Intraperitoneal Pressure/Volume Effects on Peritoneal Transport in Automated Peritoneal Dialysis

1999 ◽  
pp. 54-61 ◽  
Author(s):  
P.-Y. Durand ◽  
J. Chanliau ◽  
M. Kessler
Keyword(s):  
Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
Intraperitoneal Pressure ◽  
Peritoneal Transport ◽  
Volume Effects

Patient Selection for Automated Peritoneal Dialysis: For Whom, When?

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 102-107 ◽  
Author(s):  
Vassilios Liakopoulos ◽  
Nicholas Dombros
Keyword(s):  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Patient Choice ◽  
Rapid Decline ◽  
Automated Peritoneal Dialysis ◽  
Contributing Factors ◽  
Dialysis Dose ◽  
Intraperitoneal Pressure ◽  
Sodium Removal ◽  
Disturbed Sleep

The use of the various forms of automated peritoneal dialysis (APD) has increased considerably in the past few years. This increase has in part been driven by technology, through improved cycler design. Other contributing factors include better adjustment of APD to patient lifestyle, the flexibility that APD offers to patients, and the increased ability of APD to achieve adequacy and ultrafiltration targets. For high transporters and for patients unable to perform peritoneal dialysis (PD) on their own (for example, pediatric and elderly patients), APD is considered the most suitable PD modality. Furthermore, APD has been associated with improved compliance, lower intraperitoneal pressure, and lower incidences of peritonitis. On the other hand, concerns have been raised regarding increased complexity and cost, a more rapid decline in residual renal function, inadequate sodium removal, and disturbed sleep. Automated PD is an alternative to continuous ambulatory PD when a higher dialysis dose is needed, and it could be a reliable alternative for unplanned or urgent dialysis start. Other than beneficial results in high transporters, the medical advantages of APD remain controversial. Individual patient choice therefore remains the main indication for the application of APD, which should be made available to all patients starting PD.

Automated Peritoneal Dialysis: An alternative to Continuous Ambulatory or a First Choice Treatment?

2014 ◽  
Vol 12 (2) ◽  
pp. 77-83
Author(s):  
Evangelia Dounousi ◽  
Anila Duni ◽  
Konstantinos Leivaditis ◽  
Vassilios Liakopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Residual Renal Function ◽  
Rapid Decline ◽  
Automated Peritoneal Dialysis ◽  
Intraperitoneal Pressure ◽  
The Past ◽  
Sodium Removal ◽  
Disturbed Sleep ◽  
First Choice ◽  
Important Indication

Abstract The use of the various forms of Automated Peritoneal Dialysis (APD) has considerably increased in the past few years. This increase is driven by improved cycler design, apparent lifestyle advantages, and the increased ability to achieve adequacy and ultrafiltration targets. It is therefore reasonable to raise the question whether APD is superior to Continuous Ambulatory Peritoneal Dialysis (CAPD). APD is considered the most suitable Peritoneal Dialysis (PD) modality for high transporters as well as for assisted PD. It has also been associated with improved compliance, lower intraperitoneal pressure and possibly lower incidence of peritonitis. On the other hand, there are concerns regarding increased cost, a more rapid decline in residual renal function, inadequate sodium removal and disturbed sleep. Besides its beneficial results in high transporters, other medical advantages of APD still remain unclear. Individual patient’s choice remains the most important indication for applying APD, which should be made available to all patients starting PD.

Clinical Relevance of Intraperitoneal Pressure in Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (5) ◽  
pp. 562-567 ◽  
Author(s):  
Loreley Betancourt Castellanos ◽  
Esther Ponz Clemente ◽  
Conchita Blasco Cabañas ◽  
Dolors Marquina Parra ◽  
Mabel Bolós Contador ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Wall ◽  
Statistical Significance ◽  
Linear Regression Analysis ◽  
Individual Characteristics ◽  
Multivariate Linear Regression Analysis ◽  
Positive Correlation ◽  
Intraperitoneal Pressure ◽  
Peritoneal Transport ◽  
Daily Total

IntroductionIntraperitoneal pressure (IPP) in peritoneal dialysis (PD) increases in sitting and upright positions and is related to some individual characteristics. Adverse effects can appear with IPP > 20 cm H2O. Few studies about peritoneal transport or abdominal wall problems have directly measured IPP. We measured IPP in our prevalent PD patients to identify the clinical factors related to its variability and its possible association with peritoneal transport and abdominal wall complications.MethodsWe performed a retrospective, observational study of our stable PD patients. Intraperitoneal pressure was measured using the Durand's method in supine, sitting, and upright position.ResultsForty-nine patients were included, 70% males, mean age 61.1 ± 15 years, body mass index (BMI) 27.9 ± 5.2 kg/m2. The mean of supine IPP was 18.0 ± 4.4 cm H2O. Intraperitoneal pressure in sitting and upright positions were similar and higher than in supine. Supine IPP showed a positive correlation with BMI ( p < 0.0005) and comorbidity ( p < 0.05). A multivariate linear regression analysis showed that BMI and comorbidity ( p < 0.005) had a positive correlation with IPP; time on PD and daily total ultrafiltration (UF) (p < 0.005) showed a negative correlation. Patients with an IPP ≥ 20 cm H2O had more hernias (35% vs 17%) and leakages (21% vs 8%) without statistical significance.ConclusionOur supine IPPs were higher than others published in adults. Intraperitoneal pressure has an individual value associated with body size. Greater IPP was correlated with lower daily total UF and more hernias and leakages. The measurement of IPP is a simple technique and can help with PD prescription, especially in obese patients.

Pharmacokinetics of culture-directed antibiotics for the treatment of peritonitis in automated peritoneal dialysis: A systematic narrative review

2021 ◽  
Vol 41 (3) ◽  
pp. 261-272
Author(s):  
Chau Wei Ling ◽  
Kamal Sud ◽  
Connie Van ◽  
Syed Tabish Razi Zaidi ◽  
Rahul P. Patel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Case Reports ◽  
Plasma Concentrations ◽  
Case Series ◽  
Therapeutic Drug ◽  
Pharmacokinetic Studies ◽  
Pharmacokinetic Data ◽  
Automated Peritoneal Dialysis ◽  
Final Study ◽  
Drug Plasma

The objectives of this study were to provide a summary of the pharmacokinetic data of some intraperitoneal (IP) antibiotics that could be used for both empirical and culture-directed therapy, as per the ISPD recommendations, and examine factors to consider when using IP antibiotics for the management of automated peritoneal dialysis (APD)-associated peritonitis. A literature search of PubMed, EMBASE, Scopus, MEDLINE and Google Scholar for articles published between 1998 and 2020 was conducted. To be eligible, articles had to describe the use of antibiotics via the IP route in adult patients ≥18 years old on APD in the context of pharmacokinetic studies or case reports/series. Articles describing the use of IP antibiotics that had been recently reviewed (cefazolin, vancomycin, gentamicin and ceftazidime) or administered for non-APD-associated peritonitis were excluded. A total of 1119 articles were identified, of which 983 abstracts were screened. Seventy-three full-text articles were assessed for eligibility. Eight records were included in the final study. Three reports had pharmacokinetic data in patients on APD without peritonitis. Each of cefepime 15 mg/kg IP, meropenem 0.5 g IP and fosfomycin 4 g IP given in single doses achieved drug plasma concentrations above the minimum inhibitory concentration for treating the susceptible organisms. The remaining five records were case series or reports in patients on APD with peritonitis. While pharmacokinetic data support intermittent cefepime 15 mg/kg IP daily, only meropenem 0.5 g IP and fosfomycin 4 g IP are likely to be effective if given in APD exchanges with dwell times of 15 h. Higher doses may be required in APD with shorter dwell times. Information on therapeutic efficacy was derived from case reports/series in individual patients and without therapeutic drug monitoring. Until more pharmacokinetic data are available on these antibiotics, it would be prudent to shift patients who develop peritonitis on APD to continuous ambulatory peritoneal dialysis, where pharmacokinetic information is more readily available.

The Effect of a Nitric Oxide Inhibitor (L-Name) on Peritoneal Transport during Dialysis in Rats

1998 ◽  
Vol 18 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Andrzej Breborowicz ◽  
Katarzyna Wieczorowska Tobis ◽  
Katarzyna Korybalska ◽  
Alicja Polubinska ◽  
Maciej Radkowski ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Peritoneal Dialysis ◽  
Significant Decline ◽  
Nitric Oxide Synthesis ◽  
Dialysis Fluid ◽  
Large Molecules ◽  
Acute Peritonitis ◽  
Important Mediator ◽  
Peritoneal Transport ◽  
Nitric Oxide Inhibitor

Objective To assess the effect of an inhibitor of nitric oxide synthesis [NG-nitro-L-arginine methyl ester (L-NAME)] on peritoneal transport during peritoneal dialysis (PD) and peritonitis in rats. Methods The authors studied peritoneal transport of small and large solutes, and net ultrafiltration (UF) in rats during PD with Dianeal 3.86 (Baxter, McGaw Park, IL, U.S.A.). They evaluated the effect of L-NAME used as an additive to dialysis fluid in concentrations 0.5 -5 mg/m L on peritoneal transport of small and large molecules and on transperitoneal UF. In addition, they studied the effect of L-NAME (5 mg/mL) during acute peritonitis induced by lipopolysaccharides (5 μg/mL) given intraperitoneally. Results The addition of L-NAME to dialysis fluid increased the selectivity of the peritoneum and net UF during dialysis. Lipopolysaccharides used as an additive to the dialysis fluid, together with L-NAME, did not induce changes in transperitoneal transport of small and large solutes and did not cause a significant decline in net UF. L-NAME given intraperitoneally reduced both local and systemic production of nitric oxide, which might explain its effects on peritoneal transport. Conclusions Nitric oxide is an important mediator of changes in peritoneal transport and its effect is especially significant during peritonitis.

scholarly journals Relationship between Vascular Calcification, Protein-Energy Wasting Syndrome, and Sarcopenia in Maintenance Automated Peritoneal Dialysis

Life ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 666
Author(s):  
Gustavo Leal-Alegre ◽  
Claudia Lerma ◽  
Gabriela Leal-Escobar ◽  
Bernardo Moguel-González ◽  
Karen Belén Martínez-Vázquez ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Vascular Calcification ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Protein Energy Wasting ◽  
Wasting Syndrome ◽  
Protein Energy ◽  
Inflammation Score

Vascular calcifications affect 80% to 90% of chronic kidney disease patients and are a predictive factor of cardiovascular mortality. Sarcopenia and protein-energy wasting syndrome are also associated with mortality. The aim was to assess the relationship between vascular calcification, sarcopenia, and protein-energy wasting syndrome (PEW) in automated peritoneal dialysis patients. Fifty-one maintenance automated peritoneal dialysis patients were included (27 were male, mean age 39 ± 14 years). Vascular calcification was assessed based on abdomen, pelvis, and hand radiographs. Sarcopenia was assessed with bioimpedance analysis and a hand grip strength test. The Malnutrition–Inflammation Score and the presence of PEW were also assessed. Vascular calcification was present in 21 patients (41.2%). Univariate logistic regression analysis showed that age (p = 0.001), Malnutrition–Inflammation Score (p = 0.022), PEW (p = 0.049), sarcopenia (p = 0.048), and diabetes (p = 0.010) were associated with vascular calcification. Multivariate logistic regression analysis showed that age (p = 0.006) was the only variable associated independently with vascular calcification. In conclusion, there is association between vascular calcification, PEW, and sarcopenia in patients with maintenance automated peritoneal dialysis. These associations are not independent of age. This demonstrates the importance of nutritional status in the prevention of vascular calcification.

scholarly journals A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis

2016 ◽  
Vol 36 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Vicente Pérez-Díaz ◽  
Alfonso Pérez-Escudero ◽  
Sandra Sanz-Ballesteros ◽  
Guadalupe Rodríguez-Portela ◽  
Susana Valenciano-Martínez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Fluid Overload ◽  
Glucose Solution ◽  
Osmotic Gradient ◽  
Single Session ◽  
Peritoneal Equilibration Test ◽  
Peritoneal Transport ◽  
Constant Rate ◽  
Limited Power

Background Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. Methods We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). Results Ultrafiltration averaged 653 ± 363 mL/4 h — twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload ( p < 0.01) and inversely proportional to final peritoneal glucose concentration ( p < 0.05). Conclusion This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.

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