Nutritional effects of increasing dialysis dose by adding an icodextrin daytime dwell to Nocturnal Intermittent Peritoneal Dialysis (NIPD) in children

Hoeck, Koen J. M. Van; Rusthoven, Esther; Vermeylen, Linda; Vandesompel, Annemie; Marescau, Bart; Lilien, Marc R.; Schröder, Cornelis H.

doi:10.1093/ndt/gfg120

Cited by 31 publications

(18 citation statements)

References 19 publications

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“…In our experience, as well as that expressed in other communications [15,22,24,26], children tend to show a greater Kt/V and nPNA than the adult dialyzed population, an expected result because of the higher protein requirements in young patients secondary to growth along with a greater loss of albumin in dialysate [22,25,27]. Schaefer et al [22] showed that serum albumin appeared to be mainly determined by peritoneal losses in dialyzed children, and both the time-averaged mean albumin concentrations and the relative change in serum albumin during the observation period were negatively correlated with mean daily albumin loss in that study.…”

Section: Discussionsupporting

confidence: 86%

“…Davis et al [23] analyzed the net effect of increasing the dialysis dose to malnourished adult dialyzed patients, increasing the peritoneal Kt/Vurea 22.5%, without reaching any increase in protein intake, as judged by dietetic interview or protein nitrogen appearance. Van Hoeck et al [24] examined the nutritional effects of increasing the dialysis dose in eight children on peritoneal dialysis, without confirming any impact on daily protein or caloric intake.…”

Section: Discussionmentioning

confidence: 99%

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Kt/V and nPNA in pediatric peritoneal dialysis: a clinical or a mathematical association?

et al. 2005

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The relationship between dialysis dose and nutrition is a field of particular interest in chronic pediatric dialysis (PD), and a positive correlation between ureaKt/V and nPNA has been published, suggesting a better nutritional status is associated with higher dialysis doses. However, this relationship has also been criticized as being the result of a mathematical coupling resulting from the same variables. The objective of the study was to establish the relationship between dialysis dose (Kt/V) and nutritional variables: daily protein intake (DPI), protein catabolic rate (PCR), protein equivalent of total nitrogen appearance (PNA) and nitrogen balance (NB) in dialyzed children. A cohort, prospective, observational study was carried out, for which 223 biochemical measurements were performed in 20 patients, ages 1 month to 14.3 years old (13 males), under PD for a 12-month period of follow-up. Monthly residual and total ureaKt/V, DPI, PCR, nPNA and NB were calculated, and the correlation between Kt/V and the nutritional parameters was evaluated. The Borah equation was used to calculate the nPNA. The data are reported as the mean plus or minus the standard error. All statistical comparisons were done with a paired t test, and two-way ANOVA for repeated measures was used to calculate correlations. A P <0.05 was considered significant. Mean total and residual Kt/V was 3.4+/-1.3 and 1.69+/-1.27, respectively; nPNA and PCR were 1.38+/-0.44 and 1.39+/-0.43 g/kg/day, daily protein intake (DPI) was 3.25+/-1.27 g/kg/day, and NB showed a value of 1.86+/-1.25 g/kg/day. A significant positive correlation was found between Kt/V and DPI, PCR, DPC and nPNA (all values P <0.0001), but no correlation was found between total and residual Kt/V vs. nitrogen balance ( P:ns). Total Kt/V showed a significant positive correlation with nPNA, but it did not show any correlation with nitrogen balance, suggesting that the relationship with nPNA is the result of a mathematical association calculated from the same variables.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Kt/V and nPNA in pediatric peritoneal dialysis: a clinical or a mathematical association?

et al. 2005

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“…In a randomized study of 50 PD patients receiving either 2.27% glucose or icodextrin for a long exchange, there was no differences observed in inflammatory markers, with the exception of plasma albumin at baseline on univariate analysis (r ϭ Ϫ0.39; P ϭ 0.007), which disappeared on multivariate analysis (58). One-week use of icodextrin in eight children on nocturnal intermittent PD when switched to APD led to loss of essential and nonessential AAs in the dialysate without affecting serum albumin or AA levels (59). This loss could be due to the extra AA loss caused by adding a daytime exchange, however the serum albumin levels stayed the same.…”

Section: Icodextrin Pd Solutionmentioning

confidence: 86%

Biocompatible Peritoneal Dialysis Solutions

Chaudhary

Khanna

2010

Clinical Journal of the American Society of Nephrology

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Clinical experience and literature evidence suggest that peritoneal dialysis (PD) is a safe and effective treatment in short term (3 to 5 years) for stage 5 chronic kidney disease patients. A major limitation to long-term PD has been peritoneal membrane structural and functional alterations over time, resulting in significant technique failure. Much evidence implicates glucose contained in conventional PD solutions as the major cause of membrane changes. Other harmful characteristics of glucose or its degradation products are thought to cause systemic undesirable metabolic and cardiovascular effects. This led to the search for more "biocompatible" PD solutions to ameliorate complications associated with conventional glucose solutions. Studies in animals and humans show that newer biocompatible solutions may preserve membrane functions better, lead to less therapy failure, and avoid the undesirable metabolic and cardiovascular effects of systemic glucose exposure. There is evidence in specific, clinical, short-term situations of biochemical and metabolic benefits of biocompatible solutions. However, are these solutions superior to glucose in preserving peritoneal membrane long term? Are they truly more biocompatible? Clinical and experimental data suggest that newer solutions, albeit most of them glucose based, are less toxic compared with the current PD solution; however, there is currently no osmotic agent that can safely replace glucose. The future appears to be in using combinations of different osmotic agents in a more biocompatible solution, whether they are mixtures in a single bag or daily exchanges of different osmotic agents. This review discusses the current status of these biocompatible solutions in PD patients.Clin J Am Soc Nephrol 5: 723-732, 2010. doi: 10.2215/CJN.05720809 P eritoneal dialysis (PD) has been an accepted form of renal replacement therapy (RRT) for end-stage renal disease patients (1). Conventional PD solutions contain dextrose as the osmotic agent. Absorbed glucose is metabolized and is used as a source of energy. However, long-term systemic exposure of glucose has been well recognized to cause metabolic and cardiovascular abnormalities, which contribute to some of the morbidities seen in PD patients. PD solutions have a shelf life, and the glucose over time degrades to form glucose degradation products (GDPs), which have been implicated in a variety of adverse effects on the peritoneal membrane, in addition to the well known other systemic effects. Several studies both in vivo and in vitro have shown that conventional solutions damage the mesothelial cells lining the peritoneum, cause peritoneal membrane thickening, and lead to changes of the peritoneal blood vessels (2,3). The dextrose-based solutions have been shown to cause structural as well as functional changes in the peritoneal membrane, which in long-term patients ultimately leads to ultrafiltration failure and discontinuation of PD (4,5). The glucose-based solutions do not contain bicarbonate, which is substituted with the ...

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“…Limited information is available on the use of Icodextrin in children [5,7]. Net UF has been reported as positive in all patients [5].…”

Section: Discussionmentioning

confidence: 99%

Icodextrin re-absorption varies with age in children on automated peritoneal dialysis

et al. 2005

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Information on the use of Icodextrin in children remains scarce; however, it is believed that the characteristics are similar across all ages. We report the use of Icodextrin in a cohort of pediatric automated peritoneal dialysis (APD) patients younger than those previously reported (n=8, median age of 2.8, range 0.02-17.1 years). Net Icodextrin daytime dwell ultrafiltration was calculated in each patient for every day on therapy as ml/h/m2. Half of the patients showed re-absorption even when reducing Icodextrin dwells from a median of 10 to 6 h. All four patients who re-absorbed the Icodextrin (ranging from -23.7+/-7.5 to -2.5+/-6.0 ml/h/m2) were treated with cyclic nocturnal APD, and three of these four patients were high transporters on the peritoneal equilibration test (PET). Icodextrin fluid removal correlated significantly with age (Spearman rank r=0.8571, P=0.0107). The data suggest that Icodextrin behaves differently in young children.

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Nutritional effects of increasing dialysis dose by adding an icodextrin daytime dwell to Nocturnal Intermittent Peritoneal Dialysis (NIPD) in children

Cited by 31 publications

References 19 publications

Kt/V and nPNA in pediatric peritoneal dialysis: a clinical or a mathematical association?

Kt/V and nPNA in pediatric peritoneal dialysis: a clinical or a mathematical association?

Biocompatible Peritoneal Dialysis Solutions

Icodextrin re-absorption varies with age in children on automated peritoneal dialysis

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