scholarly journals Peritoneal Dialysis Vintage and Glucose Exposure but Not Peritonitis Episodes Drive Peritoneal Membrane Transformation During the First Years of PD

2019 ◽  
Vol 10 ◽  
Author(s):  
Maria Bartosova ◽  
Betti Schaefer ◽  
Karel Vondrak ◽  
Peter Sallay ◽  
Christina Taylan ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Membrane ◽  
Dialysis Vintage ◽  
Glucose Exposure ◽  
Membrane Transformation

MO710GALECTIN-3, IS IT A NEW PLAYER IN PERITONEAL INFLAMMATION AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Yael Einbinder ◽  
Keren Cohen-Hagai ◽  
Sydney Benchetrit ◽  
Tali Zitman-Gal
Keyword(s):  
Cell Culture ◽  
Peritoneal Dialysis ◽  
Endothelial Cell ◽  
Protein Expression ◽  
Inflammatory Process ◽  
Peritoneal Membrane ◽  
Peritoneal Equilibration Test ◽  
Endothelial Cell Culture ◽  
Dialysis Vintage ◽  
Mrna And Protein Expression

Abstract Background and Aims Peritoneal dialysis (PD) is a common used method for renal replacement therapy. Prolonged PD treatment causes structural and functional changes in the peritoneal membrane which are attributed to local inflammatory process in the peritoneal cavity. Galectin-3 (Gal-3) is a galactoside-binding lectin with pro-inflammatory and pro-fibrotic effects. The aim of this study was to assess correlation between Gal-3 serum and dialysate effluent levels with peritoneal membrane transport characteristics. Method Gal-3 levels in serum and dialysate effluent were measured simultaneously in prevalent PD patients in morning visit or during peritoneal equilibration test (PET). Gal-3 levels were correlated with clinical and laboratory parameters. Interlukin (IL) -6 levels were measured in dialysate effluent. Gal-3 mRNA and protein expression were evaluated after exposure of primary endothelial cell culture to several dialysate solutions. Results 37 PD patients were included in the study; mean age was 65.7±13.1 years, mean dialysis vintage was 17.5±13 months. Gal-3 levels in dialysate effluent correlated with peritoneal equilibration test (PET) results (0.663, p=0.005) and effluent IL-6 levels (0.674, p=0.002) but not with serum Gal-3 levels or dialysis vintage. Patients with high PET results had higher effluent Gal-3 levels as compared average low PET results. In multivariate regression analysis effluent IL-6 level was the most dominant predictor of effluent Gal-3 levels. Gal-3 mRNA and protein expression in primary endothelial cell culture were not affected by stimulation with dialysate solutions. Conclusion Our study demonstrated presence of Gal-3 within the dialysate effluent in PD patients. Gal-3 levels correlated with peritoneal membrane transport characteristics and effluent IL-6 levels suggesting a role in the inflammatory process within the peritoneal cavity.

Association between Peritoneal Glucose Exposure and Peritonitis in Peritoneal Dialysis Patients: TheBalANZ Trial

2017 ◽  
Vol 37 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Melissa Nataatmadja ◽  
Yeoungjee Cho ◽  
Elaine M. Pascoe ◽  
Darsy Darssan ◽  
Carmel M. Hawley ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Peritoneal Dialysis ◽  
High Glucose ◽  
Controlled Trial ◽  
Exposure Group ◽  
Peritoneal Membrane ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Low Glucose ◽  
Glucose Exposure

BackgroundGlucose is the primary osmotic medium used in most peritoneal dialysis (PD) solutions, and exposure to glucose has been shown to exert detrimental effects both locally, at the peritoneal membrane, and systemically. Moreover, high dialysate glucose exposure may predispose patients to an increased risk of peritonitis, perhaps as a result of impaired host defences, vascular disease, and damage to the peritoneal membrane.MethodsIn this post-hoc analysis of a multicenter, multinational, open-label randomized controlled trial of neutral pH, low-glucose degradation product (GDP) versus conventional PD solutions ( balANZ trial), the relationship between peritonitis rates of low (< 123.1 g/day) versus high (≥ 123.1 g/day) dialysate glucose exposure was evaluated in 177 incident PD patients over a 2-year study period.ResultsPeritonitis rates were 0.44 episodes per patient-year in the low-glucose exposure group and 0.31 episodes per patient-year in the high-glucose exposure group, (incidence rate ratio [IRR] 0.69, p = 0.09). There was no significant association between dialysate glucose exposure and peritonitis-free survival on univariable analysis (high glucose exposure hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.40 –1.08) or on multivariable analysis (adjusted HR 0.64, 95% CI 0.39 – 1.05). Moreover, there was no relationship between peritoneal glucose exposure and type of organism causing peritonitis. Physician-rated severity of first peritonitis episodes was similar between groups, as was rate and duration of hospital admission.ConclusionsOverall, this study did not identify an association between peritoneal dialysate glucose exposure and peritonitis occurrence, severity, hospitalization, or outcomes. A further large-scale, prospective, randomized controlled trial evaluating patient-level outcomes is merited.

scholarly journals The Influence of Initial Peritoneal Transport Characteristics, Inflammation, and High Glucose Exposure on Prognosis for Peritoneal Membrane Function

2012 ◽  
Vol 32 (6) ◽  
pp. 636-644 ◽  
Author(s):  
M. José Fernández-Reyes ◽  
M. Auxiliadora Bajo ◽  
Gloria Del Peso ◽  
Marta Ossorio ◽  
Raquel Díaz ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
High Glucose ◽  
Peritoneal Membrane ◽  
Transfer Coefficients ◽  
High Exposure ◽  
Membrane Function ◽  
Peritoneal Transport ◽  
Fast Transport ◽  
Glucose Exposure

♦ BackgroundFast transport status, acquired with time on peritoneal dialysis (PD), is a pathology induced by peritoneal exposure to bioincompatible solutions. Fast transport has important clinical consequences and should be prevented.♦ ObjectiveWe analyzed the repercussions of initial peritoneal transport characteristics on the prognosis for peritoneal membrane function, and also whether the influence of peritonitis and high exposure to glucose are different according to the initial peritoneal transport characteristics or the moment when such events occur.♦ MethodsThe study included 275 peritoneal dialysis patients with at least 2 peritoneal function studies (at baseline and 1 year). Peritoneal kinetic studies were performed at baseline and annually. Those studies consist of a 4-hour dwell with glucose (1.5% during 1981 – 1990, and 2.27% during 1991 – 2002) to calculate the peritoneal mass transfer coefficients of urea and creatinine (milliliters per minute) using a previously described mathematical model.♦ ResultsMembrane prognosis and technique survival were independent of baseline transport characteristics. Fast transport and ultrafiltration (UF) failure are reversible conditions, provided that peritonitis and high glucose exposure are avoided during the early dialysis period. The first year on PD is a main determining factor for the membrane's future, and the mass transfer coefficient of creatinine at year 1 is the best functional predictor of future PD history. After 5 years on dialysis, permeability frequently increases, and UF decreases. Icodextrin is associated with peritoneal protection.♦ ConclusionsPeritoneal membrane prognosis is independent of baseline transport characteristics. Intrinsic fast transport and low UF are reversible conditions when peritonitis and high glucose exposure are avoided during the early dialysis period. Icodextrin helps in glucose avoidance and is associated with peritoneal protection.

The Influence of Glucose Exposure Load and Peritoneal Membrane Transport on Body Composition and Nutritional Status Changes after 1 Year on Peritoneal Dialysis

2017 ◽  
Vol 37 (4) ◽  
pp. 458-463 ◽  
Author(s):  
Rafaela Siviero Caron-Lienert ◽  
Carlos Eduardo Poli-de-Figueiredo ◽  
Ana Elizabeth Prado Lima Figueiredo ◽  
Bartira Ercília Pinheiro da Costa ◽  
Carlo Crepaldi ◽  
...  
Keyword(s):  
Body Composition ◽  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Membrane Transport ◽  
Dry Weight ◽  
First Year ◽  
Peritoneal Membrane ◽  
Tissue Mass ◽  
Glucose Exposure ◽  
Composition Changes

BackgroundThe characteristics of peritoneal membrane transport differ among patients, affecting the prescription of peritoneal dialysis (PD) modality and glucose exposure in order to achieve an effective dialysis. This study aims to verify the influence of glucose exposure load and peritoneal membrane transport on body composition and nutritional status changes after the first year of PD.MethodsWe examined a cohort of 85 incident PD patients during the first year of treatment. We established a cut-off of 5% to define changes in dry weight (DW), lean tissue mass (LTM), and fat mass (FM).ResultsIn total, 50.6% of the patients presented DW gain, 41.2% showed LTM loss, and 65.9% presented FM gain. Over the time (T0 – T12), we found significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI). Patients with lower dialysate-to-plasma creatinine ratio showed DW and FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with DW no gain. As for glucose exposure load, no body composition changes were seen.ConclusionsMost patients presented DW gain, FM gain, and LTM loss. The characteristics of peritoneal membrane transport affected DW during the first year, changes being greater in nonfast than in fast transporters.

scholarly journals Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Jacek Waniewski ◽  
Stefan Antosiewicz ◽  
Daniel Baczynski ◽  
Jan Poleszczuk ◽  
Mauro Pietribiasi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Fluid Transport ◽  
Peritoneal Membrane ◽  
Transport Parameters ◽  
Patient Age ◽  
Pore Model ◽  
Peritoneal Transport ◽  
Patient Âgé ◽  
Dialysis Vintage

During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (αu), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage,αuwas higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

scholarly journals Peritoneal dialysis: from bench to bedside and bedside to bench

2016 ◽  
Vol 311 (5) ◽  
pp. F999-F1004 ◽  
Author(s):  
Jeffrey Perl ◽  
Joanne M. Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
Direct Consequence ◽  
Metabolic Effects ◽  
Peritoneal Membrane ◽  
Dialysis Membrane ◽  
Membrane Injury ◽  
Internal Lining ◽  
Glucose Exposure ◽  
End Stage

For patients with end-stage kidney disease unable to receive a kidney transplant, replacement of kidney function with dialysis is necessary to extend life. Peritoneal dialysis (PD) and hemodialysis (HD) are the two major forms of dialysis therapy. HD involves the passage of blood via an extracorporeal circuit whereby removal of small solutes, toxins, and water is achieved across a synthetic, semipermeable dialysis membrane. In contrast, in PD, the dialysis membrane is the highly vascularized internal lining of the peritoneal cavity. Intraperitoneal installation of hypertonic high glucose PD solution creates a transmembrane osmotic and diffusive gradient that facilitates water removal [ultrafiltration (UF)], convection, and diffusion of uremic toxins. Insight into the physiology of solute and water transport across the peritoneal membrane has been enhanced by the proposal of the ′'three-pore model'' of peritoneal membrane transport. Transport characteristics and UF capacity of the peritoneal membrane vary among individuals, and deleterious changes in the membrane may ensue over time. The degree to which these changes are a direct consequence of the type and composition of currently available PD solutions, recurrent infectious episodes, genetic differences among individuals, or a combination thereof is the subject of intense study. Adverse consequences resulting from the systemic and local metabolic effects of intraperitoneal glucose exposure, infection of the PD fluid, PD catheter dysfunction, and patient burnout from self-care often limit the long-term success of the therapy. Research aimed at addressing these challenges will examine the use of more biocompatible PD solutions and strategies aimed at attenuating progressive peritoneal membrane injury.

Effects of Peritoneal Resting on Peritoneal Fluid Transport Kinetics

2007 ◽  
Vol 27 (5) ◽  
pp. 575-579 ◽  
Author(s):  
Xing-wei Zhe ◽  
Xin-kui Tian ◽  
Lei Cheng ◽  
Tao Wang
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Fluid Transport ◽  
Fluid Absorption ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Dialysis Solution ◽  
Before And After ◽  
Glucose Exposure

Background Peritoneal resting has been used to restore peritoneal ultrafiltration capacity in peritoneal dialysis patients. Therefore, in the present study, we made a detailed investigation on the effects of peritoneal resting on peritoneal fluid transport characteristics in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods A temporary transfer to daytime ambulatory peritoneal dialysis with a nocturnal “empty belly” was applied to let the peritoneal membrane rest overnight in patients with poor ultrafiltration capacity. All included patients were asked to record appropriately their dialysis exchanges for the assessment of peritoneal fluid transport characteristics, which were evaluated before and after peritoneal resting. Results Seven CAPD patients were included in the present study. There was a significant improvement in peritoneal ultrafiltration capacity as assessed by ultrafiltration volume per gram of glucose load. Patients’ daily glucose exposure and dialysate-to-plasma ratio of creatinine were significantly decreased after peritoneal resting. The peritoneal fluid absorption rate was also significantly decreased after peritoneal resting: 1.011 ± 0.4484 versus 0.625 ± 0.3833 mL/minute. Conclusion The present study suggests that peritoneal resting can improve CAPD patients’ ultrafiltration capacity and decrease the use of hypertonic dialysis solution. The improved ultrafiltration capacity by peritoneal resting was due to decreased membrane solute transport rate and decreased peritoneal fluid absorption rate.

scholarly journals Volume-Based Peritoneal Dialysis Prescription Guide to Achieve Adequacy Targets

2016 ◽  
Vol 36 (2) ◽  
pp. 188-195 ◽  
Author(s):  
Alp Akonur ◽  
Catherine A. Firanek ◽  
Mary E. Gellens ◽  
Audrey M. Hutchcraft ◽  
Pranay Kathuria ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Membrane Transport ◽  
Kinetic Modeling ◽  
Demographic Data ◽  
Uremic Toxin ◽  
Peritoneal Membrane ◽  
Fluid Removal ◽  
Glucose Exposure ◽  
Total Glucose ◽  
Urea Distribution Volume

BackgroundThe use of automated and continuous ambulatory peritoneal dialysis (APD and CAPD) prescriptions (Rxs) to achieve adequate uremic toxin and fluid removal targets is important for attaining optimal patient outcomes. One approach for predicting such Rxs is the use of kinetic modeling.MethodsDemographic data and peritoneal membrane characteristics derived from a peritoneal equilibration test (PET) were available from 1,005 patients in North American centers who participated in a national adequacy initiative in 1999. Twelve patient subgroups were identified according to peritoneal membrane transport type and tertiles of total body water, assumed equal to urea distribution volume (Vurea). Each patient was then modeled using PD Adequest 2.0 to be treated by 12 CAPD and 34 APD Rxs using both glucose and icodextrin solutions to achieve adequacy targets of weekly urea Kt/V of 1.7 and 1 L of daily ultrafiltration (UF). Residual kidney function (RKF) was assumed to be 0, 2, 4, and 6 mL/min. Feasible peritoneal dialysis (PD) Rxs were identified where: 1) the 95% confidence limit achieved the goal of meeting the targets for urea Kt/V, daily UF, and both in 85%, 75%, and 70% of patients, respectively; 2) average PD solution dextrose concentration was < 2.5%; and 3) the number of daytime exchanges was minimized.ResultsFeasible PD Rxs were similar when RKF was ≥ 2 mL/min, allowing condensed recommendations based on RKF ≥ 2 mL/min or < 2 mL/min. Individuals with lower or slower membrane transport required relatively greater 24-h solution volumes to achieve adequacy targets when RKF fell below 2 mL/min. With increasing Vurea, there was disproportionately greater dependence on RKF to achieve targets. While multiple Rxs achieving urea Kt/V and daily UF goals were identified for all membrane transport types, use of icodextrin in the long dwell reduced the need for a midday exchange in APD, glucose exposure, required fill and 24-h dwell volumes, irrespective of RKF and Vurea. While these benefits were most notable in high and high-average transporters, similar results were also seen in low and low-average transporters.ConclusionsKinetic modeling identified multiple APD and CAPD Rxs that achieved adequate uremic solute and fluid removal for patients, irrespective of RKF and Vurea. Use of icodextrin rather than glucose in the long dwell reduced the complexity of the PD regimen, total glucose exposure, and 24-h total treatment solution volumes. Irrespective of modeling, adequacy of any PD prescription should be based upon individual clinical evaluation both for volume and solute removal.

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