Changes in Water Transport across the Peritoneum during Treatment with Continuous Ambulatory Peritoneal Dialysis in Selected Patients with and without Peritonitis (original) (raw)
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Chang Gung medical journal, 2004
To assess changes in the peritoneal membrane after peritonitis episodes in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). From 1989 to 2002, CAPD patients who had peritonitis episodes were enrolled. We used the peritoneal equilibration test (PET) and measured plasma creatinine (Cr) levels at 2 hours, and dialysate Cr and glucose levels at 0, 2, and 4 hours. In addition, the dialysate-to-plasma ratio of Cr (D/PCr) at 0, 2, and 4 hours, the ratio of glucose levels in the dialysate effluent and infused dialysate ((D/D0)G), the drained ultrafiltration (UF) volume at 4 hours, and the mass transfer area coefficient of Cr (MTAC) normalized for the body surface area were also calculated. D/PCr, (D/D0)G, UF volume, and MTAC were measured at the baseline and after 2 years, and the results were analyzed and compared. Totally 27 patients were enrolled in the peritonitis group, including 17 males and 10 females. They had received CAPD for 71.23 +/- 28.13 months. Forty-nine...
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 1989
Serum and overnight dialysate samples were obtained from 36 adult uraemic patients at the end of their continuous ambulatory peritoneal dialysis (CAPD) training. The samples were analysed for albumin, IgG, C3, and antistaphylococcal peptidoglycan antibody. None of the dialysate measurements correlated with the risk of peritonitis during up to one year's CAPD treatment. Nineteen of the 36 patients were retested 6 to 20 months after starting CAPD. There were significant rises in serum C3 ( p < 0.02) and albumin ( p < 0.001) and a significant fall in dialysate IgG ( p < 0.02). Eight further patients were sampled at the end of training and three weeks later. They had a significant fall in dialysate IgG ( p < 0.05). During CAPD training peritoneal permeability appears to be transiently increased. Analysis of overnight dialysate samples during training does not allow prediction of those at risk of subsequent peritonitis.
Assessing the peritoneal dialysis capacities of individual patients
Kidney International, 1995
Assessing the peritoneal dialysis capacities of individual patients. A method for measuring the peritoneal dialysis capacity (PDC) of the individual patient has been developed as an aid to treatment of patients with renal failure and peritoneal dialysis. The patient collects the data him or herself during an almost normal CAPD day using a carefully designed protocol whereby the nursing time is kept to a minimum. The three-pore model is used to describe the PDC with three physiological parameters: (1.) the 'Aiea' parameter (Ajx), which determines the diffusion of small solutes and the hydraulic conductance of the membrane (LS); (2.) the final reabsorption rate of fluid from the abdominal cavity to blood (JvAR) when the glucose gradient has dissipated; and (3.) the large pore fluid flux (of plasma, JvL), which determines the loss of protein to the PD fluid. In the adult PD population (age 60, N = 97) the normal 'Area' parameter was 23,600 cm/1.73 m2, with an SEM of 650. The JVAR was 1.49 ml/min/1.73 m2 and JvL was 0.078 ml/min/1.73 m2. The PDC parameters were reproducible and could adequately predict the concentrations of the test sQiutes as well as that of 132-microglobulin. The results in terms of clearance, 'UF volume' and nutritional consequences were presented on easily understandable graphs, whereby patient compliance was improved, These physiological parameters are highly dynamic, as evidenced by the marked increases observed during peritonitis. It seems safe to conclude that PDC is a useful tool to achieve adequate dialysis and to enhance the understanding of PD exchange. Peritoneal dialysis (PD) is an increasingly popular life-supporting therapy for patients with chronic renal failure. In contrast to the membranes used in hemodialysis, the functional characteristics of the individual PD membrane are unknown. indeed, it was recognized early that there are large differences in solute and fluid exchange between individual patients treated with continuous ambulatory peritoneal dialysis (CAPD) [1]. Moreover, the consequences of inadequate, or rather insufficient, dialysis appear gradually over a long period of time and include the reappearing uremic symptoms as well as increased morbidity and mortality. The effects appear in patients as the residual renal function declines, a phenomenon often denoted "the end of the honeymoon period." Previously, infections were the major complications of PD. However, the risk of peritonitis has been reduced in the last few years and other problems such as underdialysis are now evident. Against this background, it is not surprising that there is growing interest in methods of measuring PD exchange and providing adequate dialysis. In 1987, Twardowski et al introduced a simple peritoneal equilibration test (PET) which greatly improved our knowledge of
2004
Background: Peritonitis is considered to change peritoneal permeability and influences the long-term change in permeability during peritoneal dialysis. The objective of this study is to evaluate water transport across the peritoneum, expressed as drained ultrafiltration volume, before, during, and after episodes of peritonitis. Methods: A retrospective analysis of data from a group of patients was performed in which drained ultrafiltration volume and glucose concentration in dialysis fluid were recorded for each dwell time every day during time on continuous ambulatory peritoneal dialysis treatment as a part of the clinical routine performed. Days with peritonitis and average of daily measurements 1 month before and after each peritonitis episode were evaluated separately for day and night exchanges. In all, 64 episodes of peritonitis in 30 patients were included in this study. Approximately 15,000 exchanges were recorded. Paired t-test and repeated-measures analysis of variance were performed. Results: Compared with the average for the previous month, there was a significant decrease in ultrafiltration volume for day exchanges occurring 2 days before the appearance of other clinical symptoms of peritonitis (P ؍ 0.029). For night exchanges, the decrease in ultrafiltration volume occurred 24 hours before diagnosis (P < 0.001). Ultrafiltration volume was at its minimum the day of diagnosis for both the day (P < 0.001) and night (P < 0.001) exchanges compared with average volume for the previous month. Ultrafiltration volumes remained low for 2 days after diagnosis during both the day (P ؍ 0.009) and night (P ؍ 0.017) exchanges. Relative to the previous month, glucose concentration on the day of clinical diagnosis of peritonitis did not differ significantly (P ؍ 0.328 and P ؍ 0.963 for day and night shifts, respectively). Overall, no significant changes in ultrafiltration volumes or glucose concentrations from the month before to the month after the peritonitis episode were found (P ؍ 0.99 and P ؍ 0.27 for measurements during the day, respectively). Conclusion: Osmotic forced ultrafiltration decreased during infectious peritonitis, most significantly for a long dwell time, consistent with an increase in both functional peritoneal surface area and hydraulic conductivity. This finding appeared 2 days before other clinical symptoms and remained significantly low 2 days after diagnosis. Am J Kidney Dis 43:485-491.
Amer J Kidney Dis, 2005
Background: Previous comparisons of peritonitis rates between continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) have produced varying results. Methods: Using United States Renal Data System data, the authors evaluated peritonitis rates in 1994 through 1997 incident CAPD (n ؍ 9,190) and CCPD (n ؍ 2,785) Medicare patients. Patients were characterized during a 6-month entry period (months 4 through 9) and followed for a maximum of 2 years (months 10 through 33). Medicare claims data provided the date of the first peritonitis episode during the follow-up period. The time to first peritonitis after 9 months of PD was compared by the log-rank test, and then by Cox regression with adjustment for peritoneal dialysis modality, age, sex, race, primary end-stage renal disease (ESRD) diagnosis, number of entry-period hospital days, peritonitis during the entry period, hematocrit value, and congestive heart failure. Results: For CAPD and CCPD, the adjusted average months to first peritonitis after 9 months of PD were 17.1 and 16.1, respectively. The probabilities of remaining without a peritonitis episode after 1 year of follow-up were 0.53 and 0.50, respectively (P ؍ 0.008). The risk of peritonitis was lower for CAPD than for CCPD (relative risk, 0.939; 95% confidence interval, 0.883 to 0.998). Other significant risk factors included age <44 years, black race, diabetes as primary ESRD diagnosis, peritonitis during the entry period, greater than 4 entry-period hospital days, and congestive heart failure. Patients treated with recombinant human erythropoietin with a hematocrit value of >36% had lower risk of peritonitis. Conclusion: Compared with CCPD, CAPD is associated with a slightly but significantly lower risk for development of a first peritonitis episode after 9 months of peritoneal dialysis therapy.
Time Course of Peritoneal Function in Automated and Continuous Peritoneal Dialysis
Peritoneal Dialysis International, 2012
♦ Background and Objectives In automated peritoneal dialysis (APD), a patient's peritoneal membrane is more intensively exposed to fresh dialysate than it is in continuous ambulatory peritoneal dialysis (CAPD). Our aim was to study, in incident peritoneal dialysis (PD) patients, the influence of APD—compared with that of CAPD—on peritoneal transport over 4 years. ♦ Design, Setting, Participants, and Measurements Patients were included if at least 2 annual standard permeability analyses (SPAs) performed with 3.86% glucose were available while the patient was using the same modality with which they had started PD (APD or CAPD). Patients were followed until their first modality switch. Differences in the pattern of SPA outcomes over time were tested using repeated-measures models adjusted for age, sex, comorbidity, primary kidney disease, and year of PD start. ♦ Results The 59 CAPD patients enrolled were older than the 47 APD patients enrolled (mean age: 58 ± 14 years vs 49 ± 14 ye...
Lack of correlation between baseline peritoneal membrane status and pre-dialytic characteristics
Advances in peritoneal dialysis. Conference on Peritoneal Dialysis, 2010
The determinants of peritoneal transport status in incident peritoneal dialysis (PD) patients are not well defined. Comorbidity, inflammation status, race, age, and mesothelial cell mass are some factors correlated with the baseline dialysate-to-plasma ratio of creatinine. Our aim was to define factors in the pre-dialysis period that possibly correlate with baseline peritoneal transport characteristics. Our study included patients starting PD at our center over the last 7 years. These patients should have been followed in our department for at least 1 year before PD start. Demographic and laboratory data were collected at 12 and 6 months before PD start. Protein intake was calculated from 24-hour urine collections. The Davies comorbidity index was scored for the pre-dialytic period. A baseline standard peritoneal permeability analysis was performed within the 6 first months of PD therapy. The mass transfer area coefficients (MTACs) for creatinine and urea were calculated. Of 94 cons...
Bosnian Journal of Basic Medical Sciences, 2010
e aim of this study was to analyze the importance of the peritoneal equilibration test (PET) in evaluation of the peritoneal membrane tranport status in patients treated with continuous ambulatory peritoneal dialysis (CAPD). e study included adult continuous ambulatory peritoneal dialysis (CAPD) patients, male and female, mean age ± , years with a prescription of four exchanges of litres (L) per day, who underwent peritoneal equilibration test (PET). Eleven of patients were diabetics. A modifi ed PET was performed during a hours dwell using , glucose dialysis solution. e dialysate/ plasma ratio of creatinine (D/P) at the end of the procedure, and the dialysate min/ initial dialysate ratio of glucose (D/D) were calculated and used as parametar of solute transport. With the test, chategorisation of patients was possible into high (H), high-average (HA), low average (LA), and low (L) transporters. In multivariate analysis age, gender, time on dialysis, comorbid diseases, diabetes mellitus (DM), serum albumin, were concidered as independent factors infl uencing the PET. Among patients (,) were classifi ed as H transpoters, () as HA, and (,) as LA. ere were no patients in low category. Creatinine D/P at hours was not diff erent DM and non-DM patients. ere were signifi cant diff erences in gender, comorbid disease, serum albumin, D/D glucose and volume drained in hours. e high transporter group had higher proporsion of man (p<,), higher proportion of patients with comorbid diseases, lower serum albumin concentration (p<,), lower D/D glucose (p<,), and lower drained volume (p<,). e PET was en easy, inexpensive, reliable test to assess peritoneal transport type and it also provided information about peritoneal clearance of solutes and ultrafi ltration. Peritoneal transport type classifi cation was recognized not only as aid for prescription, but also as a prognostic index.