Practical methods for assessing dialysis efficiency during peritoneal dialysis.
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Biomarkers↗
Biomedical subjects
G C Koomen
Publications and source records attributed to G C Koomen.
Circadian rhythm of glomerular filtration rate in patients after kidney transplantation.
Within 6 months of a kidney transplantation the graft can be regarded as an organ deprived of its innervation. We analysed whether the transplanted kidney has a diurnal rhythm of its glomerular filtration rate (GFR) similar to the GFR rhythm that has been demonstrated in normal individuals and in patients with nephrotic syndrome. GFR was measured by inulin clearances every 3 h during 1 day of bed-rest and identical food and fluid intake per 3 h in seven patients, 4-7 months after a successful kidney transplantation, and in 10 healthy volunteers. Similar to these healthy subjects, a normal circadian rhythm of GFR was detected in all but one patient with a maximum of 57 (range 45-82) ml/min in daytime, a minimum of 47 (range 36-70) ml/min during the night and a relative amplitude of 21 (range 10-41)%. The circadian rhythm of GFR was absent in the patient with the lowest value of GFR (39 ml/min). In conclusion, GFR has a circadian rhythm in patients studied within 6 months of a kidney transplantation, despite the absence of renal innervation.
Adult↗
Evaluation of short-chain polypeptides as an osmotic agent in continuous ambulatory peritoneal dialysis patients.
OBJECTIVES: To assess whether dialysate containing short-chain polypeptides is well tolerated in continuous ambulatory peritoneal dialysis (CAPD) patients and to determine its effect on fluid and solute transport, plasma amino acid levels, and biochemical parameters. DESIGN: Two-treatment, two-period cross-over design. SETTING: Renal Unit, Academic Medical Center, Amsterdam and Renal Unit, University Hospital, Gent. PATIENTS: Two groups of 10 stable CAPD patients. INTERVENTION: All patients received a trial solution (1.36% glucose and 1% peptides, 381 mOsm/kg) and a control solution (2.27% glucose, 404 mOsm/kg) in randomized order. The patients were examined on four consecutive days in which two dwell periods on days 1 and 3 of either 4 (Group I) or 8 hours (Group II) were performed. RESULTS: The peptide solution was well tolerated in all patients. In addition, no differences were found in the parameters for the effective peritoneal surface area and the intrinsic permeability, implying that no irritating effect of the peptide solution was present. Net ultrafiltration was not different in Group I: -43 +/- 125 versus 86 +/- 125 mL (mean +/- SEM) and marginally lower in Group II: -94 +/- 64 versus 51 +/- 64 mL, despite the lower osmolality of the trial solution compared to the control solution. Glucose absorption was higher than the peptide absorption in all patients: Group I: 66 +/- 10% versus 57 +/- 13% (p = 0.0003); Group II: 80 +/- 5% versus 72 +/- 11% (p = 0.006). No differences in plasma amino acid profiles could be detected. CONCLUSIONS: Short-chain polypeptides are absorbed less than glucose and can be used as an osmotic agent in CAPD patients. However, longer-term studies are needed to evaluate possible additional effects of peptides on the nutritional status of CAPD patients.
Adult↗
The use of peptides in peritoneal dialysis fluids.
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Animals↗
The effect of serum albumin at the start of continuous ambulatory peritoneal dialysis treatment on patient survival.
OBJECTIVE: To analyze the effect of serum albumin using immunoturbidimetry, demographic, biochemical, and kinetic factors on survival of continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A review of prospectively collected data in a 2-year follow-up study of peritoneal transport kinetics. SETTING: University medical center. PARTICIPANTS: Sixty-one patients, evaluated within 3 months after the start of CAPD. MAIN OUTCOME MEASURES: Covariables used in the survival analysis were plasma urea, and creatinine, albumin, hemoglobin, mass transfer area coefficient of creatinine, peritoneal albumin clearance, 4-hour peritoneal albumin loss, net ultrafiltration, age, blood pressure, body mass index, difference between actual and ideal bodyweight, and presence or absence of systemic disease. RESULTS: Overall survival was 64% at 2 years. Median serum albumin was 30.9 g/L, range 18.1-43.9 g/L. Patients with a serum albumin below the median had a lower survival rate than those higher than the median (2-year survival 49% vs 79%, p = 0.01). Using the Cox model, survival was related to systemic disease (p = 0.004), age (p = 0.02), hemoglobin (p = 0.03), and serum albumin (p = 0.1). CONCLUSIONS: The results confirm the strength of serum albumin as predictor of survival. However, in this study serum albumin merely reflected the presence of a systemic disease, which was the most important risk factor for patient survival.
Comorbidity↗
Cancer antigen 125 is locally produced in the peritoneal cavity during continuous ambulatory peritoneal dialysis.
The local production of cancer antigen (CA) 125 in the peritoneal cavity of 14 continuous ambulatory peritoneal dialysis patients was studied. In addition, the relationship between the concentration of mesothelial cells and CA 125 in the peritoneal dialysate effluent was examined. The median results and ranges were as follows: plasma CA 125 14 U/mL (range 10-23), dialysate CA 125 18 U/mL (range 5.2-76), dialysate/plasma ratio 1.9 (range 0.61-5.4), and number of mesothelial cells 400/mL (range 10-5000). Peritoneal concentrations of mesothelial cells and CA 125 were positively correlated (r = 0.50, p < 0.01). Using a monoclonal antibody, CA 125-positive cells were found in the cytospin preparations of the cells of dialysis effluents. All these CA 125 positive cells were also positive for cytokeratin used as a mesothelial cell marker. In vitro experiments using mesothelial cells in monolayers showed a linear increase in CA 125 concentration both in time and in relation to the number of mesothelial cells. From these experiments a production rate of 24 U/hour/10(6) cells could be calculated. It is therefore concluded that CA 125 is locally produced in the peritoneal cavity during CAPD and that the mesothelial cells are the major source of this CA 125.
Antigens, Tumor-Associated, Carbohydrate↗
Urinary sodium excretion in patients with nephrotic syndrome, and its circadian variation.
We analysed sodium excretion and its circadian variation in 70 patients with nephrotic syndrome and 19 healthy controls over 1-3 days, with a regimen of bed rest and constant sodium intake around the clock. We sampled urine and blood and took their blood pressure every 3 h. We also scored 60 renal biopsies for presence of interstitial fibrosis and tubular atrophy. Peripheral oedema was estimated in 37 patients. Fifty-nine patients excreted > 10 mmol sodium per 24 h, in equilibrium with dietary intake. In group A (n = 24), sodium excretion followed a normal circadian rhythm, with a daytime peak. In group B (n = 35), 29 had reversed circadian rhythm with a night-time peak, and 6 had no apparent rhythm. Nephrotic syndrome was more severe in group B than in A (serum albumin 19.5 vs. 24.1 g/l, p < 0.05; oedema 7.0 vs. 3.8 kg, p < 0.01). Group B also had signs of more advanced renal disease (GFR 49 vs. 99 ml/min; number of biopsies with tubulo-interstitial damage: 20/28 vs. 4/23; p < 0.001). Reversed sodium rhythm was associated with reversed circadian rhythms for GFR, effective renal plasma flow and urine flow, and blunting or reversal of the day-night differences in blood pressure and plasma renin activity. Eleven patients had urinary sodium excretion < 1 mmol/24 h. With respect to severity of nephrosis, they resembled group B, but GFR and incidence of tubulointerstitial lesions were like group A. Half of the patients with nephrotic syndrome had reversed circadian rhythm for sodium excretion.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Interleukin-8 during peritonitis in patients treated with CAPD; an in-vivo model of acute inflammation.
CAPD-related peritonitis was used as an in-vivo model to study Il-8 during peritoneal inflammation. Eleven episodes were studied in nine patients, who were followed on 8 consecutive days from the start of peritonitis and once after recovery (control). Il-8 was measured in dialysate (night dwells) and serum. The Il-8 time course was compared to Il-6 and TNF alpha. In addition, an in-vivo relationship between dialysate Il-8 and intraperitoneal accumulation of neutrophils was studied. A highly increased peritoneal appearance rate of Il-8 was found in the acute phase that decreased to control values during recovery. A remarkable parallelism was observed for dialysate Il-8 and Il-6 with respect to the time course and the peritoneal appearance rate. In contrast, the appearance rate of TNF alpha was much less and had a different time course. In three of four cases where the dialysate Il-8 peak occurred on day 2, the dialysate Il-6 peak still coincided with Il-8, in contrast to TNF alpha (always day 1). Dialysate Il-8 generally exceeded serum concentrations during the entire follow-up, indicating intraperitoneal Il-8 synthesis. A positive correlation was present between the dialysate Il-8 peak and the maximal number of neutrophils in dialysate. This relationship was absent for Il-6 and TNF alpha. In five of six episodes where neutrophils were quantified on both day 1 and 2, the Il-8 peak occurred simultaneously with the neutrophil peak. These findings suggest that Il-8 is involved in the recruitment of neutrophils towards the dialysate during peritonitis.
Acute Disease↗
Measurement of peritoneal fluid handling in children on continuous ambulatory peritoneal dialysis using autologous hemoglobin.
OBJECTIVE: Previous measurements of peritoneal fluid handling in children treated by continuous ambulatory peritoneal dialysis (CAPD) were performed with human albumin as a fluid marker. A major disadvantage of this substance is that endogenous patient albumin enters the peritoneal cavity during the dwell period. For this reason peritoneal fluid kinetics were measured in a group of children on CAPD, using autologous hemoglobin as a volume marker. DESIGN: Autologous hemoglobin was added to dialysate containing 1.36% glucose as a volume marker. Marker clearance (MC), which is presently the best available approximation of lymphatic absorption in the clinical setting, and transcapillary ultrafiltration (TCUF) were measured during a 4-hour dwell. SETTING: University hospital. PATIENTS: Children on CAPD (N = 9), with a median age of 8.1 years (range 2.1-3.2 years). RESULTS: MC was 521 +/- 166 mL/4 hour/1.73 m2, which is high compared to the literature data on adult CAPD patients. TCUF was 519 +/- 92 mL/4 hour/1.73 m2, which is similar to data concerning adult patients. TCUF reached no maximum during the 4-hour dwell, and the deviation of the TCUF curve from linear was markedly less than usually seen in adult patients. CONCLUSIONS: MC in children treated with CAPD is higher when compared to the literature data on adults. Difficulties to achieve sufficient ultrafiltration in children could be caused by relatively small differences between MC and TCUF from the beginning to the end of the dwell.
Absorption↗
Creatinine clearance with cimetidine for measurement of GFR.
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Cimetidine↗
Effect of dialysate osmolarity on the transport of low-molecular weight solutes and proteins during CAPD.
Osmotic-induced fluid and solute transport was studied in ten stable CAPD patients, who were examined twice within one week, using dialysate with 1.36% glucose on the first and 3.86% glucose on the second day. Peritoneal fluid kinetics were determined using intraperitoneally administered dextran 70 as a volume marker. After a four-hour dwell period, an increase in mean transcapillary ultrafiltration rate (TCUFR) with 3.86% glucose compared to 1.36% glucose was found (3.40 +/- 0.62 ml/min vs. 1.20 +/- 0.57, P < 0.001), but the lymphatic absorption was unchanged (1.32 +/- 0.10 ml/min vs. 1.42 +/- 0.15). The increased TCUFR resulted in a higher clearance of beta 2-microglobulin, but no differences were present in the clearances of albumin, transferrin, IgG, IgA and alpha 2-macroglobulin. This is consistent with the two pore theory for transcapillary transport with a small pore size of less than 40 A. The contribution of osmotic induced convection to the total transport of beta 2-microglobulin was small (6% during 1.36% glucose, 16% during 3.86% glucose), suggesting that macromolecules are mainly transported by diffusion or hydrostatic convection. The peritoneal restriction coefficient was 2.37 +/- 0.04, indicating restricted diffusion for macromolecules. In contrast, the restriction coefficient for low-molecular weight solutes was 1.24 +/- 0.03, in accordance with a process of mainly unrestricted diffusion for solutes smaller than 16 A. Higher values of protein clearances were found during the first hour of dialysis compared with the subsequent hours.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effect of an increased intraperitoneal pressure on fluid and solute transport during CAPD.
The effect of an increased intraperitoneal pressure on fluid and solute transport was studied in eight stable CAPD patients. Two permeability tests of two hours each with continuous registration of the intraperitoneal pressure were performed while patients were in supine position. The intra-abdominal pressure was raised by means of a tightening girdle with inflatable cuffs in one of the experiments. Intraperitoneally administered dextran 70 was used as a volume marker in order to determine the peritoneal fluid kinetics. The increment in the intra-abdominal pressure of 10.0 +/- 1.0 mm Hg caused a decline in the net ultrafiltration. This was mainly determined by an increase in the lymphatic absorption: 1.07 +/- 0.18 ml/min (without compression) versus 1.86 +/- 0.25 ml/min (with compression; P < 0.01), whereas the transcapillary ultrafiltration rate tended to decrease: 2.02 +/- 0.23 versus 1.73 +/- 0.27 ml/min (P = 0.08). External compression also diminished solute transport from the circulation to the peritoneal cavity. The decline in the mass transfer area coefficient of urea, creatinine, urate and beta 2-microglobulin was 13%, indicating a smaller effective peritoneal surface area caused by external compression probably due to a decrease in the number of the perfused peritoneal capillaries. The fall in the peritoneal protein clearances was more pronounced the higher the molecular weight of the protein, consistent with a decline in the intrinsic permeability of the peritoneum. Kinetic modeling using computer simulations was used to analyse these effects in terms of the pore theory, using a convection model (large pore radius 184 +/- 14 A) and a diffusion model (large pore radius 1028 +/- 218 A) for the transport of macromolecules.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Fibronectin during CAPD-related peritonitis: no indications for intraperitoneal production.
Fibronectin is a 440-kD MW glycoprotein involved in opsonization and adhesion of cells to collagen. We examined 13 episodes of peritonitis on 8 consecutive days from the start and once after recovery (control). Fibronectin clearance was compared to that of marker proteins for peritoneal transport. Increased dialysate fibronectin levels were observed on the first peritonitis day. They declined during recovery. Serum levels were stable during peritonitis. All protein clearances, including fibronectin, were increased during the acute phase and decreased during recovery. The clearance of fibronectin showed a time course similar to that of the marker proteins. It was in the range between IgG (150 kD) and alpha 2-macroglobulin (820 kD), thus as expected on the basis of its molecular weight. We conclude that elevated dialysate fibronectin levels observed during peritonitis are due to increased transperitoneal transport and not to local synthesis. This augmented transport results from increments in both effective surface area and intrinsic permeability of the peritoneum.
Adult↗
Serum interleukin-6 in continuous ambulatory peritoneal dialysis in patients.
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Humans↗
Urinary protein excretion in normal individuals: diurnal changes, influence of orthostasis and relationship to the renin-angiotensin system.
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Adult↗
The effect of glucose polymers on water removal and protein clearances during CAPD.
Two selected groups of 5 continuous ambulatory peritoneal dialysis (CAPD) patients (3 female, 7 male), mean age 60 years, were studied twice with an interval of 4 weeks. The first study was done with glucose-containing dialysate and the second study with dialysate containing glucose polymers (Dextrin 7.5%) after they had been treated with this solution (night dwell) for 4 weeks. The patients collected night bags for 3 consecutive days during the tests. Protein clearances were determined for beta 2-microglobulin, albumin, IgG, fibronectin, and alpha 2-macroglobulin in both periods to examine the influence of crystalloid-induced convection versus "colloid"-induced convection. Group I normally used 1.50% glucose and was therefore considered to have a "high ultrafiltration";group II was the "low ultrafiltration" group because they needed 4.25% glucose dialysate. For their usual glucose solutions the net ultrafiltration was not different between both groups, but the clearance of beta 2-microglobulin was higher in group II:839 +/- 98 microL/min (group I) and 1135 +/- 131 microL/min (group II) (p = 0.08). For glucose polymers the net ultrafiltration increased in both groups, but this was more pronounced in group II: 657 +/- 104 mL (group I) and 918 +/- 85 mL (group II) (p = 0.06). Also, the clearance of beta 2-microglobulin increased with the glucose polymer solution: 1268 +/- 94 microL/min (for glucose polymer) and 987 +/- 85 microL/min (for glucose) (p < 0.05), but the clearances of the larger serum proteins remained unaffected.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
The effect of amphotericin B on fluid kinetics and solute transport in CAPD patients.
Loss of net ultrafiltration capacity is an important complication in long-term continuous ambulatory peritoneal dialysis (CAPD). It has been reported in animal studies that the drained volumes after a dwell period were larger when amphotericin B had been given intraperitoneally. In this study the effect of intraperitoneally administered amphotericin B on fluid kinetics was evaluated in 3 CAPD patients. The first patient lost 2.5 kg body weight during the first 4 days of treatment, whereas the net ultrafiltration in the second patient was higher in the treatment period compared with the nontreatment period (750 +/- 38 mL/day vs 438 +/- 34 mL/day (mean +/- SEM), p < 0.0001). In the last patient it can be demonstrated that the increase in the net ultrafiltration was caused by an increase in the transcapillary ultrafiltration (570 vs 454 mL/4 hours), but that lymphatic absorption was not different (251 vs 265 mL/4 hours). The higher transcapillary ultrafiltration capacity is probably caused by an increase in the hydraulic permeability. It is likely that this phenomenon is governed by the interaction of amphotericin B with membrane-bound cholesterol leading to the formation of transcellular pores. However, the administration of amphotericin B caused a chemical peritonitis, probably due to its solvent, sodium desoxycholate. Therefore, before amphotericin B can be used for the treatment of CAPD patients with ultrafiltration failure, further investigations are necessary to obtain a solvent for amphotericin B that is nontoxic and causes no chemical peritonitis.
Amphotericin B↗
Relationship of TNF-alpha, interleukin-6, and prostaglandins to peritoneal permeability for macromolecules during longitudinal follow-up of peritonitis in continuous ambulatory peritoneal dialysis.
Infectious reactions are known to comprise changes in vasopermeability and inflammatory mediators. We used peritonitis that complicated continuous ambulatory peritoneal dialysis (CAPD) as an in vivo inflammation model to study the time courses of peritoneal permeability characteristics and mediators in dialysate. Sixteen episodes of peritonitis were prospectively followed on eight consecutive days from the onset of the infection and once after recovery (control). Dialysate night dwells were examined for marker proteins of peritoneal permeability, cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and prostaglandins (PGE2, 6-keto-PGF1 alpha, and thromboxane B2 [TxB2]). The clearance of beta 2-microglobulin was used as indicator of the effective peritoneal surface area. The intrinsic permeability was characterized functionally by the peritoneal restriction coefficient. All protein clearances were increased during the acute phase of peritonitis and subsequently decreased to control. Likewise, the intrinsic peritoneal permeability was elevated, as demonstrated by a decrease of the peritoneal restriction coefficient. Peritoneal appearance rates of TNF-alpha, IL-6, and prostaglandins were also increased during the acute phase. Peak values were reached on day 1. The largest increase was observed for IL-6 (median 854-fold), followed by TNF-alpha (35-fold). The vasodilating PGE2 and 6-keto-PGF1 alpha were increased 12-fold and the vasoconstricting TxB2 was increased threefold. Evidence was obtained for local intraperitoneal synthesis of IL-6 and prostaglandins. TNF-alpha production appeared to be present only during the early acute inflammatory response. Analysis of variance for repeated measurements revealed that changes in the clearance of beta 2-microglobulin were related to those in IL-6 and marginally also to TNF-alpha in dialysate. Changes in the peritoneal restriction coefficient were also related to IL-6, but were more closely related to alterations in dialysate PGE2. These findings suggest that TNF-alpha, IL-6, and PGE2 are involved in the changes in permeability characteristics during CAPD-related peritonitis.
6-Ketoprostaglandin F1 alpha↗