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PubMed1999

1997 Peritoneal Dialysis-Core Indicators Study: Dialysis Adequacy and Nutritional Indicators Report.

The 1997 Peritoneal Dialysis-Core Indicators Study: Dialysis Adequacy and Nutritional Indicators Report documents the current status of peritoneal dialysis within the United States. A national random sample of adult peritoneal dialysis (PD) patients participating in the United States End Stage Renal Disease (ESRD) program was surveyed. PD subjects were large, with a mean body weight of 76 +/- 18.9 kg (mean +/- 1 SD) and a body mass index (BMI) of 27 +/- 6.4. The dialysis prescriptions documented achieved a mean weekly Kt/Vurea (wKt/V) and weekly creatinine clearance (wCrCl) of 2. 45 +/- 2.29 and 65.5 +/- 35.2 L/wk/1.73m2, respectively. The serum albumin of these patients was 3.5 +/- 0.48 g/dL, their normalized protein equivalent of nitrogen appearance (nPNA) 1.0 +/- 0.63 g/kg/d, and their normalized creatinine appearance rate (nCAR) 14 +/- 6.0 mg/kg/d. Serum albumin correlated meagerly but in a positive fashion with BMI, nPNA, and nCAR, and negatively with wCrCl. Among adult US PD patients, serum albumin values appear to correlate poorly with alternative measures of nutritional status and are inversely related to the intensity of renal replacement therapy. The presumptive dietary protein intake (nPNA) and creatinine appearance rate (nCAR) derived for PD patients do correlate in a positive fashion with dialysis delivery, at least up to a wCrCl of 60 to 80 L/wk/1.73 m2 and wKt/V = 2.1, but their values suggest that 30% to 50% of PD patients have marginal nutritional status.

Adolescent↗
PubMed1984

Opsonic deficiency of peritoneal dialysis effluent in continuous ambulatory peritoneal dialysis.

Staphylococcus epidermidis peritonitis frequently complicates the clinical course of patients treated with continuous ambulatory peritoneal dialysis (CAPD). Since bacterial opsonization is critical to the effective defense of the peritoneal cavity by phagocytic cells, we prospectively evaluated the opsonic activity of peritoneal dialysis effluent obtained from 17 CAPD patients during 102 patient months. Samples of peritoneal dialysis effluent contained concentrations of opsonins against S. epidermidis that were less than 2% of that observed in serum. Moreover, heat-labile opsonic activity against Escherichia coli was absent from all dialysis effluents. During the study, there were ten episodes of peritonitis in nine CAPD patients (1 per 10.2 patient months). S. epidermidis was isolated in seven episodes, a gram-negative bacillus in one, and two episodes were culture negative. the incidence of S. epidermidis peritonitis was 1 per 62 patient months in the patients with "high" peritoneal dialysis effluent opsonic activity against S. epidermidis but was nearly tenfold greater in patients with "low" opsonic activity (1 per 6.7 patient months). We conclude that peritoneal dialysis effluent opsonic activity predicts which CAPD patients are at an increased risk to develop S. epidermidis peritonitis.

Aged↗
PubMed1983

Carbohydrate and lipid metabolism during continuous ambulatory peritoneal dialysis (CAPD): the effect of a single dialysis cycle.

The effect on hormonal status and intermediary metabolism of a single 6 h dialysis cycle at two different concentrations of dialysate glucose was investigated in six patients on continuous ambulatory peritoneal dialysis. The basal blood glucose level was elevated by 0.5 mmol/l, associated with a threefold increase in basal serum insulin compared with seven normal controls. Blood glucose and serum insulin rose further during dialysis, particularly with hypertonic (215 mmol of glucose/l) dialysis fluid and levels remained high for 6 h after the onset. Plasma glucagon concentrations were 2.7-fold increased and did not decrease to normal during dialysis. Concentrations of the gluconeogenic precursors lactate and alanine were consistently raised, and levels of circulating non-esterified fatty acids and ketone bodies were lowered, particularly with hypertonic dialysis fluid. The long-term effects of sustained hyperinsulinaemia, including suppression of lipolysis and ketogenesis, require further investigation.

Adult↗
PubMed2003

Clinical experience with two physiologic bicarbonate/lactate peritoneal dialysis solutions in automated peritoneal dialysis.

UNLABELLED: Clinical experience with two physiologic bicarbonate/lactate peritoneal dialysis solutions in automated peritoneal dialysis. BACKGROUND: Patients on automated peritoneal dialysis (APD) usually receive larger volumes of dialysis solution and more frequent, shorter exchanges than patients on continuous ambulatory peritoneal dialysis (CAPD), and therefore are likely to derive greater benefit from more physiologic solutions. METHODS: Peritoneal dialysis solutions containing 25 mmol/L bicarbonate and either 10 or 15 mmol/L lactate were compared with standard lactate solutions (35 or 40 mmol/L) in two prospective, open-label studies of patients on APD. Each study included a 2-week baseline period (lactate solution), a 6-week treatment period (bicarbonate/lactate solution), and a 2-week follow-up period (same lactate solution as baseline). Biochemical analyses and assessments of vital signs and safety parameters were conducted at baseline, every 2 weeks during treatment, and at the end of the follow-up period. A product use questionnaire was administered in one study at the end of treatment. RESULTS: A statistically significant rise in plasma bicarbonate (approximately 2 mmol/L) occurred when patients switched from a lactate solution to the bicarbonate/lactate solution with equimolar buffer concentration (P < 0.001 for each solution). Plasma bicarbonate decreased by 1.16 mmol/L after a switch from lactate 40 mmol/L to bicarbonate/lactate 35 mmol/L (P < 0.001). When patients switched to bicarbonate/lactate 35, the majority of individual venous plasma bicarbonate values were in the normal range. A switch from a lower calcium (1.25 mmol/ L) lactate solution to a higher calcium (1.75 mmol/L) lactate/bicarbonate solution resulted in a statistically significant rise in serum calcium (0.06 mmol/L, P < 0.018). The product use questionnaire revealed improvements in symptoms, including reduced pain on infusion. CONCLUSION: Bicarbonate/lactate solutions may be used safely and effectively in patients on APD. The availability of 2 formulations with different buffer and calcium content provides flexibility for the control of acidosis as well as calcium balance.

Automation↗
PubMed2003

Nutritional management of dialysis patients: balancing among nutrient intake, dialysis dose, and nutritional status.

BACKGROUND: Recommended protein intake for dialysis patients is much higher compared with allowance for normal adults. The authors tried to make a consideration on balancing among nutrient intake, dialysis dose, and nutritional status in maintenance dialysis patients. METHODS: In 57 patients, 13 on hemodialysis (HD) and 44 on continuous ambulatory peritoneal dialysis (CAPD), serum urea nitrogen (SUN), albumin, weekly creatinine clearance of CAPD, and body protein mass by multifrequency bioelectrical impedance analysis were measured. Energy intake was examined from the patients' food diary by a registered dietitian, and protein intake was estimated by both the patients' food diary and calculation of protein equivalent nitrogen appearance. RESULTS: In HD patients, predialysis SUN levels significantly correlated with the amounts of protein intake (r = 0.893; P < 0.001), and there was no correlation between post- and next predialysis SUN levels. In CAPD patients, SUN levels significantly correlated with the amounts of protein intake (r = 0.645; P < 0.001), and there was no correlation between SUN levels and weekly Ccr. The amounts of protein intake were significantly correlated with body protein mass (r = 0.365; P = 0.014), and there were significantly positive relationships between the amounts of protein intake and energy intake in both HD (r = 0.798; P < 0.001) and CAPD patients (r = 0.631; P = 0.006). CONCLUSION: Whereas higher intake of protein requires higher doses of dialysis, lower intake of protein with sufficient energy intake requires lower doses of dialysis, and both could give the same effects on nutritional status.

Adult↗
PubMed1998

Simultaneous peritoneal dialysis catheter insertion and removal in catheter-related infections without interruption of peritoneal dialysis.

Catheter-related infections result in high patient morbidity, the need for temporary haemodialysis, and high costs. These infections are the main cause of limited technique survival in peritoneal dialysis. We introduced a protocol for the simultaneous peritoneoscopic insertion and removal of peritoneal catheters in patients with catheter-related infections. Peritoneal dialysis was continued the day after surgery using low-volume dwells and a dry abdomen during the daytime. The dialysate leukocyte count had to be below 100/mm3 before exchanging catheters, which was performed under antibiotic therapy based on culture sensitivity. The old catheter was removed after the new catheter had been inserted in the opposite abdominal region. CAPD patients were switched to APD for 1 week, which made prolonged hospitalization necessary. Simultaneous catheter insertion and removal was performed 25 times in 22 patients on CCPD and 15 times in 14 patients on CAPD. In CCPD patients, peritoneal dialysis was restarted after 1.0+/-0.1 days in 24 cases. One patient had sufficient residual renal function and discontinued CCPD until day 10. In 10 CAPD patients (11 procedures) APD was started 1.3+/-0.2 days after the procedure with CAPD beginning 7.1+/-0.6 days thereafter. Three CAPD patients preferred haemodialysis and restarted CAPD 10.0+/-2.1 days after surgery. One patient continued CAPD the day after surgery. In addition to minor complications (e.g. position-dependent outflow problems), dialysate leakage occurred in two patients. Two patients developed peritonitis within the first 30 days after surgery, one of which was procedure related. One patient had severe lower gastrointestinal bleeding 2 weeks after the procedure, which was not related to the catheter replacement. Ultimately, in 38 of 40 procedures the patients could successfully continue peritoneal dialysis. We conclude that simultaneous insertion and removal of a peritoneal dialysis catheter without interruption of peritoneal dialysis is a safe procedure in patients with catheter-related infections.

Adult↗
PubMedDate not supplied

Peritoneal sodium mass removal in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis: influence on blood pressure control.

BACKGROUND/AIM: Sodium and water retention is common in peritoneal dialysis patients and contributes to cardiovascular disease. As peritoneal sodium removal depends partly on dwell time, and automated peritoneal dialysis (APD) often uses short dwell time exchanges, the aim of this study was to compare the 24-hour peritoneal sodium removal in APD and standard continuous ambulatory peritoneal dialysis (CAPD) patients and to analyze its possible influence on blood pressure control. METHODS: A total of 53 sodium balance studies (30 in APD and 23 in CAPD) were performed in 36 stable peritoneal dialysis patients. The 24-hour net removal of sodium was calculated as follows: M = ViCi - VdCd, where Vd is the 24-hour drained volume, Cd is the solute sodium concentration in Vd, Vi is the amount of solution used during a 24-hour period, and Ci is the sodium concentration in Vi. Peritoneal sodium removal was compared between APD and CAPD patients. Residual renal function, serum sodium concentration, daily urinary sodium losses, weekly peritoneal Kt/V and creatinine clearance, 4-hour dialysate/plasma creatinine ratio, proportion of hypertonic solutions, net ultrafiltration, systolic and diastolic blood pressures, and need for antihypertensive therapy were also compared between the groups. RESULTS: Peritoneal sodium removal was higher (p < 0.001) in CAPD than in APD patients. There were no significant differences in residual renal function, serum sodium concentration, urinary sodium losses, peritoneal urea or creatinine clearances, 4-hour dialysate/plasma creatinine ratio, or proportion of hypertonic solutions between groups. The net ultrafiltration was higher in CAPD patients and correlated strongly (r = 0.82; p < 0.001) with peritoneal sodium removal. In APD patients, peritoneal sodium removal increased significantly only in those patients with a second daytime exchange. The systolic blood pressure was higher (p < 0.05) in APD patients, and the proportion of patients with antihypertensive therapy was also higher in APD patients, although no significant relationship between blood pressure values and amount of peritoneal sodium removal was found. CONCLUSIONS: The 24-hour sodium removal is higher in CAPD than in APD patients, and there is a trend towards better hypertension control in CAPD patients. As hypertension control and volume status are important indices of peritoneal dialysis adequacy, our results have to be considered in the choice of the peritoneal dialysis modality.

Adult↗
PubMed1992

Effect of amino acid based dialysis solution on peritoneal permeability and prostanoid generation in patients undergoing continuous ambulatory peritoneal dialysis.

The acute effect of amino acid based dialysis solution on peritoneal kinetics of amino acids and plasma proteins in comparison to conventional glucose-based dialysate was studied in 9 patients with end-stage renal failure on continuous ambulatory peritoneal dialysis. Instillation of 2.6% amino acid solution resulted in raised plasma concentrations of all essential amino acids included in the dialysis fluid (p less than 0.005). The amino acid solution induced an augmented leakage of plasma proteins into the dialysate at all dwell times investigated (1-8 h). After a dwell time at 8 h, the dialysate total protein increased from 2.62 +/- 0.45 g with glucose dialysate to 3.85 +/- 0.42 g with amino acid solution (p less than 0.05). Corresponding results were obtained for beta 2-microglobulin, albumin, transferrin, IgG, and for the non-essential amino acids alanine, citrulline, and glutamine (p less than 0.025) not included in the initial amino acid composition of the dialysis fluid. During the use of amino acid based dialysis fluid, the effluent prostaglandin E2 concentration increased by more than 80% in comparison to glucose dialysate (p less than 0.025). The augmented loss of proteins induced by the amino acid solution was positively correlated with increased dialysate prostaglandin E2 (r = 0.8894; p less than 0.001). Peritoneal ultrafiltration was not affected by the use of amino acid based dialysate fluid. The present results indicate that amino acid based dialysis fluid enhances the peritoneal permeability for plasma proteins and amino acids, probably mediated by locally generated prostanoids.

Adult↗
PubMed1995

Hospitalization among United States dialysis patients: hemodialysis versus peritoneal dialysis.

Measurements of hospitalization in the dialysis population are important because they provide insight into the morbidity and the cost of treatment among dialysis patients. Prior comparisons of hospitalization for different dialysis modalities have had conflicting results. This study was designed to compare hospitalization for patients treated with peritoneal dialysis (PD) versus hemodialysis (HD) using the data from the U.S. Renal Data System 1993 Annual Data Report. The study population included all Medicare dialysis patients prevalent on January 1, 1988 through 1990. Patients were monitored to transplantation, death, or end of the calendar year for a total of 189,654 patient years. Hospital admission rates were computed from the total number of hospital admissions during the year divided by the total number of patient years at risk. Patients were classified by treatment modality (PD, HD), cause of ESRD (diabetes as a cause of ESRD versus all other causes), age (0 to 19, 20 to 44, 45 to 65, +65), and race (black, white). Rate ratios (RR:PD/HD) for hospital admissions per year at risk were estimated, while adjusting for the other factors with Poison regression. On average, hospital admission rates per patient year at risk for dialysis patients treated with PD were 14% higher than for those treated with HD (RR = 1.14; 95% confidence interval (Cl), 1.13 to 1.15) when adjusting for race, age, gender, and cause of ESRD. The excess in the overall adjusted admission rates in PD patients compared with HD patients was higher for black than for white patients (RR:PD/HD = 1.22 versus RR = 1.11; 95% Cl, 1.10 to 1.13).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1999

Current practice of peritoneal dialysis in children: results of a longitudinal survey. Mid European Pediatric Peritoneal Dialysis Study Group (MEPPS).

Since 1993, the Mid European Pediatric Peritoneal Dialysis Study Group (MEPPS) has been accumulating epidemiological data regarding the practice of peritoneal dialysis (PD) in children. More than 200 children have been evaluated to date. While treatment modalities were evenly distributed in 1993, automated peritoneal dialysis (APD) has emerged as the preferred mode of therapy during the last few years. Technique survival was 95% at 2 years, but decreased to 65% after 4 years of treatment, the main reasons for treatment failure being recurrent peritonitis, ultrafiltration failure, or both. Most centers use double-cuff curled Tenckhoff catheters with an upward pointing exit site. The first catheter was still functioning in 82% of patients after 1 year, and in 57% of patients after 4 years of treatment. While the overall peritonitis incidence between 1993 and 1997 was 1 episode per 17 months, it was much higher in children below 6 years of age. Empirical PD prescription resulted in a mean total weekly creatinine clearance of 57 L/1.73 m2/week in both continuous ambulatory peritoneal dialysis (CAPD) and APD patients, while average total weekly Kt/V urea was higher in APD-treated (2.45) than in CAPD-treated children (1.96). Antihypertensive treatment was required in 40%-50% of patients; oral phosphate binders in 75%-80%; bicarbonate substitution in 30%; potassium binders in 7%-14%; and NaCl supplementation in 9%-21% of patients. While growth retardation had a prevalence of 57%, body mass relative to height was in the normal range. After one year of dialysis, 20% of patients received growth hormone treatment. In conclusion, peritoneal dialysis in children, preferably performed as APD, achieves technique survival rates similar to those reported for adults. Young children are at increased risk for peritonitis. The current empirical PD prescription is of limited efficacy in terms of small-solute and fluid removal.

Body Constitution↗
PubMedDate not supplied

Metallothionein and dendritic cells in skin of end-stage renal disease patients not on dialysis, or on hemodialysis or peritoneal dialysis.

OBJECTIVE: Renal failure leads to a variety of defects in immune function. The skin, as a major player in the immune system network, also exhibits multiple derangements. The pathogenesis of these defects and derangements are poorly understood; therefore, we studied immune competent cells, dermal dendrocytes (DC), and a special proinflammatory protein, metallothionein (MT), in the skin of these patients. DESIGN: 22 patients with end-stage renal disease (ESRD) but not on dialysis, 18 patients on hemodialysis (HD), 14 patients on peritoneal dialysis (PD), and 35 healthy controls were included in the study. Immunohistochemical staining of skin biopsies for DC and MT was performed with the following antibodies: for DC, antibody against factor XIIIa; and for MT, Dako-MT, E9 (Dako, Carpinteria, California, USA). Measurements were made by counting stained DC per square millimeter, and by optical density (OD) for MT (mean SEM). RESULTS: Metallothionein was increased in the skin of HD (OD 0.42 +/- 0.05, p < 0.01) and PD patients (OD 0.33 +/- 0.04, p < 0.05) compared to controls (OD 0.23 +/- 0.02) and ESRD patients not on dialysis (OD 0.22 +/- 0.05). In contrast, numbers of DC were reduced in patients on PD compared to controls (59 +/- 13 vs 96 +/- 59 DC/mm2, p < 0.01) and increased in patients with ESRD prior to dialysis (141 +/- 13 DC/mm2, p < 0.05). Patients on HD were in-between (105 +/- 20 DC/mm2), with a significant difference versus patients on PD (p < 0.05). CONCLUSIONS: Our data show that the mode of dialysis influences the number of antigen-presenting cells in the dermis. However, in both dialysis modes, a proinflammatory immune status of the skin (MT) was present and, therefore, other regulatory elements for dermal dendrocytes apart from proinflammation exist.

Adult↗
PubMed1995

Dialysis adequacy indices in high membrane transporters treated with short-dwell peritoneal dialysis.

Treatment of high-membrane transporters with continuous ambulatory peritoneal dialysis (CAPD) is associated with ineffective ultrafiltration, increased dialysate protein loss, lower serum albumin levels, and lower protein catabolic rates, suggesting development of inadequate dialysis. The use of short-dwell nightly intermittent peritoneal dialysis (NIPD) and daytime ambulatory peritoneal dialysis (DAPD) has not been evaluated. Patients with inadequate ultrafiltration secondary to rapid membrane transport [peritoneal equilibration test (PET) confirmation] were managed with NIPD and DAPD (group A, n = 32) and compared to patients on CAPD and continuous cycling peritoneal dialysis (CCPD) (group B, n = 53) after at least 3 months of therapy. Groups A and B were similar in age, gender, diabetic status, prestudy months on peritoneal dialysis (PD), and residual renal function. No significant differences were observed between the groups with respect to serum albumin, daily protein loss, normalized protein catabolic rate (PCRN), or weekly KT/V urea indices. Diabetics demonstrated lower levels of serum albumin and PCRN than nondiabetics while maintaining equivalent KT/V urea indices. Reassessment of patients 6 months later also revealed no differences in outcome measures between group A (n = 20) and group B (n = 36). High transporters treated with NIPD and DAPD appear to have similar dialysate protein loss, adequacy, and nutrition indices when compared to patients on CAPD and CCPD. Future studies will determine if delivery of higher target small-solute clearances benefits patients on NIPD/DAPD as contrasted with continuous PD modalities (CAPD/CCPD), or diabetics compared to nondiabetics.

Biological Transport↗
PubMed1995

Variability in calculations of dialysis adequacy in patients using nightly intermittent peritoneal dialysis compared to CAPD.

Increasing numbers of patients receive peritoneal dialysis using noncontinuous methods such as nightly intermittent peritoneal dialysis (NIPD) rather than continuous ambulatory peritoneal dialysis (CAPD). We hypothesized that blood solute levels before and after NIPD would be large enough to produce significant variability in formulas based on the continuous peritoneal dialysis (PD) model. We found no diurnal differences in serum creatinine in NIPD or CAPD. However, our data demonstrate a 7.9% difference in serum urea measurements from evening to morning in patients treated by NIPD. This mathematical difference contributes to a 6.3% difference in the calculated value of KT/V and a 9.4% difference in the calculation of total urea clearance (liters per week) in these patients. By contrast, no difference in serum values or in calculated values of adequacy could be shown in patients on CAPD. These observations support the premise that CAPD represents a steady-state condition. NIPD patients demonstrate variability in serum levels of urea which may result in inaccurate calculations of dialysis adequacy. When blood samples are obtained in the morning soon after completing a cycle of NIPD, dialysis adequacy as measured by KT/V or total urea clearance (but not by total creatinine clearance) may be systematically overestimated.

Adult↗
PubMed1996

The influence of nutritional status, dialysis adequacy, and residual renal function on the response to hepatitis B vaccination in peritoneal dialysis patients.

Little is known about the factors contributing to the reduced antibody response to hepatitis B vaccination in peritoneal dialysis patients. The influence of nutritional status [as assessed by serum albumin and nitrogen protein appearance (nPNA)], residual renal function, and dialysis adequacy (weekly Kt/V(urea)) on the development of hepatitis B antibodies was examined in 32 continuous ambulatory peritoneal dialysis/continuous cycling peritoneal dialysis patients. Vaccination with Engerix 40 micrograms given intramuscularly at 0, 1, 2, and 6 months resulted in a 63% response with 20 converters and 12 nonconverters. Patient age, sex, months on peritoneal dialysis, and race were not different among converters and nonconverters. Median serum albumin (3.75 vs 3.8 g/dL), nPNA (0.96 vs 0.94 g/kg/day initial and 0.78 vs 0.84 g/kg/day final), residual renal function (5.4 vs 4.0 mL/min), and final weekly Kt/V (2.12 vs 1.96) were not different among converters and nonconverters, respectively. Initial Kt/V was higher in converters (2.37 vs 2.01, p = 0.02). Nutritional status, residual renal function, and weekly Kt/V in nutritionally replete and well-dialyzed peritoneal dialysis patients do not predict response to hepatitis B vaccine. Patients with higher weekly Kt/V early in the course of peritoneal dialysis may be more likely to respond to hepatitis B vaccination.

Adult↗
PubMed2005

[Influence of new dialysis solutions on clinical results in patients treated with peritoneal dialysis].

Long-term peritoneal dialysis is associated with changes in the peritoneal membrane. Conventional dialysate solutions are bioincompatible because of their low pH, high glucose content, hyperosmolality and increased concentration of glucose degradation products. The development of double-compartment systems has made it possible to separate glucose from the buffer during heat sterilization, resulting in a higher or even physiologic pH of the solution with reduced concentration of glucose degradation products. These new solutions are less toxic for several cell groups and are better than conventional solutions in preserving membrane function, as demonstrated by experiments in rats. Glucose degradation products promote formation of advanced glycation end-products, and plasma levels of these are markedly reduced when double-compartment systems are used. Clinical studies with these more physiologic dialysis solutions have demonstrated better correction of acidosis, less inflow pain, significantly elevated CA-125 dialysate levels and lower concentrations of markers for inflammation and fibrosis in the effluent. In a retrospective study, a lower rate of mortality was observed in patients who were treated using a double-compartment system than in those treated with standard dialysis solution. Amino acids (in the low-molecular-weight range) and icodextrin (in the high-molecular-weight range) are newer osmotic agents that have been developed as alternatives to glucose. Several clinical studies have shown that amino-acid solution improves various nutritional parameters in patients with malnutrition and is more biocompatible than standard glucose solution. Icodextrin is an iso-osmolar dialysis solution. Ultrafiltration takes place via colloid osmotic pressure and is sufficient in all types of peritoneal transport. Clinical studies using icodextrin have shown better fluid control, especially in high transporters, reduced carbohydrate load and fewer patients with ultrafiltration failure compared with those treated with conventional dialysis solutions. However, allergic skin reactions have been observed in up to 10% of patients treated with icodextrin. Icodextrin may induce a fall of sodium plasma levels. Because of cross-reaction with elevated plasma levels of maltose, serum amylase is determined falsely low and glucose (using the glucose-dehydrogenase method) is measured falsely high, but high plasma levels of maltose do not affect measurement of lipase or measurement of glucose using the glucose-oxidase method. New dialysate solutions will have a positive influence on both survival and technical drop-out rates in patients receiving peritoneal dialysis treatment.

Clinical Trials as Topic↗
PubMed1982

Determination of unbound fraction of disopyramide in plasma: a comparison of equilibrium dialysis, ultrafiltration through dialysis membranes and ultrafree anticonvulsant drug filters.

A simple, rapid ultrafiltration technique for determination of free drug concentration in plasma is described and compared with equilibrium dialysis and ultrafiltration through dialysis membranes. When used for disopyramide protein binding studies, this method requires only 1 ml of plasma and up to 20 samples may be filtered simultaneously in 20-40 min. Commercially available Ultrafree anticonvulsant drug filters are used, these are attached to 2 ml leur tip syringes, which provide the pressure gradient for filtration. Compared to equilibrium dialysis this technique is far quicker and permits protein binding to be measured at the drug concentration in the original plasma. Ultrafiltration through dialysis membranes was found to be more tedious and time-consuming than it was through Ultrafree filters. Adsorption of disopyramide from the plasma sample and protein leakage were also problems with this method. Leakage of protein did not occur with either Ultrafree filters or equilibrium dialysis. With the Ultrafree method, recovery of 14C-labeled disopyramide in buffer at 1.1 micrograms/ml and 8.4 micrograms/ml was 87% and 89% respectively. In carefully controlled experiments, a comparison of the Ultrafree method with equilibrium dialysis and ultrafiltration gave comparable values for the free fraction of the drug for total concentrations from 0.3-8 microgram/ml disopyramide.

Blood Proteins↗
PubMedDate not supplied

Emergency department presentation of renal dialysis patients: indications for EMS transport directly to dialysis centers.

To determine the pattern of emergency department (ED) utilization by renal dialysis (RD) patients, a prospective study was conducted of dialysis patients presenting to the ED of a regional dialysis center. The most common presenting complaints were shortness of breath (SOB), chest pain, abdominal pain, and vomiting; the most common diagnoses were congestive heart failure, chest wall pain, and electrolyte abnormalities. Interventional dialysis (ID), defined as emergent dialysis required to treat the patient's presenting complaint, was required for 30 patients, with the most common presenting complaints of these patients being shortness of breath, weakness, and chest pain. Only SOB was statistically significant in predicting the need for ID (P less than 0.001), with a positive predictive value of 0.63 and a negative predictive value of 0.85. Prehospital implications of these data suggest that RD patients with a chief complaint of SOB should be transported directly to a facility capable of dialysis on an emergent basis.

Emergencies↗
PubMed1994

Coronary artery bypass grafting in chronic renal dialysis patients: intensive perioperative dialysis and extensive usage of arterial grafts.

Twenty-three chronic renal dialysis patients underwent coronary artery bypass grafting (CABG). Eighteen patients were maintained on hemodialysis and 5 patients received continuous ambulatory peritoneal dialysis. Eighteen patients (78%) had triple vessel disease or left main disease. The mean number of revascularized vessels was 2.2 +/- 0.8, and the graft materials used were left internal thoracic artery (21), right internal thoracic artery (7), right gastroepiploic artery (7), and saphenous vein (15). The utilization index of arterial grafts (percentage of patients with at least one arterial graft) was 95.7%. Intraoperative hemodialysis (HD) was performed during cardiopulmonary bypass in all patients. In 17 patients on HD preoperatively, peritoneal dialysis (PD) was initiated immediately after the operation, and maintained until the hemodynamics stabilized sufficiently to resume HD (mean: 5.7 +/- 3.4 days after operation). In the patients with a gastroepiploic artery pedicle, PD could be established without leakage of dialysis fluid into the pericardial cavity by means of making a smaller hole in the diaphragm, passing the skeletonized portion of the graft through the hole and sealing the hole using fibrin glue. There were no hospital deaths. Angiography revealed an overall graft patency rate of 95.8% (46/48), and all arterial grafts were patent. There were 4 late deaths (1 cardiac, 3 cerebral hemorrhage). In conclusion, CABG can be accomplished in chronic renal dialysis patients with excellent early and long-term results through an intensive perioperative dialysis program and extensive usage of arterial grafts.

Adult↗