Differences in predicting glucose absorption from peritoneal dialysate compared to measured absorption in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis and ambulatory peritoneal dialysis cyclers

2020 ◽  
Vol 43 (7) ◽  
pp. 461-467
Author(s):  
Theerasak Tangwonglert ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Absorption ◽  
Osmotic Gradient ◽  
Systematic Bias ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Predictive Equations ◽  
Disease Outcomes

Background and aims: Glucose-containing peritoneal dialysates are used to generate an osmotic gradient for the convective removal of water and sodium. Predictive equations were developed to estimate glucose absorption without having to formally measure changes in dialysate glucose. In view of the changes in peritoneal dialysis prescriptions over time, we compared predicted and measured glucose absorption. Subjects/methods: We measured peritoneal glucose losses when peritoneal dialysis patients attended their first assessment of peritoneal membrane function, and compared this to glucose exposure and Kidney Disease Outcomes Quality Initiative, Grodstein and Bodnar predictive equations. Results: We studied 689 patients; 329 (56.9%) males, 53 (37.1%) diabetics, with mean age 57.1 ± 16.2 years, with 186 treated by automated peritoneal dialysis cyclers and 377 by automated peritoneal dialysis with a daytime icodextrin exchange and 126 by continuous ambulatory peritoneal dialysis. Using Bland -Altman analysis, all equations demonstrated systematic bias overestimating glucose absorption with increasing glucose absorption. For continuous ambulatory peritoneal dialysis patients, the Kidney Disease Outcomes Quality Initiative formula underestimated glucose absorption (bias 188 (−39 to 437) mmol/day, as did Grodstein (bias 37.9 (−105 to 29) mmol/day, whereas mean bias for Bodnar was −29 (−130 to 180)). There was systematic overestimation for all equations for both automated peritoneal dialysis with and without a daytime exchange, with increasing bias with greater glucose absorption. Conclusion: Although formally measuring peritoneal glucose absorption is time consuming and requires patient co-operation, current predictive equations overestimate glucose absorption and do not provide accurate estimations of glucose absorption particularly for automated peritoneal dialysis patients.

The Effect of Dialysate Osmolality on Ultrafiltration and Vascular Refilling Rate

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 67-69 ◽  
Author(s):  
Luis G. Burdiel ◽  
Antonio Jiménez ◽  
Alejandro Martin-Malo ◽  
Domingo Castillo ◽  
Mariano Rodriguez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Driving Force ◽  
Glucose Absorption ◽  
Dilution Method ◽  
Osmotic Gradient ◽  
Water Shift

The osmotic gradient is the main driving force for ultrafiltration (UF) in continuous ambulatory peritoneal dialysis (CAPD). Depending on glucose absorption, its changes over a period of time could influence the plasma refilling rate. The aim of this study was to evaluate the Influence of changes In the plasma refilling rate obtained by dlalysates of different osmolalities upon the rate of UF. Stable CAPD patients were studied twice during a 4-hour exchange 2 weeks apart with dialysate containing 1.5% and 4.25% glucose, respectively. UF was estimated by the autologous hemoglobin dilution method every 30 minutes. Hematocrit and colloidosmotic pressure (COP) decraase when using 1.5% glucose dialysate, reflecting a rise In plasma water mediated by the plasma refilling rate. This water shift Is greater than the osmotic gradient generated between peritoneal and intravascular compartments as reflected by a low UF rate. However, when the osmotic gradient Increases by means of 4.25% glucose dialysate, the plasma refilling rate is efficiently counterbalanced by UF.

scholarly journals Transperitoneal Calcium Balance in Anuric Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Chieko Hamada ◽  
Yasuhiko Tomino
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Biochemical Parameters ◽  
Calcium Balance ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Intact Pth ◽  
Rapid Removal ◽  
The Difference ◽  
Short Time

Backgrounds. Calcium (Ca) and bone metabolism in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients show a remarkable difference depending on dialysis modalities. The levels of serum Ca and phosphate (P) in HD patients fluctuate contributing to the intermittent and rapid removal of plasma solute unlike in CAPD. Characteristics of plasma solute transport in automated peritoneal dialysis (APD) patients are resembled with that in HD. The purpose of the present study was to examine the difference of transperitoneal Ca removal between APD and CAPD anuric patients.Subjects and Methods. Twenty-three APD anuric patients were enrolled in this study. Biochemical parameters responsible for transperitoneal Ca removal in 24-hour and 4-hour peritoneal effluents were analyzed on CAPD and APD.Results. Transperitoneal Ca removal on APD was smaller compared with that on CAPD. The Ca removal was related to the ultrafiltration during short-time dwell. Decrease of the Ca removal during NPD induced by short-time dialysate dwell caused negative or small Ca removal in APD patients. The levels of intact PTH were increased at the end of PET.Conclusion. It appears that short-time dwell and frequent dialysate exchanging might suppress the transperitoneal Ca removal in anuric APD patients.

scholarly journals Comparison of sodium removal in peritoneal dialysis patients treated by continuous ambulatory and automated peritoneal dialysis

2019 ◽  
Vol 32 (6) ◽  
pp. 1011-1019 ◽  
Author(s):  
Sarju Raj Singh Maharjan ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fluid Balance ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Membrane Function ◽  
Peritoneal Dialysate ◽  
Hypertonic Glucose ◽  
Sodium Removal

Abstract Background Optimal fluid balance for peritoneal dialysis (PD) patients requires both water and sodium removal. Previous studies have variously reported that continuous ambulatory peritoneal dialysis (CAPD) removes more or equivalent amounts of sodium than automated PD (APD) cyclers. We therefore wished to determine peritoneal dialysate losses with different PD treatments. Methods Peritoneal and urinary sodium losses were measured in 24-h collections of urine and PD effluent in patients attending for their first assessment of peritoneal membrane function. We adjusted fluid and sodium losses for CAPD patients for the flush before fill technique. Results We reviewed the results from 659 patients, mean age 57 ± 16 years, 56.3% male, 38.9% diabetic, 24.0% treated by CAPD, 22.5% by APD and 53.5% APD with a day-time exchange, with icodextrin prescribed to 72.8% and 22.7 g/L glucose to 31.7%. Ultrafiltration was greatest for CAPD 650 (300–1100) vs 337 (103–598) APD p < 0.001, vs 474 (171–830) mL/day for APD with a day exchange. CAPD removed most sodium 79 (33–132) vs 23 (− 2 to 51) APD p < 0.001, and 51 (9–91) for APD with a day exchange, and after adjustment for the CAPD flush before fill 57 (20–113), p < 0.001 vs APD. APD patients with a day exchanged used more hypertonic glucose dialysates [0 (0–5) vs CAPD 0 (0–1) L], p < 0.001. Conclusion CAPD provides greater ultrafiltration and sodium removal than APD cyclers, even after adjusting for the flush-before fill, despite greater hypertonic usage by APD cyclers. Ultrafiltration volume and sodium removal were similar between CAPD and APD with a day fill.

In Younger Dialysis Patients, Automated Peritoneal Dialysis is Associated with Better Long-Term Patient and Technique Survival than is Continuous Ambulatory Peritoneal Dialysis

2011 ◽  
Vol 31 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Chiao-Yin Sun ◽  
Chin-Chan Lee ◽  
Yu-Yin Lin ◽  
Mai-Szu Wu
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Age Groups ◽  
Nutrition Status ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Adjusted Risk ◽  
Technique Failure ◽  
Overall Mortality

BackgroundIn the U.S. Renal Data System registry, technique and patient survival are similar with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). The clinical outcomes of APD and CAPD in various age groups have not been clarified.ObjectivesWe investigated whether patient and technique survival are different for incident dialysis patients treated with APD or CAPD in two age groups.MethodsOur retrospective study of prospectively collected data included 282 incident peritoneal dialysis (PD) patients (161 on APD, 121 on CAPD). Patients on PD for less than 3 months were excluded. The patients were divided into those less than 65 years of age and those 65 years of age or older. Overall mortality and technique failure were the primary endpoints of the study. Hazard ratios (HRs) for mortality and technique failure were calculated by the Cox proportional hazards model and were adjusted for age, sex, diabetes mellitus, initial peritoneal equilibration test (PET), weekly peritoneal and renal creatinine clearances, and PD caregiver (self or other).ResultsThe characteristics and clinical data were not significantly different between patients on APD and CAPD, except for age and sex. The adjusted risk for overall mortality was not different between patients on APD and CAPD (HR: 0.72; 95% CI: 0.44 to 1.20; p = 0.207). The adjusted risk for technique failure was lower in APD patients than in CAPD patients (HR: 0.58; 95% CI: 0.34 to 0.98; p = 0.041). In patients less than 65 years of age, those on APD had a significantly lower risk of mortality (HR: 0.35; 95% CI: 0.16 to 0.75; p = 0.007) and technique failure (HR: 0.52; 95% CI: 0.28 to 0.95; p = 0.034) than did those on CAPD. In patients 65 years of age and older, those on APD had risks for mortality (HR: 1.14; 95% CI: 0.53 to 2.46; p = 0.730) and technique failure (HR: 0.51; 95% CI: 0.17 to 1.50; p = 0.220) that were similar to those of patients on CAPD. Nutrition status, including serum albumin and protein catabolic rate, was not significantly different between patients on APD and on CAPD, in either younger or older patients.ConclusionsYounger Chinese patients on APD have better patient and technique survival than do those on CAPD. However, there is a strong possibility that this benefit may be confounded or accounted for by baseline differences between the APD and CAPD populations.

Impact of Dialysis Duration and Glucose Absorption on Nutritional Indices in Stable Continuous Ambulatory Peritoneal Dialysis Patients

2008 ◽  
Vol 18 (6) ◽  
pp. 503-508 ◽  
Author(s):  
Jernej Pajek ◽  
Andrej Guček ◽  
Radoslav Kveder ◽  
Maja Bučar-Pajek ◽  
Staša Kaplan-Pavlovčič ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Absorption ◽  
Nutritional Indices ◽  
Dialysis Patients ◽  
Dialysis Duration

scholarly journals Cardiovascular mortality in peritoneal dialysis: the impact of mineral disorders

2021 ◽  
Author(s):  
César Truyts ◽  
Melani Custodio ◽  
Roberto Pecoit-Filho ◽  
Thyago Proenca de Moraes ◽  
Vanda Jorgetti
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Cardiovascular Mortality ◽  
Serum Levels ◽  
Dialysis Patients ◽  
Disease Outcomes ◽  
Confounding Variables ◽  
Study Results ◽  
The Subject ◽  
The Impact

Abstract Introduction: Mineral and bone disorders (MBD) are associated with higher mortality in dialysis patients. The main guidelines related to the subject, Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO), were elaborated based on published information from hemodialysis participants. The aim of our study was to evaluate the impact of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) (according to guideline ranges from KDOQI and KDIGO) on the cardiovascular mortality of peritoneal dialysis (PD) patients. Methods: We used the BRAZPDII database, an observational multi-centric prospective study, which assessed participants on PD between December 2004 and January 2011. Amongst 9,905 participants included in this database, we analyzed 4424 participants who were on PD for at least 6 months. The appropriate confounding variables were entered into the model. Serum levels of Ca, P, and PTH were the variables of interest for the purposes of the current study. Results: We found a significant association between high P serum levels, categorized by KDOQI and KDIGO (P above 5.5 mg/dL), and cardiovascular survival (p < 0.01). Likewise, a compelling association was found between lower levels of PTH, categorized by guidelines (KDOQI and KDIGO - PTH less than 150 pg/mL, p < 0.01), and cardiovascular survival. Conclusion: In conclusion, levels of P above and PTH below the values proposed by KDOQI and KDIGO were associated with cardiovascular mortality in PD patients.

scholarly journals The Impact of Dialysis Modality on Left Ventricular Function in Patient with End Stage Kidney Disease

2020 ◽  
Vol 5 (2) ◽  
pp. 2-9
Author(s):  
Abhishek Maskey ◽  
Navaraj Paudel ◽  
Subash Sapkota ◽  
Pooja Jha
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
End Stage

Introduction: Cardiovascular disease is frequent in end-stage kidney disease patients, and is a major cause of morbidity and mortality. This study was carried out to assess the comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis on left ventricular function.Methods: A prospective observational study was carried out in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis at least for 6 months. The duration of the study was from June 2019 to May 2020. CAPD consists of 3 to 4 exchanges/day and haemodialysis 2-3 times/week for 4 hours. Baseline characteristics age, gender, dialysis duration, hypertension, diabetes and hyperlipidaemia were collected. The same cardiologist performed all echocardiography at the end of hemodialysis session in hemodialysis patients and after the drain of dialysate in peritoneal dialysis patients.Results: Sixty patients (40 hemodialyses, 20 peritoneal dialyses) were enrolled. The mean age of the patient was 53.71±13.00 years (range 25-76). There was a slightly higher number of male in the hemodialysis group (p= 0.065). Systolic and diastolic blood pressure were significantly higher in hemodialysis groups (p<0.001). Regarding left ventricular parameters, hemodialysis patients had a higher prevalence of left ventricular diastolic dysfunction, left ventricular hypertrophy, left ventricular mass compared to peritoneal dialysis patients. Pericardial effusion and thickening were present higher in hemodialysis patients and was statistically significant (p<0.05).Conclusion: The modality of dialysis influence left ventricular function. Left ventricle dysfunction is prevalent among hemodialysis patients compared to peritoneal dialysis. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.

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