Longitudinal membrane function in functionally anuric patients treated with APD: Data from EAPOS on the effects of glucose and icodextrin prescription

Davies, Simon; Brown, Edwina A.; Frandsen, Niels Erik; Rodrigues, Anabela; Rodríguez‐Carmona, Ana; Vychytil, Andreas; MacNamara, E.; Ekstrand, Agneta; Tranæus, Anders; Filho, José C. Divino

doi:10.1111/j.1523-1755.2005.00243.x

Cited by 161 publications

(126 citation statements)

References 22 publications

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“…Although spontaneous bacterial peritonitis cannot be ruled out, the cell counts in each of these rats was low (mean 71 cells/mm 3 ) and the positive cultures were likely the result of accidental bowel perforation at the intraperitoneal injection, just before the transport experiments. A relatively low cell count was also observed for nearly half of the rats that received a needle injection (NI) and whose culture was positive.…”

Section: Bacterial Cultures and Cell Counts After Injection Periodmentioning

confidence: 94%

“…2 Exposure of patients to glucose-based dialysis solutions resulted in significant functional changes in transperitoneal transport in a 2-yr study of patients who were treated with automated PD. 3 Studies in animal models parallel these changes and have demonstrated benefit of solutions that are thought to be more biocompatible. 4 -6 Studies in our laboratory using an animal model with a subcutaneous injection port connected to a silicone catheter tunneled to the cavity demonstrated angiogenesis and thickening of the perito-neum after 8 wk of daily exposure to sterile solutions.…”

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confidence: 99%

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Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Flessner

Credit²,

Henderson³

et al. 2007

Journal of the American Society of Nephrology

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Most current animal models that are used to study effects of long-term peritoneal exposure to dialysis solutions use an indwelling catheter for daily injections. It was hypothesized that the presence of a foreign body in the peritoneal cavity (PC) might alter the inflammatory response to the solutions and that the response would depend on exposure duration. For addressing these, long-term injections were carried out for 2 to 8 wk in 90 Sprague-Dawley rats: 40 via a subcutaneous port connected to a silicone catheter tunneled to the PC, 40 via direct needle injection, and 10 noninjected, age-control rats. Daily volumes were 30 to 40 ml of filter-sterilized, bicarbonate-buffered solutions that contained 4% dextrose. After 2, 4, 6, and 8 wk, anesthetized rats underwent transport experiments with a chamber affixed to the abdominal wall to determine mass transfer coefficients of mannitol (MTC mannitol ) and albumin (MTC BSA ), osmotic filtration flux (J osm ), and hydrostatic pressure-driven flux. After the rats were killed, tissues were collected for measurement of peritoneal thickness, vascular density, and immunohistochemical staining. ANOVA demonstrated significant (P Ͻ 0.01) differences in thickness, vessel density, MTC mannitol , and MTC BSA among the groups at the various time intervals and in overall means. Differences among the groups were less pronounced for hydrostatic pressure-driven flux and J osm . Vessel density, MTC mannitol , MTC BSA , and J osm were dependent on injection duration (P Ͻ 0.01). There were marked differences between the needle injection and catheter injection groups at various intervals in the expression of three cytokines. It is concluded that the histologic and functional response depends on the duration of injection with animals that are exposed for as little as 2 wk demonstrating alterations. These findings confirm the hypothesis that the presence of a PC catheter increases inflammatory response to sterile solutions as evidenced by the structural and functional changes in the peritoneal barrier. 18: 229418: -230218: , 200718: . doi: 10.1681 Exposure of the peritoneum to sterile solutions that contain glucose results in changes in cellular characteristics, histology, and barrier function. Long-term peritoneal dialysis (PD) without evidence of peritonitis alters the phenotypic appearance of the human peritoneum in 8 to 12 mo. 1 Biopsy studies of longterm (Ͼ3 yr) PD patients have demonstrated marked thickening over time of the subcompact zone, a region between the mesothelial cells and their basement membrane, with corresponding changes in the underlying microvasculature. 2 Exposure of patients to glucose-based dialysis solutions resulted in significant functional changes in transperitoneal transport in a 2-yr study of patients who were treated with automated PD. 3 Studies in animal models parallel these changes and have demonstrated benefit of solutions that are thought to be more biocompatible. 4 -6 Studies in our laboratory using an animal model with a subcutaneous inj...

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Section: Bacterial Cultures and Cell Counts After Injection Periodmentioning

confidence: 94%

mentioning

confidence: 99%

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Flessner

Credit²,

Henderson³

et al. 2007

Journal of the American Society of Nephrology

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“…Impaired ultrafiltration severe enough to require cessation of PD occurs in about 10% of cases [22], which then requires referral to alternative renalreplacement therapy. Long-term PD for more than 2 years, repeated peritonitis, exposure to glucose in PD solution, diabetes, and beta-blockers contribute to these phenomena [23,24]. Therefore, detecting time-dependent functional and structural changes of the PM is important to sustain PM function in the long term, and to plan any referral to alternative renal-replacement therapy.…”

Section: Discussionmentioning

confidence: 99%

In Vivo Measurement of Site-Specific Peritoneal Solute Transport Using a Fiber-Optic-based Fluorescence Photobleaching Technique

Lee¹,

Kim²,

Shin³

et al. 2015

Journal of the Optical Society of Korea

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Fluorescence recovery after photobleaching (FRAP) is a well-established method commonly used to measure the diffusion of fluorescent solutes and biomolecules in living cells or tissues. Here a fiber-optic-based FRAP (f-FRAP) system was developed, and validated using macromolecules in water and agarose gels of different concentrations. We applied f-FRAP to measure the site-specific diffusion of fluorescein (NaFluo) in peritoneal membranes (PMs) on the liver, cecum, and kidney of a living rat during peritoneal dialysis. Diffusion of fluorescein in PM varied in a time-dependent manner according to the type of organ (DPM on Liver/DNaFluo = 0.199 ± 0.085, DPM on Cecum/DNaFluo = 0.292 ± 0.151, DPM on Kidney/DNaFluo = 0.218 ± 0.110). The proposed method allows direct quantitative measurement of the three-dimensional diffusion in local PM in vivo, which was previously inaccessible by peritoneal function test methods such as peritoneal equilibration test (PET) and standardized PM assessment (SPA). f-FRAP is promising for local and dynamic assessments of peritoneal pathophysiology and the mass transport properties of PMs, presumed to be affected by variation of tissue structures over different organs and functional changes of the PM with years of peritoneal dialysis.

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“…Icodextrin use may be associated with preservation of PM function. In EAPOS (55), longitudinal changes in membrane function were least apparent in the patients using icodextrin from the start of PD. Patients using icodextrin had no change in UF capacity whereas patients using 2.27% or 3.86% dextrose had a significant decrease in UF capacity at 2 years.…”

Section: Dialysis Fluids and Pm Integritymentioning

confidence: 92%

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Kendrick

Teitelbaum

2010

Clinical Journal of the American Society of Nephrology

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The incidence and prevalence of ESRD in the United States continues to increase. Currently there are over 26,000 patients maintained on peritoneal dialysis. Mortality rates have fallen over the past several years, but long-term survival remains poor, with only 11% of peritoneal dialysis patients surviving past 10 years. Cardiovascular disease accounts for most deaths, and dialysis patients have many traditional and nontraditional cardiovascular risk factors. Lowering of these risk factors has not resulted in reduced cardiovascular morbidity and mortality in dialysis patients. Maneuvers to improve long-term peritoneal dialysis patient survival must therefore focus on modifiable risk factors including residual renal function, peritoneal membrane integrity, rate of infections, and peritoneal dialysis center size. This article reviews strategies for preserving residual renal function and peritoneal membrane integrity as well as strategies for reducing the rate of infections to enhance long-term survival in peritoneal dialysis patients.Clin J Am Soc Nephrol 5: 1123-1131, 2010. doi: 10.2215/CJN.04300709T he incidence and prevalence of ESRD continues to increase worldwide. In the United States alone there are over 480,000 patients on dialysis and the number of incident dialysis patients each year exceeds 100,000 (1). Peritoneal dialysis (PD) is an established treatment modality for patients with ESRD. Currently, 26,082 patients are maintained on PD in the United States (1). Mortality rates in ESRD patients have declined significantly over the past 20 years, but longterm survival remains poor, with the overall survival for all dialysis patients [hemodialysis (HD) and PD] being only 11%. These data were not censored for modality change, the effect of which is difficult to gauge. On a proportional basis, a greater percentage of PD than HD patients switch modality; however, in absolute numbers, more HD patients transition to PD than the reverse. Nevertheless, the overall adjusted probability of survival in incident PD patients at 1 year is 86.8%, but only 11.3% at 10 years (1). The reason for this dramatic decrease in patient survival over time is multifactorial and depends on several patient and dialysis center factors.There are several patient factors that affect survival on PD, most of which are nonmodifiable. Age, presence of diabetes, ESRD etiology, and ESRD vintage are all independent predictors of patient survival (2). For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001]. Patients with diabetes have a 30% increased risk of death compared with nondiabetic patients, and dialysis-naive patients have a 28% decreased risk of death compared with patients transferred from HD (2). Cardiovascular disease (CVD) accounts for most deaths in dialysis patients (approximately 50%). The genetics of the patient may be another nonmodifiable determinant of CVD. For example, a recent study of 1200 HD patients found an increased risk of CVD in patients with a specific complemen...

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Longitudinal membrane function in functionally anuric patients treated with APD: Data from EAPOS on the effects of glucose and icodextrin prescription

Cited by 161 publications

References 22 publications

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

Peritoneal Changes after Exposure to Sterile Solutions by Catheter

In Vivo Measurement of Site-Specific Peritoneal Solute Transport Using a Fiber-Optic-based Fluorescence Photobleaching Technique

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

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