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.

Computer simulations of steady concentration peritoneal dialysis

2020 ◽  
Vol 40 (1) ◽  
pp. 76-83
Author(s):  
Kyoung Jin Lee ◽  
Dong Ah Shin ◽  
Hee Su Lee ◽  
Jung Chan Lee
Keyword(s):  
Peritoneal Dialysis ◽  
Computer Simulations ◽  
Glucose Concentration ◽  
Infusion Rate ◽  
Dwell Time ◽  
Fluid Overload ◽  
Glucose Solution ◽  
Glucose Absorption ◽  
Osmotic Gradient ◽  
Sodium Removal

Background: Steady concentration peritoneal dialysis (SCPD), which maintains transperitoneal osmotic gradient by infusing 50% glucose solution throughout the dwell time, has been proposed as a potent treatment for peritoneal dialysis (PD) patients with fluid overload. However, SCPD has yet to be explored theoretically. Here, we investigated SCPD via computer simulations. Methods: A model was developed by adding the variables for infusing 50% glucose solution to a traditional three-pore model for continuous ambulatory PD. The simulated scenarios involved the instillation of 2-L dialysate, 1.36% or 2.27%, followed by the infusion of 50% glucose solution, varying the rate from 0 mL/h to 90 mL/h. A dwell with 3.86% dialysate was also simulated for the purpose of comparison. Four sets of patient parameters corresponding to peritoneal transport categories were used. Results: The net ultrafiltration (UF) during SCPD increased with time as well as with glucose infusion rate. The glucose absorption and sodium removal of SCPD were slightly higher than those of the conventional dwell with 3.86% dialysate under the condition of the same net UF and dwell time. SCPD resulted in the larger UF and the lower peak intraperitoneal glucose concentration when it was simulated with the higher transport properties. Conclusions: These simulations indicate that SCPD can improve UF beyond those achievable by a conventional 3.86% glucose exchange while also exhibiting a lower peak osmolarity in the dialysate as compared to a conventional 3.86% dwell. However, further studies are needed to confirm these theoretical findings.

Pathophysiology of Ultrafiltration in Peritoneal Dialysis

1990 ◽  
Vol 10 (2) ◽  
pp. 119-126 ◽  
Author(s):  
Claudio Ronco ◽  
Mariano Feriani ◽  
Stefano Chiaramonte ◽  
Alessandra Brendolan ◽  
Luisa Bragantini ◽  
...  
Keyword(s):  
Blood Flow ◽  
Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Peritoneal Membrane ◽  
Dialysis Membrane ◽  
Ultrafiltration Rate ◽  
Peritoneal Equilibration Test ◽  
Common Causes ◽  
Catheter Malposition ◽  
Causes Of Failure

Pathophysiology of peritoneal ultrafiltration is analyzed in the present study. Peritoneal equilibration test is the easiest procedure to study in detail the possible causes of failure to control the ultrafiltration rate in patients undergoing peritoneal dialysis. Membrane failure, reduction in peritoneal blood flow, excessive lymphatic reabsorption catheter malposition, and fluid sequestration are the most common causes of ultrafiltration loss. Pharmacologic manipulation of peritoneal membrane, correction of mechanical inconvenients, reduction in peritonitis rate and in the level of immunostimulation of the mesotelial macrophages, together with a careful policy in terms of glucose concentration in the dialysate and dwell times may contribute not only to treat different forms of ultrafiltration loss but also to prevent their incidence.

Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 260-262 ◽  
Author(s):  
Alberto Edefonti ◽  
Marina Picca ◽  
Raffaele Galato ◽  
Sophie Guez ◽  
Marisa Giani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Glucose Solution ◽  
Transport Rate ◽  
Chronic Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Equilibration Test ◽  
Blood Samples ◽  
Mean Values ◽  
Significant Difference

The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively. There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.

Evaluation of Non-Linear and Linear Mathematical Models for Creatinine and Glucose Fitting in Peritoneal Dialysis

1996 ◽  
Vol 19 (4) ◽  
pp. 221-231
Author(s):  
G. Amici
Keyword(s):  
Peritoneal Dialysis ◽  
Concentration Ratio ◽  
Linear Models ◽  
Linear Transformations ◽  
Peritoneal Equilibration Test ◽  
Peritoneal Transport ◽  
Non Linear ◽  
Definition Of ◽  
The Individual ◽  
Fitting In

Four non-linear and five linear models for predicting the creatinine dialysate/plasma ratio (CRD/P) and the glucose dialysate/initial concentration ratio (GLD/Do) were evaluated in a group of 31 patients on peritoneal dialysis and subjected to the peritoneal equilibration test (PET 3.86%, 240'). PET results and classification were compared to obtain a definition of patient peritoneal transport characteristics. The monomolecular and rectangular hyperbola non-linear models, the Lineweaver-Burk, Hanes-Woolf and Dadone linear transformations were considered for the CRD/P fitting. A monoexponential and two-exponential decay plus the semilogarithmic transformations were considered for the GLD/Do. These models are simple, accurate and functionally homogeneous. Further studies are advisable however on the individual peritoneal transport classification, since ∼30% of the patients were in different categories for CRD/P and GLD/Do and the fittings do not give better classification results.

How to Increase Adequacy of Peritoneal Dialysis in Children?

2005 ◽  
Vol 25 (3_suppl) ◽  
pp. 135-136
Author(s):  
Cornelis H. Schröder
Keyword(s):  
Peritoneal Dialysis ◽  
Surface Area ◽  
Body Surface ◽  
Glucose Concentration ◽  
Peritoneal Membrane ◽  
Dialysis Fluid ◽  
Peritoneal Equilibration Test ◽  
Dialysis Adequacy ◽  
Intraperitoneal Pressure ◽  
Dialysis Solution

Since children on dialysis are treated most often with nightly intermittent peritoneal dialysis, adequacy of dialysis is determined by the number and duration of cycles, the volume of the dialysis fluid applied, and the choice of dialysis solution. The number and duration of cycles are dependent on the maximal acceptable duration of night rest and the permeability properties of the peritoneal membrane. The latter can be established by performance of a peritoneal equilibration test. The volume used should be about 1200 mL/m2 body surface area, and intraperitoneal pressure should be between 5 and 15 cm H2O. The dialysis solution administered should have a glucose concentration as low as possible, and an icodextrin daytime dwell may be considered.

scholarly journals Clinical relevance of marginal factors on ultrafiltration in peritoneal dialysis

2020 ◽  
pp. 089686082090455 ◽  
Author(s):  
Vicente Pérez-Díaz ◽  
Alfonso Pérez-Escudero ◽  
Sandra Sanz-Ballesteros ◽  
Luisa Sánchez-García ◽  
Esther Hernández-García ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Body Size ◽  
Clinical Relevance ◽  
The Other ◽  
Clinical Settings ◽  
Osmotic Gradient ◽  
Peritoneal Equilibration Test ◽  
Intraperitoneal Pressure ◽  
Sex Influence ◽  
Peritoneal Permeability

Background: Ultrafiltration (UF) in peritoneal dialysis (PD) is mainly driven by the osmotic gradient and peritoneal permeability, but other factors—such as intraperitoneal pressure (IPP)—also have an influence. Methods: To assess the clinical relevance of these marginal factors, we studied 41 unselected PD patients undergoing two consecutive 2 h, 2.27% glucose exchanges, first with 2.5 L and then with 1.5 L. Results: IPP, higher in the 2.5 L exchange, had a wide interpatient range, was higher in obese and polycystic patients and their increase with infusion volume was higher for women regardless of body size. UF with 2.5 L correlated inversely with IPP and was higher for patients with polycystosis or hernias, while for 1.5 L we found no significant correlations. The effluent had higher glucose and osmolarity in the 2.5 L exchange than in the 1.5 L one, similar for both sexes. In spite of this stronger osmotic gradient, only 21 patients had more UF in the 2.5 L exchange, with differences up to 240 mL. The other 20 patients had more UF in the 1.5 L exchange, with stronger differences (up to 800 mL, and more than 240 mL for 9 patients). The second group, with similar effluent osmolarity and peritoneal equilibration test (PET) parameters than the first, has higher IPP and preponderance of men. The sex influence is so intense that men decreased average UF with 2.5 L with respect to 1.5 L, while women increased it. Conclusions: With 2.27% glucose, sex and IPP—modulated by obesity, polycystosis, hernias, and intraperitoneal volume—significantly affect UF in clinical settings and might be useful for its management.

Arterial Pulse Wave Velocity and Peritoneal Transport Characteristics Independently Predict Hospitalization in Chinese Peritoneal Dialysis Patients

2010 ◽  
Vol 30 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Ni Gao ◽  
Bonnie Ching-Ha Kwan ◽  
Kai-Ming Chow ◽  
Kwok-Yi Chung ◽  
Wing-Fai Pang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Fluid Overload ◽  
Technique Survival ◽  
Cardiothoracic Ratio ◽  
Peritoneal Transport ◽  
Duration Of Hospitalization

ObjectiveCardiovascular disease (CVD) is the most common cause of mortality in chronic peritoneal dialysis (PD) patients. Increased arterial stiffness may be related to a high peritoneal permeability resulting in fluid overload in PD patients. We studied the relations between arterial stiffness, peritoneal transport, and radiographic parameters of systemic fluid overload in a cohort of Chinese PD patients.DesignProspective cohort study.SettingUniversity referral center.PatientsWe studied 107 PD patients. Vascular pedicle width and cardiothoracic ratio were measured from a plain postero-anterior chest radiograph. Pulse wave velocity (PWV) was determined at carotid–femoral (C-F) and carotid–radial sites. Peritoneal transport was determined by the dialysate-to-plasma ratio (D/P) of creatinine at 4 hours of dwell. Patients were followed for 9.4 ± 4.6 months.Outcome MeasuresDuration of hospitalization; actuarial and technique survival.ResultsThere were no relationships between radiographic measures, arterial PWV, and D/P creatinine. However, both C-F PWV and D/P creatinine were independent predictors of the number of hospitalizations for CVD. None of the parameters correlated with mortality in this study.ConclusionsThere were no relationships between radiological parameters of fluid overload, peritoneal transport characteristics, and arterial PWV. Both C-F PWV and D/P creatinine were independent predictors of the number of hospitalizations for CVD. Our result suggests that arterial stiffness and high peritoneal transport each contribute to the development of CVD in this group of patients.

Does a High Peritoneal Transport Rate Reflect a State of Chronic Inflammation?

1999 ◽  
Vol 19 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Tao Wang ◽  
Olof Heimbürger ◽  
Hui-Hong Cheng ◽  
Jonas Bergström ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Chronic Inflammation ◽  
Transport Rate ◽  
Peritoneal Equilibration Test ◽  
Blood Concentrations ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Peritoneal Transport ◽  
Continuous Cycling ◽  
Serum Crp

Objective It has recently been reported that a high peritoneal transport rate was associated with increased mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. One possible explanation is that a high peritoneal transport rate might be caused by a state of chronic inflammation, which also per se might result in increased mortality. Therefore, in this study we investigated whether high peritoneal transport rate patients are in a state of chronic inflammation. Methods The study included 39 clinically stable peritoneal dialysis patients (free of peritonitis) who had been on PD for more than 3 months (16.8 ± 11.8 months). Seven patients were treated with continuous cycling peritoneal dialysis (CCPD) and the others were on CAPD. A 4-hour standard peritoneal equilibration test (PET) using 2.27% glucose solution was performed in each patient. Dialysate samples at 4 hours and blood samples at 2 hours were measured for interleukin-1β (IL-β), tumor necrosis factoroc (TNFα), C-reactive protein (CRP), and hyaluronan as markers of inflammation. Results There was no significant correlation between dialysate/plasma (D/P) creatinine (0.82 ± 0.15, range 0.51 - 1.15) and blood concentrations of IL-1β (11.2 ng/L, range <5 - 65.9 ng/L), TNFα (12.1 ng/L, range <5 - 85.4 ng/L), CRP (<10 mg/L, range <10 - 76 mg/L), nor with the blood hyaluronan concentration (165 μg/L, range 55 - 955 μg/L). The dialysate concentrations of IL-1β and TNFα were below the detectable level in most of the samples. Although dialysate hyaluronan concentration (334 μg/L, range 89 - 1100 μg/L) was correlated with D/P creatinine ( r = 0.36, p < 0.05), there was no correlation between the total amount of hyaluronan in the effluent and D/P creatinine. However, a significant correlation was found between serum hyaluronan concentration and glomerular filtration rate (GFR) ( r = -0.49, p < 0.005); GFR also tended to be correlated with serum TNFα ( r = -0.31, p = 0.058) but not with serum IL-1β and serum CRP. Conclusion Our results suggest that a high peritoneal transport rate is not necessarily related to a state of chronic inflammation in CAPD patients. The high mortality rate observed in high transporters may relate to other issues, such as fluid balance or abnormal nutrition and metabolism, rather than to chronic inflammation.

scholarly journals Monitoring of Intraperitoneal Fluid Volume during Peritoneal Equilibration Testing using Segmental Bioimpedance

2019 ◽  
Vol 44 (6) ◽  
pp. 1465-1475
Author(s):  
Fansan Zhu ◽  
Samer R. Abbas ◽  
Roxana M. Bologa ◽  
Nathan W. Levin ◽  
Peter Kotanko
Keyword(s):  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Fluid Volume ◽  
Bioimpedance Analysis ◽  
Creatinine Ratio ◽  
Peritoneal Equilibration Test ◽  
Lower Trunk ◽  
Time To Peak ◽  
Ultrafiltration Failure ◽  
Dialysate Volume

Background: Ultrafiltration failure and fluid overload are common in peritoneal dialysis (PD) patients. Knowledge of intraperitoneal volume (IPV) and time to peak IPV during a dwell would permit improved PD prescription. This study aimed to utilize trunk segmental bioimpedance analysis (SBIA) to quasi-continuously monitor IPV (IPVSBIA) during the peritoneal dwell. Methods: IPVSBIA was measured every minute using lower-trunk SBIA (Hydra 4200; Xitron Technologies Inc., CA, USA) in 10 PD patients during a standard 240-min peritoneal equilibration test (PET). The known dialysate volume (2 L) rendered IPVSBIA calibration and calculation of instantaneous ultrafiltration volume (UFVSBIA) possible. UFVSBIA was defined as IPVSBIA – 2 L. Results: Based on dialysate-to-plasma creatinine ratio, 2 patients were high, 7 high-average, and 1 low-average transporters. Technically sound IPVSBIA measurements were obtained in 9 patients (age 59.0 ± 8.8 years, 7 females, 5 African Americans). Drained ultrafiltration volume (UFVdrain) was 0.47 ± 0.21 L and correlated (r = 0.74; p < 0.05) with end-dwell UFVSBIA (0.55 ± 0.17 L). Peak UFVSBIA was 1.04 ± 0.32 L, it was reached 177 ± 61 min into the dwell and exceeded end-dwell UFVSBIA by 0.49 ± 0.28 L (95% CI: 0.27–0.7) and UFVdrain by 0.52 ± 0.31 L (95% CI: 0.29–0.76), respectively. Conclusion: This pilot study demonstrates the feasibility of trunk segmental bioimpedance to quasi-continuously monitor IPVSBIA and identify the time to peak UFVSBIA during a standard PET. Such new insights into the dynamics of intraperitoneal fluid volume during the dwell may advance our understanding of the underlying transport physiology and eventually assist in improving PD treatment prescriptions.

Bone Metabolism and Peritoneal Membrane Transport in Children on Chronic Peritoneal Dialysis

2003 ◽  
Vol 23 (5) ◽  
pp. 487-492 ◽  
Author(s):  
Helena Ziólkowska ◽  
Malgorzata Pańczyk-Tomaszewska ◽  
Andrzej Debiński ◽  
Andrzej Sawicki ◽  
Maria Roszkowska-Blaim
Keyword(s):  
Peritoneal Dialysis ◽  
Bone Metabolism ◽  
Glucose Concentration ◽  
Test Group ◽  
Peritoneal Membrane ◽  
Bone Formation Rate ◽  
Peritoneal Transport ◽  
Group I ◽  
Bone Biopsies ◽  
Group Ii

Objective The aim of the study was to assess the influence of peritoneal membrane permeability on bone metabolism in dialyzed children. Patients and Methods 24 children with end-stage renal failure and being treated with peritoneal dialysis (PD) were studied. The children were divided into two groups based on the results of a standard peritoneal equilibration test: group I, high peritoneal transport [ratio of dialysate glucose concentration at 4 hours to dialysate glucose concentration at 0 hours (D/D0) < 0.26, dialysate-to-serum ratio of creatinine concentration at 4 hours (D/P) > 0.81], 10 children aged 9.9 ± 2.9 years; group II, other peritoneal transport types (D/D0 > 0.26, D/P < 0.81), 14 children aged 11.4± 2.7 years. Serum levels of calcium (sCa), phosphorus (sP), protein, albumin, alkaline phosphatase (AP), and parathormone (PTH) were measured, and bone biopsies were performed in all children. Alfacalcidol and calcium carbonate doses were adjusted to sCa, sP, and PTH levels in all patients. Results No statistically significant differences (NS) between the two groups were found in age, duration of PD, sCa, sP, AP, PTH, protein, or albumin levels. The mean alfacalcidol dose was 0.055 ± 0.057 μg/kg body weight/week in group I and 0.099 ± 0.065 μg/kg/week in group II ( p = NS). In group I, the high peritoneal transport group, significantly lower osteoclast surface (OcS/BS) and bone formation rate (BFR/TV) were found compared with group II (3.1% ± 1.7% vs 4.6% ± 2.0%, and 483.5 ± 329.2 μm3/mm2/day vs 913.9 ± 558.3 μm3/mm2/day, respectively, p < 0.05). We also found significant positive correlation between D/D0 and BFR/TV and OcS/BS ( r = 0.45, p < 0.05). Conclusion Bone turnover in children treated with PD may depend on peritoneal permeability.

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