhaps the most practical advances in allowing successful commencement of this excellent home dialysis modality.
Topics: Catheterization; Dialysis Solutions; Home Care Services; Humans; Materials Testing; Peritoneal Dialysis
PubMed: 17699465
DOI: 10.2215/CJN.03331006 -
BioMed Research International 2015Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine... (Review)
Review
Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS) enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis.
Topics: Dialysis Solutions; Epithelium; Extracellular Matrix; Fibroblasts; Humans; Hyaluronic Acid; Models, Biological; Peritoneal Dialysis; Peritoneum
PubMed: 26550568
DOI: 10.1155/2015/427038 -
Peritoneal Dialysis International :... 1997
Review
Topics: Animals; Cell Survival; Cells, Cultured; Dialysis Solutions; Epithelium; Humans; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory
PubMed: 9163791
DOI: No ID Found -
Contributions To Nephrology 1999
Review
Topics: Dialysis Solutions; Glucans; Glucose; Humans; Icodextrin; Osmotic Pressure; Peritoneal Dialysis
PubMed: 10590876
DOI: 10.1159/000060018 -
Contributions To Nephrology 1999
Review
Topics: Acetates; Bicarbonates; Buffers; Dialysis Solutions; Humans; Lactic Acid; Peritoneal Dialysis
PubMed: 10590877
DOI: 10.1159/000060019