Effects of long-term treatment with low-GDP, pH-neutral solutions on peritoneal membranes in peritoneal dialysis patients

Tawada, Mitsuhiro; Hamada, Chikuma; Suzuki, Yoshio; Sakata, Fumiko; Sun, Ting; Kinashi, Hiroshi; Kuriyama, Takayuki; Takei, Yoshiyuki; Maruyama, Shoichi; Honda, Kazuho; Mizuno, Masashi; Ito, Yasuhiko

doi:10.1007/s10157-018-1679-7

Cited by 22 publications

(29 citation statements)

References 33 publications

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“…106,107 The more biocompatible PD solutions have also been associated with stable peritoneal membrane function and UF capacity over time, compared with conventional glucose-based solutions, which have been associated with a progressive decline in UF capacity over time. [108][109][110] Icodextrin. Moderate-certainty evidence indicates that icodextrin augments peritoneal UF compared with standard glucose solutions.…”

Section: Hypertension and The Pd Prescriptionmentioning

confidence: 99%

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Flythe¹,

Chang²,

Gallagher³

et al. 2020

Kidney International

175

163

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Section: Hypertension and The Pd Prescriptionmentioning

confidence: 99%

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Flythe¹,

Chang²,

Gallagher³

et al. 2020

Kidney International

175

163

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“…These changes were affected by the PDF, and recognition of this fact led to the development of a biocompatible, neutral, low-GDP PDF. Many reports have shown that this new PDF results in less damage to the peritoneum than conventional acidic high-GDP PDF [3,6,7]. However, even this neutral, low-GDP PDF does not prevent all pathological changes to the peritoneum [8].…”

Section: Discussionmentioning

confidence: 93%

Effect of lactate as a peritoneal dialysis fluid buffer on rat peritoneal mesothelial cells

2020

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Background Neutral, low-glucose degradation product (GDP) peritoneal dialysis fluid (PDF) is less damaging to the peritoneum than conventional PDF but is still insufficient for biocompatibility. One remaining issue is the problem of buffering. Methods Using cultured rat peritoneal mesothelial cells (PMCs), the present study examined the difference between the effects of neutral low-GDP lactate PDF and neutral low-GDP bicarbonate/lactate PDF on cells. The effects of lactate stimulation on these cells were also examined. Results Lactate PDF enhanced mRNA expressions of α-smooth muscle actin (αSMA) and type 1 and type 3 collagens and lowered expression of e-cadherin mRNA in PMCs compared to bicarbonate/lactate PDF. Lactate stimulation increased mRNA expressions of αSMA, matrix metalloproteinase 2 (MMP2), and basic fibroblast growth factor (bFGF) and suppressed e-cadherin mRNA expression. Transforming growth factor (TGF)-β1 and TGF-β2 and collagen type 1 and 3 mRNA expressions were also enhanced by lactate stimulation. Conclusions These results suggest that lactate as a PDF buffer may act on PMCs to promote epithelial-mesenchymal transition (EMT) and production of TGF-β, bFGF, and collagen.

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“…To identify factors related to the PMT at baseline (measured within 4 weeks of the introduction of PD) (bPMT), at last measurement (lPMT), and the PMT change rate, univariate and multivariate linear regression analyses were performed. In the multivariate analysis, candidate variables, including age, sex, BMI, PD duration, having diabetes mellitus (DM), history of peritonitis, and D/P Cr, were selected by referencing previous studies [9][10][11][12][13][14][15][16]. Of the 115 patients, 42 patients had at least two PMT measurements, including a bPMT measurement.…”

Section: Outcomes and Statistical Analysismentioning

confidence: 99%

“…In Japan, since around 2005, most PD patients have used a pH-neutral, low-glucose degradation product (GDP) dialysate, which is more biocompatible than conventional dialysates. Since then, several studies have shown that a pH-neutral low-GDP dialysate might prevent morphological and functional changes in the peritoneum [15,[18][19][20]. Tawada et al compared the peritoneal biopsy samples of 54 PD patients treated with a conventional acidic dialysate to those of 73 PD patients treated with a pH-neutral low-GDP dialysate [15].…”

Section: Comparison Between Two Groups Divided By Pmt Change Rate Dismentioning

confidence: 99%

“…Since then, several studies have shown that a pH-neutral low-GDP dialysate might prevent morphological and functional changes in the peritoneum [15,[18][19][20]. Tawada et al compared the peritoneal biopsy samples of 54 PD patients treated with a conventional acidic dialysate to those of 73 PD patients treated with a pH-neutral low-GDP dialysate [15]. They showed that the PMT was higher and the lumen/vessel diameter ratio was smaller in the conventional dialysate group than in the pH-neutral dialysate group and that the lumen/vessel diameter ratio negatively correlated with PD duration and D/P Cr in the conventional dialysate group but not in the pH-neutral dialysate group.…”

Section: Comparison Between Two Groups Divided By Pmt Change Rate Dismentioning

confidence: 99%

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Long-term sonographic evaluation of the peritoneum in peritoneal dialysis patients: A retrospective cohort study

Taguchi

Ohtake

Mochida

et al. 2020

Preprint

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Background Long-term peritoneal dialysis (PD) causes morphological changes to the peritoneum. However, the sequential morphological changes of the peritoneum remain unclear due to the invasiveness and ethical dilemmas surrounding peritoneal biopsies. We aimed to evaluate these long-term morphological peritoneal changes using sonography, which was recently reported to be useful for morphological peritoneal evaluation. Methods We retrospectively identified 115 PD patients who underwent sonographic peritoneal membrane thickness (PMT) measurement. Univariate and multivariate linear regression analyses identified factors related to PMT at baseline (bPMT), at last measurement (lPMT), and the PMT change rate. Of the 115 patients, 42 patients had at least two PMT measurements, including a bPMT measurement. We evaluated the PMT change between bPMT and lPMT. We also evaluated the annual PMT change for 3 years before PD withdrawal in patients who discontinued PD due to peritoneal dysfunction. Clinical characteristics and parameters were analyzed according to PMT change rates (≤ 0 [n = 28] or > 0 [n = 20]). Results The mean age at PD introduction and mean PD duration were 63.7 ± 12.7 years and 40.5 ± 30.1 months, respectively. There was a significant positive correlation between the dialysate to plasma ratio of creatinine (D/P Cr) and lPMT (r = 0.386, p = 0.004), but not bPMT (r=-0.114, p = 0.326). In the multivariate analyses, D/P Cr remained an independent predictor of lPMT (r = 0.478, p = 0.001) after adjusting for age, sex, body mass index, PD duration, diabetes, and peritonitis rate. The mean bPMT and lPMT were 0.67 ± 0.15 mm and 0.69 ± 0.10 mm, respectively, without statistical difference (p = 0.49). Annual PMTs for 3 years before PD withdrawal were 0.67 ± 0.13 mm, 0.66 ± 0.11 mm, and 0.67 ± 0.08 mm, respectively, with no significant differences among measurements (p = 0.967). There were no differences in PD duration, the use of a dialysate containing over 2.5% glucose or icodextrin, and the peritonitis rate between groups divided by the PMT change rate. Conclusions PMT, measured by sonography, was positively correlated with peritoneal permeability. Repeated evaluation of the peritoneum by sonography will enable the recognition of transition in peritoneal function in real time and allow for more appropriate PD management. Furthermore, the peritoneum was not necessarily thickened regardless of PD duration or cause of withdrawal.

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Effects of long-term treatment with low-GDP, pH-neutral solutions on peritoneal membranes in peritoneal dialysis patients

Cited by 22 publications

References 33 publications

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Effect of lactate as a peritoneal dialysis fluid buffer on rat peritoneal mesothelial cells

Long-term sonographic evaluation of the peritoneum in peritoneal dialysis patients: A retrospective cohort study

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