Carbohydrate and Lipid Metabolism during Continuous Ambulatory Peritoneal Dialysis (CAPD): The Effect of a Single Dialysis Cycle

1983 ◽  
Vol 65 (5) ◽  
pp. 539-545 ◽  
Author(s):  
A. Heaton ◽  
D. G. Johnston ◽  
J. M. Burrin ◽  
H. Orskov ◽  
M. K. Ward ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Glucose ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Ketone Bodies ◽  
Serum Insulin ◽  
Dialysis Fluid ◽  
Long Term Effects ◽  
Carbohydrate And Lipid Metabolism ◽  
Normal Controls

1. 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. 2. 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. 3. Plasma glucagon concentrations were 2.7-fold increased and did not decrease to normal during dialysis. 4. 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. 5. The long-term effects of sustained hyper-insulinaemia, including suppression of lipolysis and ketogenesis, require further investigation.

Short-Term Studies on the Use of Glycerol as An Osmotic Agent in Continuous Ambulatory Peritoneal Dialysis (CAPD)

1984 ◽  
Vol 67 (1) ◽  
pp. 121-130 ◽  
Author(s):  
A. Heaton ◽  
M. K. Ward ◽  
D. G. Johnston ◽  
D. V. Nicholson ◽  
K. G. M. M. Alberti ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Ketone Bodies ◽  
Calorific Value ◽  
Long Term Effects ◽  
Short Term ◽  
Peritoneal Dialysis Fluid ◽  
Osmotic Agent ◽  
Circulating Levels

1. The use of glycerol as an osmotic agent in two different concentrations (92 mmol/l and 272 mmol/l) in peritoneal dialysis fluid was investigated over 3 days in six patients on continuous ambulatory peritoneal dialysis and compared with two concentrations of glucose (76 mmol/l and 215 mmol/l) in the same patients. 2. The calorific value of the absorbed osmotic agent was lower, by 19% with isotonic and 22% with hypertonic solutions, when glycerol was used in place of glucose. However, glycerol provided significantly lower total ultrafiltration than glucose at each concentration, despite a higher initial osmotic pressure of the glycerol-based solutions. Thus, the higher concentration of glycerol required to provide equal ultrafiltration may offset any calorific advantage. 3. Equilibration of creatinine and urea was slower and creatinine clearance lower with glycerol. Solutions containing glycerol were initially less acid (pH 6.5) than those containing glucose (pH 5.1). 4. Blood glycerol levels, which were in the physiological range with glucose as the osmotic agent, reached a peak 80-fold greater at 4.3 ± 0.8 mmol/l during dialysis with fluid containing glycerol at 272 mmol/l and eightfold higher at 0.42 ± 0.09 mmol/l with glycerol at 92 mmol/l. There was no evidence of haemolysis or other toxic effect despite these levels. 5. The rise in blood glucose and insulin noted during the use of glucose-based solutions was not found with glycerol. Circulating levels of lactate, pyruvate, alanine, non-esterified fatty acids and the ketone bodies were similar with the two agents. 6. Although these short-term studies have shown no conclusive advantage of glycerol over glucose, long-term effects of glycerol, particularly on circulating lipid levels, will determine its future role as an osmotic agent in continuous ambulatory peritoneal dialysis.

Renal Transplantation in Children Treated with Continuous Ambulatory Peritoneal Dialysis

1983 ◽  
Vol 3 (1) ◽  
pp. 5-8 ◽  
Author(s):  
Constantinos J. Stefanidis ◽  
J. Williamson Balfe Gerald S ◽  
Arbus Brian E. Hardy Bernard ◽  
M. Churchill ◽  
C. Phillip Rance
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Renal Transplant ◽  
Graft Survival ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Long Term Effects ◽  
Fungal Peritonitis ◽  
Sick Children

Over the last three years 23 children, who were managed by CAPD at the Hospital for Sick Children, Toronto received a renal transplant. Their actuarial graft survival was similar to those of children on hemodialysis and to patients not dialyzed before transplantation. In addition, we analyzed the actuarial graft survival of 130 children treated before transplantation with peritoneal dialysis (IPD and CAPD), hemodialysis or no dialysis to determine the long-term effects of peritoneal dialysis. Again, we found no significant differences among the various groups. Posttransplantation complications in the CAPD patients included fungal peritonitis in one and ascites in seven.

Long-term use of hemodiafiltration in two patients undergoing continuous ambulatory peritoneal dialysis

1997 ◽  
Vol 1 (1) ◽  
pp. 51-55
Author(s):  
Tamiko Nishimura ◽  
Takao Suga ◽  
Fumio Takemura ◽  
Keiko Nakajima ◽  
Yasuo Nomoto ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis

Peritoneal Clearances, Ultrafiltration, and Diuresis in Long-Term Continuous Ambulatory Peritoneal Dialysis

1990 ◽  
pp. 87-90 ◽  
Author(s):  
E. Bordoni ◽  
V. Lombardo ◽  
L. Bibiano ◽  
P. Carletti ◽  
E. Franciulli ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis

scholarly journals Long-term hyperglucagonaemia induces early metabolic and renal phenotypes of Type 2 diabetes in mice

2008 ◽  
Vol 114 (9) ◽  
pp. 591-601 ◽  
Author(s):  
Xiao C. Li ◽  
Tang-dong Liao ◽  
Jia L. Zhuo
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glucose Tolerance ◽  
Serum Insulin ◽  
Fasting Blood Glucose ◽  
Weight Ratio ◽  
Glomerular Injury ◽  
Glucagon Receptor

Clinical studies have shown that patients with early Type 2 diabetes often have elevated serum glucagon rather than insulin deficiency. Imbalance of insulin and glucagon in favouring the latter may contribute to impaired glucose tolerance, persistent hyperglycaemia, microalbuminuria and glomerular injury. In the present study, we tested the hypothesis that long-term glucagon infusion induces early metabolic and renal phenotypes of Type 2 diabetes in mice by activating glucagon receptors. Five groups of adult male C57BL/6J mice were treated with vehicle, glucagon alone (1 μg/h via an osmotic minipump, intraperitoneally), glucagon plus the glucagon receptor antagonist [Des-His1-Glu9]glucagon (5 μg/h via an osmotic minipump), [Des-His1-Glu9]glucagon alone or a high glucose load alone (2% glucose in the drinking water) for 4 weeks. Glucagon infusion increased serum glucagon by 129% (P<0.05), raised systolic BP (blood pressure) by 21 mmHg (P<0.01), elevated fasting blood glucose by 42% (P<0.01), impaired glucose tolerance (P<0.01), increased the kidney weight/body weight ratio (P<0.05) and 24 h urinary albumin excretion by 108% (P<0.01) and induced glomerular mesangial expansion and extracellular matrix deposition. These responses were associated with marked increases in phosphorylated ERK1/2 (extracellular-signal-regulated kinase 1/2) and Akt signalling proteins in the liver and kidney (P<0.01). Serum insulin did not increase proportionally. Concurrent administration of [Des-His1-Glu9]glucagon with glucagon significantly attenuated glucagon-increased BP, fasting blood glucose, kidney weight/body weight ratio and 24 h urinary albumin excretion. [Des-His1-Glu9]glucagon also improved glucagon-inpaired glucose tolerance, increased serum insulin by 56% (P<0.05) and attenuated glomerular injury. However, [Des-His1-Glu9]glucagon or high glucose administration alone did not elevate fasting blood glucose levels, impair glucose tolerance or induce renal injury. These results demonstrate for the first time that long-term hyperglucagonaemia in mice induces early metabolic and renal phenotypes of Type 2 diabetes by activating glucagon receptors. This supports the idea that glucagon receptor blockade may be beneficial in treating insulin resistance and Type 2 diabetic renal complications.

Catheter Patency and Peritoneal Morphology and Function in a Rat Model of Citrate-Buffered Peritoneal Dialysis

2010 ◽  
Vol 30 (6) ◽  
pp. 602-610 ◽  
Author(s):  
Nicola Cavallini ◽  
Magnus Braide
Keyword(s):  
Peritoneal Dialysis ◽  
Rat Model ◽  
Fluid Transport ◽  
Separate Experiment ◽  
Control Group ◽  
Vascular Density ◽  
Long Term Effects ◽  
Catheter Patency ◽  
Peritoneal Morphology

BackgroundSingle-dwell studies in rats and humans have shown that supplementing citrate for lactate in peritoneal dialysis (PD) fluids improves ultrafiltration (UF).MethodsThe long-term effects of citrate-substituted PD fluids on PD catheter patency, UF, and peritoneal morphology were evaluated in a rat model over 5 weeks of daily PD fluid exposure. A standard 2.5% glucose 40 mmol/L lactate PD fluid and a corresponding 10/30 mmol/L citrate/lactate PD fluid were compared. In a control group, rats with catheters received no PD fluid.ResultsThe average patency time (% of 36 days) of silicone rubber PD catheters was significantly longer in the citrate PD group (98.8% ± 1.2%) and the control group (100% ± 0%) compared to the lactate PD group (54.7% ± 9.5%). In a separate experiment, heparin-coated polyurethane catheters were used to study peritoneal morphology and fluid transport. The citrate group had a higher net UF than the lactate group at the beginning and at the end of the 5 weeks. During the experiment, both fluid-treated groups suffered from UF loss; the control group showed the highest net UF at the end of the 5 weeks. Peritoneal vascular density and submesothelial thickness, indicators of angiogenesis and fibrosis, were not significantly different among the groups. Fibrosis was significantly negatively correlated to osmotic UF.ConclusionA positive acute effect of citrate on UF was confirmed and conserved over time. Citrate PD strongly improved PD catheter patency time compared with lactate. Both citrate PD and lactate PD induced negative long-term effects on UF compared with control animals.

Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)

1989 ◽  
Vol 9 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Min Sun Park ◽  
Jean Lee ◽  
Moon Sung Lee ◽  
Seung Ho Baick ◽  
Seung Duk Hwang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Absorption ◽  
Peritoneal Membrane ◽  
Vasoactive Agents ◽  
Membrane Function ◽  
Dialysis Solution ◽  
Before And After ◽  
Dialysate Volume

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (D PC), peritoneal glucose absorption (% GA), and drained dialysate volume ( VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month). There were no differences in the control (without NP) Curea, Ccr, D PC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and D PC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but D PC with NP was significantly lower in the long-term CAPD patients. The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.

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