Peritoneal Dialysis Today: A New Look

Tenckhoff, H

doi:10.1159/000180354

Cited by 59 publications

(17 citation statements)

References 18 publications

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“…With interest in the use of long term. maintenance peritoneal dialysis [18][19][20] and the application of this method of treatment to patients with end-stage diabetic nephropathy [1][2][3][4][5][6], a method for preven tion and management of hyperglycemia during dialysis is desirable. Supplemental doses of subcutaneous insulin can be given, but this procedure has several disadvantages: first, wide variations in plasma glucose may occur.…”

Section: Discussionmentioning

confidence: 99%

Absorption and Action of Insulin Added to Peritoneal Dialysate in Dogs

Shapiro¹,

Blumenkrantz²,

Levin³

et al. 1979

Nephron

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The transperitoneal kinetics of insulin transfer during peritoneal dialysis and its biologic effects were evaluated in dogs. Changes in plasma glucose and immunoreactive insulin (iRI) during dialysis with 10, 30, and 120 U insulin/ liter of dialysate and during intravenous infusions of insulin at 0.5 or 1.5 U/h, and the recovery of ¹²⁵I-insulin added to dialysate were measured. As insulin was increased via the intravenous or the intraperitoneal route, there was a greater fall in plasma glucose and a greater rise in plasma iRI. With intravenous insulin, plasma iRI rose and plateaued within 30 min, with a relatively predictable fall in plasma glucose. With intraperitoneal insulin, plasma iRI rose more slowly, plateaued at 3 h with 10 and 30 insulin/liter dialysate but continued to rise over 5 h with 120 U insulin/liter dialysate. From the observed relationship between dose of intravenous insulin and fall in plasma glucose, the quantities of intraperitoneal insulin absorbed and active were estimated. The percentages of intraperitoneal insulin absorbed, derived from fall in plasma glucose and from loss of ¹²⁵I-insulin in dialysate, were 6.1 and 25 ± 5%, respectively. The greater loss of intraperitoneal ¹²⁵I-insulin may be explained by its mesenteric binding; subsequent release could account for the slow rise of iRI. Intraperitoneal insulin has been proposed for management of hyperglycemia during peritoneal dialysis of diabetic patients. Present results suggest that intraperitoneal insulin should be used cautiously and in low concentrations because of possible cumulative effects.

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Section: Discussionmentioning

confidence: 99%

Absorption and Action of Insulin Added to Peritoneal Dialysate in Dogs

Shapiro¹,

Blumenkrantz²,

Levin³

et al. 1979

Nephron

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“…Acute renal failure is a serious and common complica tion in critically ill patients [1][2][3][4], Until recently, its treat ment has been based upon intermittent haemodialysis or peritoneal dialysis, despite their significant acknowledged shortcomings [5][6][7][8][9][10], The last decade has seen the intro duction of various forms of continuous renal replacement therapy. The first to be introduced, continuous arteriove nous haemofiltration, has been shown to be effective and well tolerated in many patients [I 1-15].…”

Section: Introductionmentioning

confidence: 99%

Use of Continuous Haemodiafiltration: An Approach to the Management of Acute Renal Failure in the Critically

et al. 1992

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We have prospectivly investigated the effect of a flexible approach to the management of acute renal failure in critically ill patients based on continuous haemodiafiltration (CHD). Fifty critically ill patients (mean APACHE II score 28.1, range 18-37), with a mean age of 59.5 years, were treated with continuous arteriovenous haemodiafiltration (CAVHD) and/or continuous venovenous haemodiafiltration (CWHD). CHD achieved excellent haemodynamic stability and control of azotaemia in all patients and permitted aggressive parenteral nutrition. The mean blood urea concentration fell from 33.9 mmol/l (95% confidence interval, CI, 29.1-38.7) to a plateau of 17 mmol/l (95% CI 14.3-19.7) after 72 h of therapy despite persistent anuria and the parenteral administration of 0.3g/kday of protein nitrogen (mean urea clearance: 24.2ml/min; 95% CI 22.9-25.5). No supplemental dialytic therapy was required during the 9,485 h of treatment. All clinically significant complications related to vascular access (14%). Twenty-two patients (44%) survived to be discharged from the ICU. CHD is relatively safe and effective in the management of acute renal failure in the critically ill.

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“…Peritoneal dialysis is now used extensively for the treat ment of acute and chronic renal failure [1,2]. Patients who live alone can easily perform dialysis independently without nursing assistance and this has given rise to an increased amount of peritoneal dialysis in ambulatory patients [3], Infection remains a major complication asso ciated with peritoneal dialysis [4][5][6], Although automated dialysis [3] equipment has produced a reduction in the incidence of peritonitis, the rate of infection remains as high as 1 every 10 patient-weeks of dialysis [7], Approxi mately 60% of the bacteria which cause these infections are gram-positive cocci, usually staphylococci, and the remaining 40% are enteric organisms or occasionally fungi [5,6].…”

Section: Introductionmentioning

confidence: 99%

Effect of Peritoneal Dialysis Solution on the Antimicrobial Activity of Cephalosporins

Appleby¹,

John²

1982

Nephron

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We studied the effect of peritoneal dialysis solution (PDS) on the antibacterial activity of seven cephalosporins, gentamicin, tobramycin and amikacin. The six bacterial species employed in the study survived in a wide range of concentrations of PDS, however, Staphylococcus aureus did not survive beyond 24 h in PDS. There were no physical incompatibilities between any of the antibiotics and PDS. None of the cephalosporins was bactericidal in PDS, whereas, the bactericidal concentrations of the aminoglycosides in PDS approximated those of aminoglycosides in broth. We conclude from these in vitro data that cephalosporins may not be ideal agents for intraperitoneal therapy when they are administered in PDS.

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Peritoneal Dialysis Today: A New Look

Cited by 59 publications

References 18 publications

Absorption and Action of Insulin Added to Peritoneal Dialysate in Dogs

Absorption and Action of Insulin Added to Peritoneal Dialysate in Dogs

Use of Continuous Haemodiafiltration: An Approach to the Management of Acute Renal Failure in the Critically

Effect of Peritoneal Dialysis Solution on the Antimicrobial Activity of Cephalosporins

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