Icodextrin and Intraperitoneal Inflammation

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 96-100 ◽  
Author(s):  
Misaki Moriishi ◽  
Hideki Kawanishi
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Chronic Glomerulonephritis ◽  
Inflammatory Reactions ◽  
Markers Of Inflammation ◽  
Peritoneal Dialysis Fluid ◽  
Peritoneal Permeability ◽  
Equilibrium Test ◽  
Stage Renal Disease ◽  
End Stage

⋄ Background The peritoneum is impaired by exposure to biocompatible dialysis solutions. Because icodextrin peritoneal dialysis fluid (PDF) is made from cornstarch, a possibility that it induces intraperitoneal inflammation has been reported. In the present study, patients on glucose PDF were switched to icodextrin PDF and then switched back to glucose PDF. Icodextrin PDF-induced intraperitoneal inflammation was investigated based on changes in peritoneal permeability and inflammatory reactions. ⋄ Patients and Methods The subjects were 7 stable peritoneal dialysis patients (4 men, 3 women), with a mean age of 59.1 ± 3.8 years (range: 55.2 - 64.6 years). The mean duration of peritoneal dialysis was 58.3 ± 27.4 months (range: 34.3 - 97.7 months), and the cause of end-stage renal disease was chronic glomerulonephritis in all patients. For the overnight dwell, glucose PDF was changed to icodextrin PDF, and the patients returned to glucose PDF 30 months later. To evaluate peritoneal permeability, a peritoneal equilibrium test (PET) was performed, and dialysate-to-plasma (D/P) ratios of creatinine (Cr), β2-microglobulin (β2M), albumin, immunoglobulin G (IgG), and α2-macroglobulin (α2M) were measured in the overnight dialysate and serum. As markers of inflammation and fibrinolysis or coagulation, interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) were measured in overnight effluent. The evaluations were made every 6 months for 36 months. ⋄ Results A significant elevation in FDP levels was detected in overnight effluent 6 months after the switch to icodextrin PDF, and IL-6 levels tended to increase. The D/P ratios of Cr, β2M, and albumin were also significantly increased, and the D/P ratios of IgG and α2M tended to increase. The D/P ratio of Cr as measured by PET was slightly increased, but the elevation was not significant. In 5 patients, after icodextrin PDF was switched back to glucose PDF at 30 months, the D/P ratios of Cr, β2M, albumin, IgG, and α2M in overnight effluent were significantly reduced. The FDP levels decreased slightly in those patients. In the remaining 2 patients, the D/P ratios of Cr on PET and of Cr, β2M, albumin, IgG, and α2M in overnight effluent, and the FDP and IL-6 levels in overnight effluent were markedly elevated after the switching from glucose to icodextrin PDF, and they remained high after the switch back to glucose PDF. One of these 2 patients developed pre-EPS and was treated with prednisolone and concomitant hemodialysis. The other was switched from peritoneal dialysis to hemodialysis. ⋄ Conclusions Icodextrin dialysis solution may induce an inflammatory reaction in the peritoneum. Further investigation is necessary for the long-term use of icodextrin PDF.

The Potential Cardiovascular Benefits of Low-Glucose Degradation Product, Biocompatible Peritoneal Dialysis Fluids: A Review of the Literature

2017 ◽  
Vol 37 (4) ◽  
pp. 375-383 ◽  
Author(s):  
Charlotte E. Grantham ◽  
Katherine L. Hull ◽  
Matthew P.M. Graham-Brown ◽  
Daniel S. March ◽  
James O. Burton
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Interstitial Fibrosis ◽  
Degradation Products ◽  
Controlled Trial ◽  
Membrane Integrity ◽  
Left Ventricular ◽  
Stage Renal Disease ◽  
End Stage

Cardiovascular mortality in the end-stage renal disease (ESRD) population remains the leading cause of death. Targeting traditional cardiovascular risk factors has proven unsuccessful in this patient population, and therefore attention has turned to risk factors related to chronic kidney disease (CKD). The toxicity of high-glucose peritoneal dialysis (PD) solutions has been well documented. The breakdown of glucose into glucose degradation products (GDP) and advanced glycation end-products (AGE) has the ability to alter cell viability and cause premature apoptosis and is strongly correlated with interstitial fibrosis and microvascular sclerosis. Biocompatible solutions have been introduced to combat the hostile milieu to which PD patients are exposed.Given the considerable cardiovascular burden for PD patients, little is known about the cardiovascular impact the new biocompatible solutions may have. This review analyzes the existing literature regarding the mechanisms through which low-GDP solutions may modulate cardiovascular risk. Interventions using low-GDP solutions have provided encouraging changes in structural cardiovascular measures such as left ventricular mass (LVM), although metabolic changes from reduced GDP and AGE exposure yield inconclusive results on vascular remodelling. It is thought that the local effects of reduced glucose exposure may improve membrane integrity and therefore fluid status. Further research in the form of a robust randomized controlled trial should be carried out to assess the true extent of the cardiovascular benefits these biocompatible solutions may hold.

Peritoneal dialysis in children: Review of surgical techniques

1992 ◽  
Vol 59 (1_suppl) ◽  
pp. 272-274
Author(s):  
N. Capozza ◽  
G. Mosiello ◽  
M. De Gennaro ◽  
E. Matarazzo ◽  
S. Rinaldi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Surgical Technique ◽  
Surgical Techniques ◽  
Average Weight ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage ◽  
Surgical Guidelines ◽  
Pediatric Icu

Peritoneal dialysis has become an effective and widely used technique for the treatment of patients with end-stage renal disease. Peritoneal dialysis has become more practical for use in pediatric patients since equipment and techniques have been adapted for smaller patients. In the present work we describe the surgical technique that we currently use at our institution for surgical placement of peritoneal dialysis catheter. From January 1985 to January 1992, 19 peritoneal catheters were placed in 17 children, at the Bambino Gesù Children's Hospital. At the time of catheter insertion the average weight of the children was 14.2 kg., and the average age was 4 y. 10m. Peritoneal dialysis catheters were always placed under sterile conditions, in an operating room or in a pediatric ICU, with surgical technique. Regarding our surgical technique we recommend: 1) to use Tenckhoff catheter, 2 cuffs pigtail (curled) type; 2) to perform a minilaparatomy with lateral surgical approach and a routine omentectomy; 3) to create a submuscular tunnel (rectus abdominis) to reduce the leakaqe of peritoneal dialysis fluid. Furthermore the various clinical problems encountered in our experience and some surgical guidelines for the prevention of complications are reviewed.

scholarly journals Histoplasma Peritonitis: An Extremely Rare Complication of Peritoneal Dialysis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Asjad Sardar ◽  
Bijin Thajudeen ◽  
Pradeep V. Kadambi
Keyword(s):  
Peritoneal Dialysis ◽  
Histoplasma Capsulatum ◽  
Rare Complication ◽  
Altered Mental Status ◽  
Response To Treatment ◽  
Fungal Peritonitis ◽  
Bacterial Peritonitis ◽  
Peritoneal Dialysis Fluid ◽  
Stage Renal Disease ◽  
End Stage

Bacterial peritonitis is a common complication of peritoneal dialysis, but fungal peritonitis is unusual and is mostly due to Candida species. Peritonitis due to Histoplasma capsulatum is rare and we report one such case. A 63-year-old female presented with progressively worsening abdominal pain, fever, and altered mental status. She had end-stage renal disease and had been on peritoneal dialysis for 4 years. She had abdominal tenderness without rebound or guarding. Laboratory studies and CT of abdomen were significant for leukocytosis and peritoneal membrane thickening, respectively. Peritoneal dialysis fluid study was consistent with peritonitis and culture of the fluid grew Histoplasma capsulatum. Treatment recommendations include removal of catheter and initiation of antifungal therapy. With the availability of newer antifungals, medical management without removal of PD catheter is possible, but at the same time if there is no response to treatment within a week, PD catheter should be removed promptly.

Patients on Chronic Peritoneal Dialysis for Ten Years or More in North America

2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 127-133 ◽  
Author(s):  
Sanjay Maitra ◽  
John Burkart ◽  
Adrian Fine ◽  
Sarah Prichard ◽  
Judy Bernardini ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Glomerulonephritis ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Common Cause ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Autonomous Hyperparathyroidism

Thirty-six patients on peritoneal dialysis (PD) for more than ten years in six North American centers were analyzed retrospectively. In the six centers, the percentage of patients surviving for more than ten years varied between 0.8% and 7.3%. The study group included 27 females and 9 males aged 38.6 ± 14.2 years [mean ± standard deviation (SD)] at the start of treatment. Of the 36 patients, 28 were Caucasian. The most common cause of end-stage renal disease (ESRD), present in 12 patients, was chronic glomerulonephritis. Only 4 patients had diabetes. At the beginning of the study, 19 patients had hypertension (the most common comorbid condition); 11 had no comorbid conditions at the start. Creatinine clearance at the start was 4.12 ± 3.5 mL per minute, and the mean duration to anuria was 51 ± 25 months. Mean initial body weight was 55 ± 9 kg, and mean body surface area was 1.5 ± 0.2 m2. Serum albumin levels showed an increase from 33.8 ± 3.6 g/L at the start of the study to 38.2 ± 3.9 g/L at the end. Hospitalization rate was low at 0.5 ± 0.3 admissions per patient–year, and duration of hospitalization was 4.8 ± 3.7 days per patient–year. Peritonitis was the most common cause of hospitalization. The mean peritonitis rate was 1 episode every 52 ± 48 patient–months. There were 36 catheter changes in 18 patients; 16 patients had a single PD catheter throughout the period of study. Autonomous hyperparathyroidism was the most common long-term complication. At the end of the study period, 11 patients were still on PD, 9 had died, 5 had been transferred to hemodialysis (HD), 1 was alive with a functioning allograft, and 1 was lost to follow-up. We conclude that patients who survive longer than ten years on PD are most likely to be young Caucasian females, small in body size, who are non diabetic, with few comorbid conditions. These long-term survivors have few hospitalizations, and their peritonitis rate is low. In this group of patients, severe autonomous hyperparathyroidism is the most common long-term complication.

Recovery of HIV Antigen in Peritoneal Dialysis Fluid

1990 ◽  
Vol 10 (1) ◽  
pp. 67-69 ◽  
Author(s):  
Ricardo Correa-Rotter ◽  
Sergio Saldivar ◽  
Luis E. Soto ◽  
Samuel Ponce De Leon ◽  
Francisco Ojeda ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Dialysis Fluid ◽  
Peritoneal Dialysis Fluid ◽  
Hiv Antibodies ◽  
Hiv Antigen ◽  
Group A ◽  
Group B ◽  
Stage Renal Disease ◽  
End Stage

We investigated the presence of HIV antigen in dialysis fluid of patients with end-stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD), previously known to be infected with this virus. Sixteen adult patients and 6 adult volunteers were included in the study in 4 groups as follows: Group A: 3 patients on CAPD, previously known to be positive for serum HIV antibodies; Group B: 7 patients on CAPD, serum HIV negative; Group C: 6 AIDS patients without renal disease; and Group D: 6 healthy volunteers. Of the 3 patients of Group A, the HIV-1 Ag was positive in dialysis fluid in only 2. In 1, serum Ab and Ag were present, while in the others only serum Ab was detected. The samples from Group B were all negative for the viral antigen in dialysis fluid. We conclude that dialysis fluid of HIV-infected patients may contain the Ag and is therefore potentially infective. The presence of the HIV antigen was not constant, and was not related to antigenemia. It is possible that the presence of the Ag depends on local factors that influence viral replication or to alterations in the permeability of the peritoneal membrane. We discuss other possible factors that could influence the presence of viral Ag in peritoneal dialysis fluid.

scholarly journals The Effect of Far-Infrared Therapy on the Peritoneal Expression of Glucose Degradation Products in Diabetic Patients on Peritoneal Dialysis

2021 ◽  
Vol 22 (7) ◽  
pp. 3732
Author(s):  
Chia-Ning Chang ◽  
Chih-Yuan Niu ◽  
Ann Charis Tan ◽  
Chia-Hao Chan ◽  
Chun-Fan Chen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Gastrointestinal Symptoms ◽  
Far Infrared ◽  
Diabetic Patients ◽  
Dialysis Adequacy ◽  
Glucose Degradation Products ◽  
Glucose Ratio ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis (PD) is a treatment modality for end-stage renal disease (ESRD) patients. Dextrose is a common osmotic agent used in PD solutions and its absorption may exacerbate diabetes mellitus, a common complication of ESRD. PD solutions also contain glucose degradation products (GDPs) that may lead to encapsulating peritoneal sclerosis (EPS), a severe complication of PD. A previous study showed that far-infrared (FIR) therapy improved a patient’s gastrointestinal symptoms due to EPS. Due to limited literature on the matter, this study aims to investigate dialysate GDPs and peritoneal function in diabetic patients on PD. Thirty-one PD patients were enrolled and underwent 40 min of FIR therapy twice daily for six months. We demonstrated the effect of FIR therapy on the following: (1) decrease of methylglyoxal (p = 0.02), furfural (p = 0.005), and 5-hydroxymethylfurfural (p = 0.03), (2) increase of D/D0 glucose ratio (p = 0.03), and (3) decrease of potassium levels (p = 0.008) in both DM and non-DM patients, as well as (4) maintenance and increase of peritoneal Kt/V in DM and non-DM patients, respectively (p = 0.03). FIR therapy is a non-invasive intervention that can decrease dialysate GDPs in PD patients by improving peritoneal transport rate and solute removal clearance, while also maintaining dialysis adequacy.

Impact of Glucose in Peritoneal Dialysis: Saint or Sinner?

2005 ◽  
Vol 25 (5) ◽  
pp. 415-425 ◽  
Author(s):  
Thomas Sitter ◽  
Matthias Sauter
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Therapeutic Interventions ◽  
Buffer System ◽  
Peritoneal Membrane ◽  
Functional Changes ◽  
Osmotic Agent ◽  
Stage Renal Disease ◽  
End Stage ◽  
Osmotic Agents

Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand, it is widely assumed that exposure of the peritoneal membrane to high glucose concentrations contributes to both structural and functional changes in the dialyzed peritoneal membrane. As in diabetes, glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end products, may contribute to peritoneal membrane failure. Although efforts to reduce glucose toxicity have been made for years, only a few suggestions, such as dual-bag systems with bicarbonate as buffer system, have found broader acceptance. Recently, some interesting new approaches to the problem of glucose-related toxicity have been made, but further investigations will be necessary before they can be used clinically. This review will focus on adverse effects of glucose in PD solutions and summarize different aspects of glucotoxicity and potential therapeutic interventions.

scholarly journals Peritoneal Dialysis in Diabetics: There Is Room for More

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
P. Cotovio ◽  
A. Rocha ◽  
A. Rodrigues
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Residual Renal Function ◽  
Volume Control ◽  
Diabetic Patients ◽  
Low Glucose ◽  
Potential Risks ◽  
Stage Renal Disease ◽  
End Stage ◽  
Therapy Strategies

End stage renal disease diabetic patients suffer from worse clinical outcomes under dialysis-independently of modality. Peritoneal dialysis offers them the advantages of home therapy while sparing their frail vascular capital and preserving residual renal function. Other benefits and potential risks deserve discussion. Predialysis intervention with early nephrology referral, patient education, and multidisciplinary support are recommended. Skilled and updated peritoneal dialysis protocols must be prescribed to assure better survival. Optimized volume control, glucose-sparing peritoneal dialysis regimens, and elective use of icodextrin are key therapy strategies. Nutritional evaluation and support, preferential use of low-glucose degradation products solutions, and prescription of renin-angiotensin-aldosterone system acting drugs should also be part of the panel to improve diabetic care under peritoneal dialysis.

Prescribing high-quality peritoneal dialysis: The role of preserving residual kidney function

2020 ◽  
Vol 40 (3) ◽  
pp. 274-281 ◽  
Author(s):  
Chang Huei Chen ◽  
Jeff Perl ◽  
Isaac Teitelbaum
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Enzyme Inhibitor ◽  
Degradation Products ◽  
Favorable Effect ◽  
Volume Depletion ◽  
Intravenous Contrast ◽  
Residual Kidney Function ◽  
Stage Renal Disease ◽  
End Stage

Maintenance of residual kidney function (RKF) is independently associated with increased survival in patients with end-stage renal disease. Presence of RKF is also associated with improved volume status, better nutritional status, reduced erythropoietin requirement, and decreased rate of peritonitis in patients on peritoneal dialysis (PD). Thus, the preservation of RKF is an important therapeutic end point in the management of patients on PD. Measurement of RKF in PD patients should be based on the mean of 24-h urinary creatinine and urea clearances, and ideally, this should be done quarterly. Compared to those started on hemodialysis, patients initiated on PD appear to have slower decline in RKF. The choice of PD modality should be based on patient preference, as there is no clear evidence to date showing one modality is superior than the other in preserving RKF. Peritoneal dialysates with neutral pH and low glucose degradation products seem to have a favorable effect on RKF. An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker should be used whenever possible to preserve RKF and reduce cardiac mortality. Both loop diuretics and icodextrin can be utilized to maintain fluid balance in PD patients. However, caution should be taken to avoid volume depletion which could accelerate RKF decline. Short-term use of aminoglycosides does not have a detrimental impact on RKF, but prolonged use (>3 weeks) should be avoided to minimize the risk of ototoxicity. Lastly, potential nephrotoxic agents such as intravenous contrast should be used judiciously.

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