scholarly journals Fluid Overload in Peritoneal Dialysis

2018 ◽  
Author(s):  
Leonardo Pazarin-Villaseñor ◽  
Francisco Gerardo Yanowsky-Escatell ◽  
Jorge Andrade-Sierra ◽  
Luis Miguel Roman-Pintos ◽  
Alejandra Guillermina Miranda-Diaz
Keyword(s):  
Peritoneal Dialysis ◽  
Fluid Overload

scholarly journals Prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident peritoneal dialysis patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jianbo Li ◽  
Jing Yu ◽  
Naya Huang ◽  
Hongjian Ye ◽  
Dan Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Multivariate Logistic Regression Analysis ◽  
Technical Failure ◽  
Cox Regression Analysis ◽  
Catheter Malfunction ◽  
All Cause Mortality ◽  
Cvd Mortality

Abstract Background Rehospitalization is a major problem for end stage renal disease (ESRD) populations. However, researches on 30-day unexpected rehospitalzation of incident peritoneal dialysis (PD) patients were limited. This study aimed to investigate the prevalence, risk factors and impact on outcomes of 30-day unexpected rehospitalization in incident PD patients. Methods This was a retrospective cohort study. Patients who accepted PD catheter implantation in our centre from Jan 1, 2006 to Dec 31, 2013 and regular follow-up were included. The demographic characteristics, laboratory parameters, and rehospitalization data were collected and analyzed. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular disease (CVD) mortality and technical failure. Results Totally 1632 patients (46.9 ± 15.3 years old, 60.1% male, 25.6% with diabetes) were included. Among them, 149 (9.1%) had a 30-day unexpected rehospitalization after discharge. PD-related peritonitis (n = 48, 32.2%), catheter malfunction (n = 30, 20.1%) and severe fluid overload (n = 19, 12.8%) were the top three causes for the rehospitalization. Multivariate logistic regression analysis showed that length of index hospital stays [Odds ratio (OR) =1.02, 95% confidence interval (CI) 1.00–1.03, P = 0.036) and hyponatremia (OR = 1.85, 95% CI 1.06–3.24, P = 0.031) were independently associated with the rehospitalization. Multivariate Cox regression analysis indicated that 30-day rehospitalization was an independent risk factor for all-cause mortality [Hazard ratio (HR) =1.52, 95% CI 1.07–2.16, P = 0.019) and CVD mortality (HR = 1.73, 95% CI 1.03–2.90, P = 0.038). Conclusions The prevalence of 30-day unexpected rehospitalization for incident PD patients in our centre was 9.1%. The top three causes for the rehospitalization were PD-related peritonitis, catheter malfunction and severe fluid overload. Thirty-day unexpected rehospitalization increased the risk of all-cause mortality and CVD mortality for PD patients.

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.

Peritoneal Dialysis

2019 ◽  
Author(s):  
Karlien François ◽  
Joanne M. Bargman
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Dialysis Fluid ◽  
Keywords Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos,  8 figures, 4 tables, and 73 references.  Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Peritoneal Dialysis

2019 ◽  
Author(s):  
Karlien François ◽  
Joanne M. Bargman
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Dialysis Fluid ◽  
Keywords Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos,  8 figures, 4 tables, and 73 references.  Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Methodology of Assessment of Fluid Status and Ultrafiltration Problems

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 143-147
Author(s):  
Graham Woodrow
Keyword(s):  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Fluid Management ◽  
Fundamental Function ◽  
Dialysis Therapy ◽  
Water Excretion ◽  
Rigorous Approach ◽  
Fluid Status ◽  
Renal Failure Fluid ◽  
End Stage

Loss of sodium and water excretion with disruption of volume homeostasis is a crucial abnormality of end-stage renal failure. Fluid management is a fundamental function of dialysis therapy, but studies show frequent occult fluid overload, hypertension, and cardiac dysfunction in peritoneal dialysis. A rigorous approach to fluid management in PD can achieve excellent fluid, hypertension, and cardiovascular results in clinical practice. The present article explores the reasons for fluid overload and poor ultrafiltration in peritoneal dialysis patients and discusses optimal assessment and management of these problems.

Fluid Overload in Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (1) ◽  
pp. 43-53 ◽  
Author(s):  
Yong-Lim Kim ◽  
Wim Van Biesen
Keyword(s):  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Dialysis Patients

scholarly journals Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload

2001 ◽  
Vol 2 (1) ◽  
Author(s):  
David Wayne Johnson ◽  
Mary Arndt ◽  
Amanda O'Shea ◽  
Rhonda Watt ◽  
Jan Hamilton ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Salvage Therapy ◽  
Fluid Overload ◽  
Dialysis Patients

scholarly journals Predictors and Prognostic Significance of Persistent Fluid Overload: a Longitudinal Study in Chinese Peritoneal Dialysis Patients

2021 ◽  
Author(s):  
Jack Kit-Chung Ng ◽  
Bonnie Ching-Ha Kwan ◽  
Gordon Chun-Kau Chan ◽  
Kai-Ming Chow ◽  
Wing-Fai Pang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Risk Model ◽  
Fluid Overload ◽  
Strong Predictor ◽  
Prognostic Significance ◽  
Adverse Outcomes ◽  
Longitudinal Change ◽  
Volume Status ◽  
Time Varying ◽  
Technique Survival

Abstract Background: Cross-sectional studies showed that fluid overload (FO) measured by bioimpedance spectroscopy (BIS) predicted adverse outcomes in patients on peritoneal dialysis (PD). We describe the longitudinal change in volume status in Chinese PD patients, and determine its relation with clinical outcomes.Methods: We performed a single-center, retrospective analysis of all PD patients who underwent repeated BIS from 2010 to 2015. FO was defined by relative hydration index (RHI; volume of overhydration adjusted by extracellular water >7%). Variability of volume status (VVS) was denoted by the standard deviation of all RHI. The association of time-averaged RHI and VVS on patient and technique survival was explored by a competing risk model.Results: A total of 269 patients were followed for a median of 47.1 months. Multivariate mixed linear regression revealed that RHI was significantly associated with time-varying systolic blood pressure, and inversely with time-varying albumin level, lean tissue index and fat tissue index (P <0.0001 for all). Patients without FO at baseline, as compared with those who had FO, showed significantly more fluid accumulation with time (adjusted between-group mean difference in RHI: 3.2% per year, 95% confidence interval [CI] 1.5 to 4.9%, P =0.0002). Time-averaged RHI independently predicted patient survival (subdistribution hazard ratio [SHR] 1.05, 95% CI 1.03-1.08, P <0.0001) and technique survival (SHR 1.04, 95% CI 1.01-1.06, P =0.001), whereas VVS did not.Conclusions: Persistent FO was a strong predictor of patient and technique failure. Repeated bioimpedance measurements for the monitoring of volume status provided additional prognostic information in PD patients.

Fluid Management With Peritoneal Dialysis After Pediatric Cardiac Surgery

2018 ◽  
Vol 9 (6) ◽  
pp. 696-704 ◽  
Author(s):  
Matthew F. Barhight ◽  
Danielle Soranno ◽  
Sarah Faubel ◽  
Katja M. Gist
Keyword(s):  
Cardiac Surgery ◽  
Peritoneal Dialysis ◽  
Cardiopulmonary Bypass ◽  
Fluid Overload ◽  
Fluid Management ◽  
Kidney Injury ◽  
Clinical Markers ◽  
Fluid Removal ◽  
Vasoactive Medication ◽  
Potential Benefits

Children who undergo cardiac surgery with cardiopulmonary bypass are a unique population at high risk for postoperative acute kidney injury (AKI) and fluid overload. Fluid management is important in the postoperative care of these children as fluid overload is associated with increased morbidity and mortality. Peritoneal dialysis catheters are an important tool in the armamentarium of a cardiac intensivist and are used for passive drainage for fluid removal or dialysis for electrolyte and uremia control in AKI. Prophylactic placement of a peritoneal catheter is a safe method of fluid removal that is associated with few major complications. Early initiation of peritoneal dialysis has been associated with improved clinical markers and outcomes such as early achievement of a negative fluid balance, lower vasoactive medication needs, shorter duration of mechanical ventilation, and decreased mortality. In this review, we discuss the safety and potential benefits of peritoneal catheters for dialysis or passive drainage in children following cardiopulmonary bypass.

Can the Inflammation Markers of Patients with High Peritoneal Permeability on Continuous Ambulatory Peritoneal Dialysis be Reduced on Nocturnal Intermittent Peritoneal Dialysis?

2006 ◽  
Vol 26 (3) ◽  
pp. 341-348 ◽  
Author(s):  
Alfonso M. Cueto-Manzano ◽  
Enrique Rojas-Campos ◽  
Héctor R. Martínez-Ramírez ◽  
Isela Valera-González ◽  
Miguel Medina ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Fluid Overload ◽  
Final Evaluation ◽  
Inflammation Markers ◽  
Overload Control ◽  
Tnf Α ◽  
Peritoneal Permeability ◽  
Serum Crp

Background Patients with high peritoneal permeability have the greatest degree of inflammation on continuous ambulatory peritoneal dialysis (CAPD), which may be associated with their higher mortality. Nocturnal intermittent peritoneal dialysis (NIPD; “dry day”) may decrease inflammation by reducing the contact between dialysate and peritoneum and/or providing better fluid overload control. Therefore, the aims of this study were to determine and compare serum and dialysate concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) of patients with high or high-average peritoneal transport on CAPD, changed to NIPD, and ultimately to continuous cyclic peritoneal dialysis (CCPD). Methods Crossover clinical trial in 11 randomly selected patients. All subjects had been on CAPD and were changed to NIPD, and ultimately to CCPD (6.4 ± 3.1 months after initiation of study). All patients used glucose-based dialysate. Evaluations of clinical and biochemical parameters, dialysis adequacy, and serum and dialysis inflammation markers were performed at baseline on CAPD, 7 – 14 days after changing to NIPD, 7 – 14 days after switching to CCPD, and after 1 year of follow-up. All patients used only 1.5% glucose dialysate during evaluation days. CRP was determined by nephelometry, and IL-6 and TNF-α by ELISA. Results Seven patients were high transporters and 4 high average. Ultrafiltration increased ( p < 0.05) when patients changed from CAPD [0.38 L (-0.3 – 1.1 L)] to NIPD [2.64 L (0.7 – 4.7 L)]; it then decreased on CCPD [0.88 L (0.4 – 1.3 L) and at the end of study [0.65 L (0.3 – 1.0 L)]. This better fluid overload control was accompanied by decreased weight and systolic and diastolic blood pressure when patients changed from CAPD (89 ± 13 kg, 160 ± 23 and 97 ± 9 mmHg, respectively) to NIPD (86 ± 17 kg, 145 ± 14 and 86 ± 9 mmHg, respectively), and increased weight and systolic and diastolic blood pressure on CCPD (85 ± 15 kg, 143 ± 23 and 88 ± 14 mmHg, respectively) and at the end of follow-up (87 ± 16 kg, 155 ± 24 and 89 ± 12 mmHg, respectively). Median serum CRP decreased ( p = 0.03), from 3.8 (1.6 – 8.5) mg/L on CAPD to 1.0 (0.4 – 4.4) mg/L on NIPD, but increased on CCPD [1.8 (1.3 – 21) mg/L] and at the end of the study [3.2 (0.3 – 8.2) mg/L]. Dialysate CRP decreased nonsignificantly, from 0.10 (0 – 0.5) mg/L on CAPD to 0 (0 – 0.03) mg/L on NIPD, to 0.01 (0 – 0.08) mg/L on CCPD, and to 0 (0 – 0) mg/L at final evaluation. Serum TNF-α concentration decreased, from 0.14 (0.04 – 0.6) pg/mL on CAPD to 0.01 (0 – 0.08) pg/mL on NIPD, and then increased to 0.06 (0 – 0.4) pg/mL on CCPD and to 0.11 (0 – 0.2) pg/mL at the end of the study; whereas dialysate TNF-α decreased, from 0.08 (0.03 – 0.2) pg/mL on CAPD to 0.04 (0 – 0.2) pg/mL on NIPD, and to 0 (0 – 0) pg/mL and 0 (0 – 0.05) pg/mL on CCPD and final evaluation respectively. Serum IL-6 decreased ( p = 0.07), from 2.5 (2.0 – 4.2) pg/mL on CAPD to 1.0 (0.7 – 2.0) pg/mL on NIPD, and to 1.0 (0.8 – 2.9) pg/mL on CCPD and 1.0 (0.5 – 9.8) pg/mL at the end of the study; whereas dialysate levels remained similar on CAPD [8.0 (3.7 – 13) pg/mL] and NIPD [7.8 (5.1 – 23) pg/mL], and increased on CCPD [11.2 (9.5 – 19) pg/mL] and at final evaluation [11.2 (8.3 – 15) pg/mL]. Conclusions NIPD significantly decreased serum CRP and displayed a trend to decrease TNF-α and IL-6 serum concentrations compared with CAPD; whereas CCPD tended to reverse these effects. These results did not appear to be due to decreased local peritoneal inflammation, but they could be associated with better control of fluid overload on NIPD. Thus, NIPD, as long as the residual renal function allows it, may be useful in reducing the systemic inflammation of patients with high peritoneal membrane permeability.

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