-
Contributions To Nephrology 1999
Review
Topics: Calcium; Dialysis Solutions; Humans; Ion Transport; Peritoneal Dialysis
PubMed: 10590875
DOI: 10.1159/000060017 -
Giornale Italiano Di Nefrologia :... 2011L-carnitine is an important compound involved both in the transfer of activated long-chain fatty acids across the mitochondrial membrane and in the modulation of the... (Review)
Review
L-carnitine is an important compound involved both in the transfer of activated long-chain fatty acids across the mitochondrial membrane and in the modulation of the acyl coenzyme A/free coenzyme A ratio in various intracellular compartments. These processes activate several metabolic and cellular functions, and L-carnitine supplementation proved able to reduce insulin resistance and improve lipid metabolism, muscle tropism and erythrocyte rheology. Thus, L-carnitine may be considered a conditional drug rather than a conditional vitamin. Several studies examined the effects of L-carnitine supplementation in dialysis patients. Most of these studies were performed in hemodialysis patients, with controversial conclusions: positive results were countered by the finding of minimal or even no effects. The results were, moreover, often biased by the small number of patients, the lack of control groups, the difference in the measured biochemical data, and the lack of evaluation of patients' compliance and intestinal drug absorption. In addition, at present it is still uncertain what is the adequate level of plasma carnitine to be considered as the target of carnitine supplementation in dialysis patients. In peritoneal dialysis, the small number of published papers provided controversial results as well. Some authors observed significant lowering of apolipoprotein B without changes in cholesterol, triglycerides, free fatty acids, phospholipids and apoliporotein A after administration for short periods of high-dose oral L-carnitine to adult or, more often, pediatric patients. Others did not observe any positive effect. In vitro studies demonstrated that peritoneal dialysis solutions containing Lcarnitine cause less damage to mesothelial and endothelial cells than glucosebased- only peritoneal dialysis solutions. More recently, L-carnitine was used as an osmotic agent in experimental dialysis solutions for human use: the peritoneal ultrafiltration was similar to that induced by glucose solutions. In addition, intraperitoneal administration allows the measurement of absorbed carnitine, thus establishing a correct dose/effect ratio. Ongoing clinical studies in peritoneal dialysis patients on the metabolic effect of glucose plus carnitine solutions, as compared to standard solutions, seem to suggest positive results.
Topics: Apolipoproteins B; Carnitine; Dialysis Solutions; Evidence-Based Medicine; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Treatment Outcome; Vitamin B Complex
PubMed: 21809308
DOI: No ID Found -
American Journal of Kidney Diseases :... Oct 2012
Topics: Diagnostic Errors; Dialysis Solutions; Equipment Design; Glucans; Glucose; Humans; Hypoglycemia; Iatrogenic Disease; Icodextrin; Monitoring, Physiologic; Peritoneal Dialysis
PubMed: 22835903
DOI: 10.1053/j.ajkd.2012.06.020 -
Nephrologie & Therapeutique Oct 2005
Review
Topics: Dialysis Solutions; Humans; Peritoneal Dialysis; Peritoneum
PubMed: 16895693
DOI: 10.1016/j.nephro.2005.06.009 -
Kidney International. Supplement Nov 1996
Review
Topics: Dialysis Solutions; Humans; Molecular Weight; Osmolar Concentration; Peritoneal Dialysis
PubMed: 8914060
DOI: No ID Found -
Peritoneal Dialysis International :... Feb 2005This review provides an overview of recent studies that show the clinical significance of biocompatibility of peritoneal dialysis fluids. (Review)
Review
This review provides an overview of recent studies that show the clinical significance of biocompatibility of peritoneal dialysis fluids.
Topics: Animals; Dialysis Solutions; Humans; Peritoneal Dialysis; Peritoneum; Randomized Controlled Trials as Topic; Rats
PubMed: 16048252
DOI: No ID Found -
Kidney International May 1996Continuous ambulatory peritoneal dialysis (CAPD) is often associated with malnutrition; reduced intake of nutrients due to anorexia is an important factor. The glucose...
Continuous ambulatory peritoneal dialysis (CAPD) is often associated with malnutrition; reduced intake of nutrients due to anorexia is an important factor. The glucose load from glucose-based peritoneal dialysis (PD) solutions and amino acids from amino acid-based solutions may favor suppression of the appetite. To study this matter we used a new experimental model in free-moving, unstressed male Wistar rats (300 to 350 g) with feeding catheters channeled from the top of the skull to the oral cavity. When the rats recovered from surgery they were tested under standardized conditions by giving them an intraoral infusion (1 ml/min) of a solution containing 342 g/liter of the sucrose or 97 g/liter protein solutions while recording the time (volume) of ingestion. Control rats consumed 18.8 +/- 0.9 ml of the sucrose and 39.8 +/- 0.8 ml of the protein solutions. Injections of PD solutions with 13.6, 22.7, and 38.6 g/liter of glucose reduced the ingestion of sucrose by 12.4%, 23.6% and 36.1%, respectively, but did not affect the ingestion of protein. Injections of 30 ml of PD solutions containing 11, 18 and 31 g/liter of amino acids reduced the ingestion of both sucrose by 9.7%, 17.1% and 33.2% and of protein by 13.5%, 25.9% and 33.1%, respectively. We conclude that in our experimental model, the inhibition of appetite caused by peritoneal solutions containing glucose or amino acids seems to be specific for each nutritional constituent and not simply an effect of hyperosmolality or large filling volumes.
Topics: Adaptation, Physiological; Amino Acids; Animals; Appetite; Dialysis Solutions; Feeding Behavior; Glucose; Male; Nutrition Disorders; Peritoneal Dialysis, Continuous Ambulatory; Rats; Rats, Wistar; Time Factors
PubMed: 8731091
DOI: 10.1038/ki.1996.182 -
Contributions To Nephrology 2003
Review
Topics: Ascites; Blood Urea Nitrogen; Dialysis Solutions; Equipment Design; Equipment Safety; Humans; Kidney Failure, Chronic; Kidney Function Tests; Peritoneal Dialysis, Continuous Ambulatory; Prognosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Ultrafiltration
PubMed: 12800371
DOI: 10.1159/000071402 -
Nature Reviews. Nephrology Nov 2011The results of several studies assessing dialysis dose have dampened the enthusiasm of clinicians for considering dialysis dose as a modifiable factor influencing... (Review)
Review
The results of several studies assessing dialysis dose have dampened the enthusiasm of clinicians for considering dialysis dose as a modifiable factor influencing outcomes in patients with acute kidney injury. Powerful evidence from two large, multicenter trials indicates that increasing the dialysis dose, measured as hourly effluent volume, has no benefit in continuous renal replacement therapy (CRRT). However, some important operational characteristics that affect delivered dose were not evaluated. Effluent volume does not correspond to the actual delivered dose, as a decline in filter efficacy reduces solute removal during therapy. We believe that providing accurate parameters of delivered dose could improve the delivery of a prescribed dose and refine the assessment of the effect of dose on outcomes in critically ill patients treated with CRRT.
Topics: Acute Kidney Injury; Dialysis Solutions; Humans; Renal Dialysis
PubMed: 22045240
DOI: 10.1038/nrneph.2011.172 -
Nephrologie & Therapeutique Jun 2018Icodextrin is a glucose polymer derived from starch that is used as an osmotic agent in peritoneal dialysis. Its high molecular weight limits blood absorption and is... (Review)
Review
Icodextrin is a glucose polymer derived from starch that is used as an osmotic agent in peritoneal dialysis. Its high molecular weight limits blood absorption and is useful for long dwell since there is few osmotic gradient dispersal. Its benefits are numerous: ltrafiltration optimization and better salt and water control especially in anuric patients with a high peritoneal permeability and also in case of infectious peritonitis, glucose sparing with less metabolic complications and a better preservation of peritoneal membrane, better biocompatibility. However it should not be forgotten that icodextrin has also side effects that must be known: allergies, cases of aseptic peritonitis, overintense water and salt depletion, lymphatic absorption of icodextrin and its metabolites (including maltose) with a risk of false capillary glucose rate estimation and a moderate increase in plasma osmolality. That is why it is not recommended now to use more than one daily icodextrin dwell. Nevertheless, several dialysis units use icodextrin in more than one daily dwell, especially in patients with an important ultrafiltration loss or in those in whom glucose sparing is essential. It seems to profit them with no more side effects. A large multicenter trial is in progress to test the efficacy and safety of icodextrin dwell twice a day in elder incident patients in peritoneal dialysis (DIDo). Moreover, icodextrin is also used combined with glucose in a long dwell (bimodal ultrafiltration) with encouraging results in terms of ultrafiltration and glucose sparing.
Topics: Dialysis Solutions; Glucans; Glucose; Humans; Icodextrin; Peritoneal Dialysis
PubMed: 29291942
DOI: 10.1016/j.nephro.2017.09.005