Mixing Osmotic Agents – Two Different Approaches

Jenkins, Sarah; Wilkie, Martin

doi:10.1177/089686080702700306

Cited by 3 publications

(1 citation statement)

References 29 publications

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“…Indeed, without reducing fluid and sodium intake, a long dwell using 7.5% icodextrin may not achieve the required fluid and sodium balance in a number of anuric or fluid overloaded patients (5). Recently, two practical strategies designed to tackle the challenge of glucose exposure and UF management in APD were proposed: the first focused on reduction of peritoneal glucose load using commercially available amino acid or icodextrin PD solutions in combination with glucose-based PD solutions during overnight APD (6,7); the second was based on the previously investigated concept of a mixed crystalloid and colloid osmosis based on a bimodal solution obtained by mixing a small molecular component (glucose or amino acids) with a glucose polymer, represented by icodextrin, at formulations ranging from 2% to 7.5% during a long dwell exchange (8)(9)(10)(11).…”

Section: Demographicsmentioning

confidence: 99%

A Combined Crystalloid and Colloid PD Solution as a Glucose-Sparing Strategy for Volume Control in High-Transport APD Patients: A Prospective Multicenter Study

et al. 2009

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Background Evidence is accumulating that the continuous exposure to high glucose concentrations during peritoneal dialysis (PD) is an important cause of ultrafiltration (UF) failure. The cornerstone of prevention and treatment of UF failure is reduction of glucose exposure, which will also alleviate the systemic impact of significant free glucose absorption. The challenge for the future is to discover new therapeutic strategies to enhance fluid and sodium removal while diminishing glucose load and exposure using combinations of available osmotic agents. Objectives To investigate in patients on automated PD (APD) with a fast transport pattern whether there is a glucose-sparing advantage to replacing 7.5% icodextrin (ICO) during the long dwell with a mixed crystalloid and colloid PD fluid (bimodal UF) in an attempt to promote daytime UF and sodium removal while diminishing the glucose strength of the dialysate at night. Design A 2 parallel arm, 4 month, prospective nonrandomized study. Setting PD units or university hospitals in 4 French and Belgian districts. Results During the 4-month intervention period, net UF and peritoneal sodium removal during the long dwell when treated by bimodal UF was about 2-fold higher than baseline (with ICO). The estimated percent change (95% confidence interval) from baseline in net daytime UF for the bimodal solution was 150% (106% – 193%), versus 18% (–7% – 43%) for ICO ( p < 0.001). The estimated percent change from baseline in peritoneal sodium removal for the bimodal solution was 147% (112% – 183%), versus 23% (–2% – 48%) for ICO ( p < 0.001). The estimated percent change from baseline in UF efficiency (24-hour net UF divided by the amount of glucose absorbed) was significantly higher ( p < 0.001) when using the bimodal solution was 71%, versus -5% for ICO. Conclusion Prescription of bimodal UF during the day in APD patients offers the opportunity to optimize the long dwell exchange in a complete 24-hour APD cycle. The current study demonstrated that a bimodal solution based on the mixing of glucose (2.6%) and icodextrin (6.8%) achieved the double target of significantly improving UF and peritoneal sodium removal by exploring a new concept of glucose-sparing PD therapy.

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Section: Demographicsmentioning

confidence: 99%

A Combined Crystalloid and Colloid PD Solution as a Glucose-Sparing Strategy for Volume Control in High-Transport APD Patients: A Prospective Multicenter Study

et al. 2009

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The contribution of combined crystalloid and colloid osmosis to fluid and sodium management in peritoneal dialysis

Freida¹,

Wilkie

Jenkins

et al. 2008

Kidney International

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The achievement of euvolemia is essential to the successful management of peritoneal dialysis patients. However, the concern that hypertonic glucose exchanges may have a role in long-term changes to the peritoneal membrane has lead to an alternative strategy to enhance ultrafiltration (UF) over the long dwell by combining crystalloid and colloid osmosis. This review summarizes the experience of mixing glucose or amino acids with polyglucose (icodextrin), with particular focus given to data from studies using glucose/icodextrin in combinations of 1.36%/7.5% and 2.61%/6.8%. Both combinations demonstrate a significant increment of UF volume and sodium removal compared with the component osmotic agents used individually over long dwells, with the 2.61%/6.8% mixture having an effect over dwells extending to 15 h. Hypothetically, the mechanism of the enhanced UF is the attenuation by the colloid osmotic force of the backflow of water through small pores from dialysate to the peritoneal capillary circulation once the crystalloid osmotic force has dissipated. This experience provides promising data that deserves further examination in longer term clinical studies.

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Prediction of Appendicular Skeletal and Fat Mass in Children: Excellent Concordance of Dual-energy X-ray Absorptiometry and Magnetic Resonance Imaging

Bridge

Pocock²,

Nguyen³

et al. 2009

Journal of Pediatric Endocrinology and Metabolism

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Mixing Osmotic Agents – Two Different Approaches

Cited by 3 publications

References 29 publications

A Combined Crystalloid and Colloid PD Solution as a Glucose-Sparing Strategy for Volume Control in High-Transport APD Patients: A Prospective Multicenter Study

A Combined Crystalloid and Colloid PD Solution as a Glucose-Sparing Strategy for Volume Control in High-Transport APD Patients: A Prospective Multicenter Study

The contribution of combined crystalloid and colloid osmosis to fluid and sodium management in peritoneal dialysis

Prediction of Appendicular Skeletal and Fat Mass in Children: Excellent Concordance of Dual-energy X-ray Absorptiometry and Magnetic Resonance Imaging

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