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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 -
Biomedicine & Pharmacotherapy =... Sep 2023Peritoneal dialysis is an efficient renal replacement therapy for patients with end-stage kidney disease. However, continuous exposure of the peritoneal membrane to... (Review)
Review
Peritoneal dialysis is an efficient renal replacement therapy for patients with end-stage kidney disease. However, continuous exposure of the peritoneal membrane to dialysate frequently leads to peritoneal fibrosis, which alters the function of the peritoneal membrane and results in withdrawal from peritoneal dialysis in patients. Among others, high glucose dialysate is considered as a predisposing factor for peritoneal fibrosis in patients on peritoneal dialysis. Glucose-induced inflammation, metabolism disturbance, activation of the renin-angiotensin-aldosterone system, angiogenesis and noninflammation-induced reactive oxygen species are implicated in the pathogenesis of high glucose dialysate-induced peritoneal fibrosis. Specifically, high glucose causes chronic inflammation and recurrent peritonitis, which could cause migration and polarization of inflammatory cells, as well as release of cytokines and fibrosis. High glucose also interferes with lipid metabolism and glycolysis by activating the sterol-regulatory element-binding protein-2/cleavage-activating protein pathway and increasing hypoxia inducible factor-1α expression, leading to angiogenesis and peritoneal fibrosis. Activation of the renin-angiotensin-aldosterone system and Ras-mitogen activated protein kinase signaling pathway is another contributing factor in high glucose dialysate-induced fibrosis. Ultimately, activation of the transforming growth factor-β1/Smad pathway is involved in mesothelial-mesenchymal transition or epithelial-mesenchymal transition, which leads to the development of fibrosis. Although possible intervention strategies for peritoneal dialysate-induced fibrosis by targeting the transforming growth factor-β1/Smad pathway have occasionally been proposed, lack of laboratory evidence renders clinical decision-making difficult. We therefore aim to revisit the upstream pathways of transforming growth factor-beta1/Smad and propose potential therapeutic targets for high glucose-induced peritoneal fibrosis.
Topics: Humans; Peritoneal Fibrosis; Dialysis Solutions; Transforming Growth Factor beta1; Peritoneum; Fibrosis; Inflammation; Glucose
PubMed: 37523983
DOI: 10.1016/j.biopha.2023.115246 -
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 -
Toxins Sep 2021Removal of protein-bound uremic toxins (PBUTs) during conventional dialysis is insufficient. PBUTs are associated with comorbidities and mortality in dialysis patients.... (Review)
Review
Removal of protein-bound uremic toxins (PBUTs) during conventional dialysis is insufficient. PBUTs are associated with comorbidities and mortality in dialysis patients. Albumin is the primary carrier for PBUTs and only a small free fraction of PBUTs are dialyzable. In the past, we proposed a novel method where a binding competitor is infused upstream of a dialyzer into an extracorporeal circuit. The competitor competes with PBUTs for their binding sites on albumin and increases the free PBUT fraction. Essentially, binding competitor-augmented hemodialysis is a reactive membrane separation technique and is a paradigm shift from conventional dialysis therapies. The proposed method has been tested in silico, ex vivo, and in vivo, and has proven to be very effective in all scenarios. In an ex vivo study and a proof-of-concept clinical study with 18 patients, ibuprofen was used as a binding competitor; however, chronic ibuprofen infusion may affect residual kidney function. Binding competition with free fatty acids significantly improved PBUT removal in pre-clinical rat models. Based on in silico analysis, tryptophan can also be used as a binding competitor; importantly, fatty acids or tryptophan may have salutary effects in HD patients. More chemoinformatics research, pre-clinical, and clinical studies are required to identify ideal binding competitors before routine clinical use.
Topics: Binding, Competitive; Dialysis Solutions; Humans; Ibuprofen; Renal Dialysis; Uremic Toxins
PubMed: 34564626
DOI: 10.3390/toxins13090622 -
Clinical and Experimental Nephrology Sep 2023Encapsulating peritoneal sclerosis (EPS), a condition with a high mortality rate, is a serious complication of peritoneal dialysis (PD). In Japan, EPS became a central... (Review)
Review
Encapsulating peritoneal sclerosis (EPS), a condition with a high mortality rate, is a serious complication of peritoneal dialysis (PD). In Japan, EPS became a central issue in the clinical setting during the mid-90s and the beginning of this century. However, following the introduction of biocompatible neutral PD solutions containing lower levels of glucose degradation products, the incidence and clinical severity of EPS has been greatly lessened. During the past three decades, the etiology of EPS has been elucidated by findings obtained by peritoneal biopsy, laparoscopy, and surgical intervention. Accumulating findings suggest the need for a paradigm change on the nature of EPS pathophysiology; notably, EPS appears not to reflect peritoneal sclerosis per se, but rather the formation of a neo-membrane as a biological reaction to peritoneal injury. This narrative review looks back on the history of EPS in Japan, and discusses EPS pathophysiology, the impact of neutral PD solution on peritoneal protection, and a future novel diagnostic approach, ultra-fine endoscope, for the identification of patients at high risk of EPS.
Topics: Humans; Peritoneal Fibrosis; Japan; Peritoneal Dialysis; Peritoneum; Dialysis Solutions; Sclerosis
PubMed: 37278945
DOI: 10.1007/s10157-023-02360-y -
Blood Purification 2015Hemodiafiltration (HDF) seems to represent the gold standard in the field of replacement of renal function by dialysis. High convective fluxes have been correlated with... (Review)
Review
Hemodiafiltration (HDF) seems to represent the gold standard in the field of replacement of renal function by dialysis. High convective fluxes have been correlated with better clinical outcomes. Sometimes, however, there are technical barriers to the achievement of high blood flows adequate to perform effective convective therapies. In spite of optimized procedures, the progressive increase in transmembrane pressure (TMP), the blood viscosity due to hemoconcentration and blood path resistance sometimes becomes inevitable. We propose two possible solutions that can be operated automatically via specific software in the dialysis machine: predilution on demand and backflush on demand. Predilution on demand consists in an automatic feedback of the machine, diverting part of the filtered dialysate into a predilution mode with an infusion of 200 ml in 30 s while the ultrafiltration pump stops. This produces a sudden hemodilution with a return of the parameters to acceptable values. The performance of the filter improves, and the pressure alterations are mitigated. Backflush on demand consists in an automatic feedback of the machine triggered by the TMP control, producing a positive pressure in the dialysate compartment due to a stop of filtration and rapid infusion of at least 100 ml of ultrapure dialysate into the hollow fiber. This not only produces a significant hemodilution, but also backflushes the membrane pores detaching protein layers and improving membrane permeability. These are two examples of how technology will permit to overcome technical barriers to a widespread diffusion of HDF and adequate convective dose delivery.
Topics: Dialysis Solutions; Diffusion; Hemodiafiltration; Humans; Kidney Failure, Chronic; Pressure; Rheology; Software; Vascular Resistance
PubMed: 26344507
DOI: 10.1159/000437403 -
Peritoneal Dialysis International :... 2016♦ (Comparative Study)
Comparative Study
UNLABELLED
♦
INTRODUCTION
Chronic exposure to conventional peritoneal dialysis (PD) solutions has been related to peritoneal function alterations in PD patients, and associated with mesothelial cell loss, submesothelial fibrosis, vasculopathy, and angiogenesis. In vitro and ex vivo analyses, as well as studies with animal models, have demonstrated that biocompatible PD solutions attenuate these morphological alterations. Our aim was to confirm the morphological benefits of biocompatible solutions in PD patients. ♦
METHODS
We analyzed biopsies from 23 patients treated with biocompatible solutions (study group, SG), and compared them with a control group (n = 23) treated with conventional solutions (CG), matched for time on PD. ♦
RESULTS
A total of 56.5% of SG patients showed total or partial preservation of mesothelial cells monolayer, in contrast with 26.1% of patients in CG (p = 0.036). Peritoneal fibrosis was not significantly less frequent in SG patients (47.8% SG vs 69.6% CG; p = 0.13). In patients without previous peritonitis, a significantly lower prevalence of fibrosis was present in SG patients (41.7% SG vs 77.8% CG; p = 0.04). Hyalinizing vasculopathy (HV) was significantly lower in SG (4.3% SG vs 30.4% CG; p = 0.02). Cytokeratin-positive fibroblast-like cells were detected in 10 patients (22%), but the prevalence was not significantly lower in SG. In the univariate regression analysis, the use of biocompatible solutions was associated with mesothelial monolayer integrity (p = 0.04) and an absence of vasculopathy (p = 0.04). ♦
CONCLUSION
The present study demonstrates in vivo in human biopsies that biocompatible solutions are better tolerated by the peritoneum in the medium and long term than conventional solutions.
Topics: Adult; Biocompatible Materials; Biopsy; Blood Vessels; Case-Control Studies; Dialysis Solutions; Epithelial Cells; Epithelial-Mesenchymal Transition; Female; Humans; Keratins; Logistic Models; Male; Middle Aged; Peritoneal Dialysis; Peritoneum
PubMed: 26475848
DOI: 10.3747/pdi.2014.00038 -
Polskie Archiwum Medycyny Wewnetrznej Apr 2009Numerous studies have confirmed beneficial effects of polyglucose dialysis solution (PG-DS), an amino acid dialysis solution (AA-DS), and bicarbonate (bic) or... (Review)
Review
Numerous studies have confirmed beneficial effects of polyglucose dialysis solution (PG-DS), an amino acid dialysis solution (AA-DS), and bicarbonate (bic) or bicarbonate/lactate (bic/lac) buffered solutions on selected components of peritoneal bioavailability or clinical parameters of peritoneal dialysis (PD) patients. Few adverse effects have also been described. A question arises whether these solutions affect the PD outcome. A better controlled fluid status of PD patients associated with the use of PG-DS has been shown in a double-blind randomized controlled trial. Continuous cyclic PD patients treated with the PG-DS did not show changes in solute kinetics and peritoneal membrane markers remained unaltered. The use of PG-DS in anuric automated PD patients was associated with less impaired membrane function. A prospective, randomized, controlled study on the AA-DS in malnourished continuous ambulatory PD patients did not show significant effects of the AA-DS on patient survival, hospitalization rate, C-reactive protein levels, total urea Kt/V, ultrafiltration and drop-out rates, but nutritional status improved or was stable. Improved acid-base balance with bic-buffered solutions was shown in patients treated with automated PD or continuous PD. A registry-based study suggests better survival of patients treated with a neutral pH, low glucose degradation product solution, but there were no differences in dialysis technique survival, peritonitis-free survival, or peritonitis rates. However, reduced peritonitis rate was also reported with the use of bic/lac solutions. Current concepts of PD solutions involve efforts to use fluids which combine the advantages of PG-DS, AA-DS and bic-buffered solutions. Large-scale studies should be continued to improve biocompatibility of peritoneal solutions and to establish their effect on the clinical outcome.
Topics: Bicarbonates; Biological Availability; Dialysis Solutions; Disease-Free Survival; Glucans; Humans; Incidence; Materials Testing; Peritoneal Dialysis; Peritoneum; Peritonitis; Survival Rate
PubMed: 19413184
DOI: No ID Found -
American Journal of Physiology. Heart... Apr 2022
Topics: Bicarbonates; Dialysis Solutions
PubMed: 35324335
DOI: 10.1152/ajpheart.00057.2022 -
Kidney360 May 2022
Topics: Dialysis Solutions; Icodextrin; Peritoneal Dialysis
PubMed: 36128486
DOI: 10.34067/KID.0001902022