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PubMed2005

How to increase adequacy of peritoneal dialysis in children?

Since children on dialysis are treated most often with nightlyintermittent peritoneal dialysis, adequacy of dialysis is determined by the number and duration of cycles, the volume of the dialysis fluid applied, and the choice of dialysis solution. The number and duration of cycles are dependent on the maximal acceptable duration of night rest and the permeability properties of the peritoneal membrane. The latter can be established by performance of a peritoneal equilibration test. The volume used should be about 1200 mL/m2 body surface area, and intraperitoneal pressure should be between 5 and 15 cm H2O. The dialysis solution administered should have a glucose concentration as low as possible, and an icodextrin daytime dwell may be considered.

Adolescent↗
PubMedDate not supplied

Fluid status and its management in Japanese peritoneal dialysis patients.

This article reviews published studies related to fluid status of Japanese peritoneal dialysis (PD) patients and its impact on technique and patient survival. In addition, some specifics related to clinical background that potentially influence fluid status are described. According to a multicenter survey conducted in Japan, nearly 25% of Japanese PD patients are overhydrated. Available data indicate that a high salt diet may conceivably play an important role in the pathogenesis of fluid overload in Japanese PD patients, and it in turn negatively impacts patient prognosis. Because of the generally adopted policy among Japanese PD experts to avoid regular use of 3.86% glucose solution, icodextrin solution is now used in more than one third of all patients. Other means of managing fluid overload, such as drug therapy, combination (complementary) therapy with hemodialysis, and low sodium PD solution, are also explored and summarized in this article.

Humans↗
PubMed2005

Risk of extracellular volume expansion in long-term peritoneal dialysis.

Although direct evidence is unavailable, indirect evidence strongly suggests that the risk of extracellular (EC) volume expansion increases with long-term peritoneal dialysis (PD). Long-term PD patients routinely develop loss of residual renal function (RRF) and often develop increased rates of peritoneal solute transport. Loss of RRF is associated with hypervolemia and increased risk of death. It is also indirectly linked both to development of high peritoneal transport (through the prescription of larger hypertonic dextrose loads) and to further limitations of peritoneal sodium removal [through automated PD (APD), which is often prescribed as a means of increasing peritoneal clearances as renal clearances decrease, and which causes, through its shortened dwell periods, low rates of peritoneal sodium removal]. High peritoneal solute transport limits peritoneal ultrafiltration and sodium removal; it is a recognized risk factor for hypervolemia. Many cross-sectional studies measuring EC volume have documented moderate to severe hypervolemia in large numbers of PD patients. In long-term PD, hypervolemia has severe consequences including morbidity and mortality. Preventing hypervolemia in PD patients requires a focus on maintaining sodium balance. The means include lowering the dialysate sodium concentration for APD exchanges, using icodextrin, and, primarily, reducing dietary sodium intake to a level determined by monitoring the patient's sodium removal rate in urine plus dialysate. Periodic measurements of sodium removal rates and appropriate adjustments of dietary sodium intake should be considered measures of adequacy in PD.

Diet, Sodium-Restricted↗
PubMed1998

Quantitation of dextran 70 in peritoneal dialysate from patients administered 7.5% polyglucose.

A method using gel permeation chromatography was evaluated for the quantitation of dextran 70 in dialysate samples containing polyglucose. Dialysate samples containing dextran 70 and polyglucose were pretreated using the enzyme alpha-amylase to selectively hydrolyze the alpha(1-4)-linked polyglucose, while leaving the alpha(1-6)-linked dextran 70 intact. Following sample deproteinization with trichloroacetic acid, dextran 70 was quantitated using gel permeation chromatography with refractive index detection. This method was evaluated for accuracy, precision, specificity, linearity, range, and analyte stability. Adequate method linearity with a correlation of >0.999 was established over the range of dextran 70 concentration from 1 to 0.025 mg/ml. Method precision was approximately 2% R.S.D. and accuracy (% recovery) was approximately 98-100% in the typical sample concentration range (1-0.5 mg/ml). This method was applied to the determination of intraperitoneal fluid kinetics in continuous ambulatory peritoneal dialysis (CAPD) patients administered daily night-time intraperitoneal exchanges with either 7.5% polyglucose or 4.25% dextrose. Dextran 70 was added to the dialysis solutions to yield an initial concentration of 1 mg/ml. Dialysate samples were collected at various times over a 10-h dwell-time and assayed for dextran 70. Intraperitoneal volume profiles based on dextran 70 concentrations and drain volumes were then calculated for each dialysis solution.

Chromatography, Gel↗
PubMed2006

Adequacy of automated peritoneal dialysis with and without manual daytime exchange: A randomized controlled trial.

Until now, it remains unclear whether the addition of manual daytime exchanges or increasing the nightly dialysate flow is the best strategy to optimize automated peritoneal dialysis (APD) treatment. In this open-label randomized controlled crossover trial, 18 patients with high-average (HA) or low-average (LA) peritoneal transport rates sequentially underwent two different APD regimens for 7 days each, with an intermittent washout period of 7 days. 'Manual exchange' treatment was a conventional APD with low nightly dialysate flow and one manual daytime exchange. 'High-flow' treatment was defined by cycler therapy with high dialysate flow but without manual daytime exchange. Creatinine clearances (8.56+/-1.22 vs 7.87+/-1.04 l/treatment, P = 0.011) and urea nitrogen clearances (12.83+/-1.98 vs 11.68+/-1.06 l/treatment, P = 0.014) were significantly increased during 'high-flow' treatment compared to 'manual exchange' treatment. Sodium removal was significantly lower and glucose absorption was higher with the 'high-flow' regimen. Phosphate clearances, beta2-microglobulin clearances, ultrafiltration, and peritoneal protein loss were not different between the two treatment modalities. Subgroup analysis dependent on peritoneal transport types showed that the effect on clearances was most marked and significant in HA transporters, whereas sodium removal was lowest in LA transporters. We conclude that small solute clearances can be significantly improved and middle molecule clearances maintained in APD patients by increasing the nightly dialysate flow instead of adding a manual daytime exchange. However, the possible benefit of better clearances with higher nightly treatment volumes has to be weighed against increased costs and the possible negative impact of impaired sodium removal, especially in LA transporters.

Adult↗
PubMed2002

Clinical advantages of new peritoneal dialysis solutions.

A review is given of the various mechanisms by which conventional glucose/lactate-based peritoneal dialysis solutions can induce damage to the peritoneal membrane. The potential advantages of newly developed dialysis solutions and the results of recent studies on their use in patients are discussed.

Amino Acids↗
PubMed2003

A spoonful of sugar.

Explore the source record for details and available documents.

Biocompatible Materials↗
PubMed2001

Improving contact area between the peritoneum and intraperitoneal therapeutic solutions.

A general assumption in peritoneal dialysis or intraperitoneal chemotherapy has been that a volume of 2 to 3 L in the human is sufficient to make contact with the entire anatomic peritoneum. On the basis of our previous experimental work and that of others, it was hypothesized that only a fraction of the anatomic peritoneum was in contact with the therapeutic solution in the cavity over a short period of time. It was also hypothesized that use of agitation of the experimental animal or a surfactant in the dialysis fluid would increase the contact area of the intraperitoneal solution. These hypotheses were tested by developing a method to measure the peritoneal contact area simultaneously with the anatomic peritoneal area. Anesthetized mice (25 to 35 g) received an injection of a relatively large volume (10 ml) of isotonic solution containing a radiolabeled protein that adhered to the peritoneum with which it came in contact. After a dwell of 1 to 24 h, the animal was killed and frozen. Cross sections of the abdominal and pelvic cavities were cut and placed against film to develop into autoradiograms, which represent the linear dimension of fluid contact in each sampling plane. The tissue sections that corresponded to the autoradiograms were stained to display the linear dimension of the anatomic peritoneum in the sampling plane. By imaging both the autoradiogram and the corresponding histologic slide, an estimate of the ratio of the contact area to anatomic area in each plane can be calculated (R(mean) = average of all ratios). Applying this method to mice that were dialyzed with an isotonic salt solution under quiescent conditions for 1 h produced R(mean) = 0.43 +/- 0.03. With rapid shaking of the animal, R(mean) = 0.54 +/- 0.03 (P: < 0.05). Addition of the surfactant dioctyl sodium sulfosuccinate (DSS) 0.5% to the solution under quiescent conditions increased R(mean) to 1.07 +/- 0.03 (P: < 0.001). Lengthening the dwell of the isotonic solution to 24 h increased R(mean) to >0.90. In further study of the effect of the concentration of DSS on contact area, there was a direct correlation of R(mean) with concentrations ranging from 0.0005 to 0.05% DSS. It is concluded that less than half of the mouse peritoneum is in contact with a large volume of solution in the peritoneal cavity. Maneuvers such as agitation and use of surfactant in the intraperitoneal solution increase the fraction of contact area. Also demonstrated was a direct dose-response of contact area versus intraperitoneal concentration of DSS, which may be useful in intraperitoneal therapies of peritoneal dialysis or intraperitoneal chemotherapy.

Animals↗
PubMed2001

Cutaneous drug reaction case reports: from the world literature.

Skin disorders are the most common adverse reactions attributed to drugs. Any skin disorder can be imitated, induced or aggravated by drugs. To help you keep up-to-date with the very latest skin reactions occurring with both new and established drugs, this section of the journal brings you information selected from the adverse drug reaction alerting service Reactions Weekly. The following case reports are selected from the very latest to be published in the world dermatology literature. Any claim of a first report has been verified by a search of AdisBase (a proprietary database of Adis International, Auckland, New Zealand) and Medline. Each case report is assessed for seriousness using the FDA MedWatch definition of serious (patient outcome is: death; life-threatening; hospitalization; disability; congenital anomaly; or requires intervention to prevent permanent impairment or damage).

Adolescent↗