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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 -
Seminars in Dialysis Mar 2014Oligo-anuric patients with end-stage kidney disease are dependent on hemodialysis to achieve and maintain the desired goal of euvolemia. The dialysis prescription, in... (Review)
Review
Oligo-anuric patients with end-stage kidney disease are dependent on hemodialysis to achieve and maintain the desired goal of euvolemia. The dialysis prescription, in addition to sodium and fluid restriction, is therefore a critically important factor in the care of hemodialysis patients. Various dialysate sodium concentrations have been favored throughout the history of dialysis, but the "optimal" concentration remains unclear. In this manuscript, we examine the historical context of changes to the dialysate sodium prescription, review the evidence of its associated effects, discuss 'individualization' of dialysate sodium, and highlight the need for definitive trials that are powered for important clinical outcomes.
Topics: Algorithms; Dialysis Solutions; Humans; Renal Dialysis; Sodium
PubMed: 24450281
DOI: 10.1111/sdi.12182 -
Kidney International Jun 2015
Topics: Dermatitis, Exfoliative; Dialysis Solutions; Drug Eruptions; Glucans; Glucose; Humans; Male
PubMed: 26024029
DOI: 10.1038/ki.2015.41 -
Journal of Nephrology Jun 2020At the start of the 2000s, the progressive diffusion of high-flux extracorporeal dialysis and membranes saw an increased use of high infusion volumes injected into the... (Review)
Review
INTRODUCTION
At the start of the 2000s, the progressive diffusion of high-flux extracorporeal dialysis and membranes saw an increased use of high infusion volumes injected into the patient's blood circuit following the advent of on-line water production plants.
METHODOLOGY
Our 15-year experience with on-line extracorporeal methodologies using very high infusion volumes has led to the detection of errors and weaknesses, thus allowing us to correct and provide for the implementation of appropriate technology in dialysis water production plants with the aim of ensuring a higher chemical-physical, bacteriological and endotoxin quality. The initial procedures had already been outlined in the 2005 Italian Guidelines, although still today Health Technicians and Nephrologists operating in the field are unable to take on board specific integrations for on-line methods due to a lack of upgrading of documentation in both European and non-European Guidelines.
RESULTS
After more than 17 years' experience, and in view of the technological implementations developed since 2005, we wish to put forward a series of suggestions in an attempt to improve the safety of on-line water, with uses ranging from drinking water, pre-treatment, osmosis, distribution circuit, hemodialysis monitors up to the most recent update of microbiological cultures.
DISCUSSION
Additional, more stringent measures are required to prevent the occurrence of acute accidents during dialysis sessions and to reduce chronic inflammation-oxidation deriving from the use of not totally ultra-pure/sterile dialysis fluids.
CONCLUSION
Our point of view based on our long-standing experience, the proposals made relate to procedures to be applied in technological maintenance, which the consultant nephrologist and other relevant personnel such as microbiologists, biologists, and technical operators should adhere to rigorously to ensure that the production of dialysis water on-line is viewed on a par with a pharmacological administration.
Topics: Dialysis Solutions; Humans; Italy; Renal Dialysis; Water
PubMed: 31713828
DOI: 10.1007/s40620-019-00667-2 -
Peritoneal Dialysis International :... Jun 2014Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We...
OBJECTIVES
Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We investigated relationships of indices of dialysis adequacy (including KT/V, KT, clearance, dialysate over plasma concentration ratio) and anthropometric and body composition parameters (BSA, TBW, body mass index (BMI), weight, height, fat mass (FM), and fat-free mass (FFM)) in male and female patients on continuous ambulatory peritoneal dialysis.
METHODS
Ninety-nine stable patients (56 males) performed four 24-hr collections of drained dialysate for four dialysis schedules with three daily exchanges of glucose 1.36% and one night exchange of either: 1) glucose 1.36%, 2) glucose 2.27%, 3) glucose 3.86% or 4) icodextrin 7.5%.
RESULTS
KT and dialysate over plasma concentration ratio, CD/CP, for urea and creatinine were similar for males and females and, in general, did not depend on body-size parameters including V (= TBW), which means that the overall capacity of the transport system in females and males is similar. However, after normalization of KT to V or 1.73/BSA yielding KT/V and creatinine clearance, Cl(1.73/BSA), respectively, the normalized indices were substantially higher in females than in males and correlated inversely with body-size parameters, especially in males.
CONCLUSIONS
As KT/V depends strongly on body size, treatment target values for KT/V should take body size and therefore also gender into account. As KT is less influenced by body size, body composition and gender, KT should be considered as a potential auxiliary index in PD.
Topics: Adult; Aged; Anthropometry; Biological Transport; Body Composition; Creatinine; Dialysis Solutions; Female; Humans; Kidney Failure, Chronic; Kidney Function Tests; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Sex Factors
PubMed: 24497588
DOI: 10.3747/pdi.2013.00018 -
Journal of the American Board of Family... 2006As the population of chronic kidney disease (CKD) and end-stage renal disease (ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in... (Review)
Review
As the population of chronic kidney disease (CKD) and end-stage renal disease (ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in the management of these patients. Early recognition of CKD and timely referral to a nephrologist when glomerular filtration rate approaches 30 mL/min/1.73 m(2) is extremely important to improve ESRD outcome and appropriate selection of dialysis modality. Peritoneal dialysis (PD) remains a viable treatment option for ESRD patients. PD is less expensive dialysis modality and may provide a survival advantages over hemodialysis in first 2 to 4 years of treatment. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. Thus preservation of RRF is an important goal in the management of PD patients. Every effort should be made to avoid nephrotoxic drugs like aminoglycosides and nonsteroidal anti-inflammatory drugs, and limit the use of radiocontrast agents in PD patients with RRF. Judicious use of prophylactic antibiotics to prevent peritonitis would further help to reduce morbidity from PD. Protecting peritoneal membrane from long-term toxic and metabolic effects of the conventional glucose-based solutions is another objective to further improve PD outcome. Development of new, more biocompatible PD solutions holds promise for the future. One such solution, icodextrin, is now approved for use in the United States. Although extremely safe to use, it is associated with unique metabolic effects that may concern primary care physicians. They include false elevation of blood glucose, a reversible increase in serum alkaline phosphatase and a false decline in serum amylase. Monitoring of glycemia by assays that use glucose dehydrogenase pyrroloquinoline quinone enzymes should be avoided and serum amylase alone should not be relied on in diagnosing pancreatitis in patients on icodextrin.
Topics: Dialysis Solutions; Glomerular Filtration Rate; Glucans; Glucose; Humans; Icodextrin; Kidney Failure, Chronic; Peritoneal Dialysis; Primary Health Care
PubMed: 16809653
DOI: 10.3122/jabfm.19.4.380 -
Clinical Journal of the American... Aug 2022Long-term peritoneal dialysis is associated with alterations in peritoneal function, like the development of high small solute transfer rates and impaired... (Review)
Review
Long-term peritoneal dialysis is associated with alterations in peritoneal function, like the development of high small solute transfer rates and impaired ultrafiltration. Also, morphologic changes can develop, the most prominent being loss of mesothelium, vasculopathy, and interstitial fibrosis. Current research suggests peritoneal inflammation as the driving force for these alterations. In this review, the available evidence for inflammation is examined and a new hypothesis is put forward consisting of high glucose-induced pseudohypoxia. Hypoxia of cells is characterized by a high (oxidized-reduced nicotinamide dinucleotide ratio) NADH-NAD ratio in their cytosol. Pseudohypoxia is similar but occurs when excessive amounts of glucose are metabolized, as is the case for peritoneal interstitial cells in peritoneal dialysis. The glucose-induced high NADH-NAD ratio upregulates the hypoxia-inducible factor-1 gene, which stimulates not only the glucose transporter-1 gene but also many profibrotic genes like TGF, vascular endothelial growth factor, plasminogen activator inhibitor-1, and connective tissue growth factor, all known to be involved in the development of peritoneal fibrosis. This review discusses the causes and consequences of pseudohypoxia in peritoneal dialysis and the available options for treatment and prevention. Reducing peritoneal exposure to the excessively high dialysate glucose load is the cornerstone to avoid the pseudohypoxia-induced alterations. This can partly be done by the use of icodextrin or by combinations of low molecular mass osmotic agents, all in a low dose. The addition of alanyl-glutamine to the dialysis solution needs further clinical investigation.
Topics: Dialysis Solutions; Glucose; Humans; Hypoxia; Inflammation; NAD; Peritoneal Dialysis; Peritoneum; Vascular Endothelial Growth Factor A
PubMed: 35168992
DOI: 10.2215/CJN.15371121 -
Journal of Artificial Organs : the... Jun 2024Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin... (Review)
Review
Excessive albumin losses during HC (haemocatharsis) are considered a potential cause of hypoalbuminemia-a key risk factor for mortality. This review on total albumin losses considers albumin "leaking" into the dialysate and losses due to protein/membrane interactions (i.e. adsorption, "secondary membrane formation" and denaturation). The former are fairly easy to determine, usually varying at the level of ~ 2 g to ~ 7 g albumin loss per session. Such values, commonly accepted as representative of the total albumin losses, are often quoted as limits/standards of permissible albumin loss per session. On albumin mass lost due to adsorption/deposition, which is the result of complicated interactions and rather difficult to determine, scant in vivo data exist and there is great uncertainty and confusion regarding their magnitude; this is possibly responsible for neglecting their contribution to the total losses at present. Yet, many relevant in vitro studies suggest that losses of albumin due to protein/membrane interactions are likely comparable to (or even greater than) those due to leaking, particularly in the currently favoured high-convection HDF (haemodiafiltration) treatment. Therefore, it is emphasised that top research priority should be given to resolve these issues, primarily by developing appropriate/facile in vivo test-methods and related analytical techniques.
Topics: Humans; Hypoalbuminemia; Renal Dialysis; Serum Albumin; Dialysis Solutions; Hemodiafiltration
PubMed: 38238597
DOI: 10.1007/s10047-023-01430-y -
Annals of Palliative Medicine Dec 2021Dialysate potassium concentration directly affects the serum potassium level and safety of hemodialysis patients. In most dialysis centers in China, a single dialysate...
BACKGROUND
Dialysate potassium concentration directly affects the serum potassium level and safety of hemodialysis patients. In most dialysis centers in China, a single dialysate potassium concentration is used for dialysis, but there is no data on whether this is reasonable or not.
METHODS
Serum potassium values before and after dialysis in maintenance hemodialysis (MHD) patients between 2019 and 2020 were collected from 5 hemodialysis centers in Shanghai, which uniformly use dialysate with a potassium concentration (KD) of 2.0 mmol/L, and data were collected 3 times per patient for analysis. Serum potassium fluctuation was analyzed after administration of individualized KD dialysate.
RESULTS
In all, 1,296 MHD patients were included in the study. Predialysis serum potassium was lower than 4.5 mmol/L in 38.0% and higher than 5.5 mmol/L in 14.6% of patients. Postdialysis serum potassium was lower than 3 mmol/L in 11.3% and higher than 4 mmol/L in 10.4% of patients. Pre-dialysis serum potassium was below 4.5 mmol/L and post- dialysis serum potassium was below 3 mmol/L in 9.54% of patients. Compared with patients younger than 40 years, patients >80 years more often exhibited predialysis serum potassium below 4.5 mmol/L and Postdialysis serum potassium below 3 mmol/L. A total of 668 patients underwent a trial of hemodialysis with individualized KD dialysate. When receiving individualized KD, compared with uniform KD 2.0 mmol/L, the number of patients with postdialysis serum potassium less than 3 mmol/L significantly decreased, the following predialysis serum potassium level was not significantly different from baseline, and the proportion of patients with predialysis serum potassium less than 4.5 mmol/L and postdialysis serum potassium less than 3 mmol/L significantly decreased.
CONCLUSIONS
Hypokalemia and fluctuations of serum potassium are common in MHD patients. KD 2.0 mmol/L dialysate should not be used for all patients, and individualized KD dialysate for patients with low serum potassium reduces the incidence of hypokalemia.
Topics: China; Dialysis Solutions; Humans; Potassium; Renal Dialysis
PubMed: 35016414
DOI: 10.21037/apm-21-3030 -
The Israel Medical Association Journal... Jan 2019
Topics: Dialysis Solutions; Humans; Renal Dialysis; Ultrafiltration; Water; Water Microbiology; Water Purification
PubMed: 30685906
DOI: No ID Found