Peritoneal-Membrane Characteristics and Hypervolemia Management in Peritoneal Dialysis: A Randomized Control Trial

Abstract

Excessive bodily-fluid retention is the major cause of hypertension and congestive heart failure in patients with end-stage renal disease. Compared to hemodialysis, peritoneal dialysis (PD) uses the abdominal peritoneum as a semipermeable dialysis membrane, providing continuous therapy as natural kidneys, and having fewer hemodynamic changes. One major challenge of PD treatment is to determine the dry weight, especially considering that the speed of small solutes and fluid across the peritoneal membrane varies among individuals; considerable between-patient variability is expected in both solute transportation and ultrafiltration capacity. This study explores the influence of peritoneal-membrane characteristics in the hydration status in patients on PD. A randomized control trial compares the bioimpedance-assessed dry weight with clinical judgment alone. A high peritoneal membrane D/P ratio was associated with the extracellular/total body water ratio, dialysate protein loss, and poor nutritional status in patients on PD. After a six-month intervention, patients with monthly bioimpedance analysis (BIA) assistance had better fluid (−1.2 ± 0.4 vs. 0.1 ± 0.4 kg, p = 0.014) and blood-pressure (124.7 ± 2.7 vs. 136.8 ± 2.8 mmHg, p < 0.001) control; however, hydration status and blood pressure returned to the baseline after we prolonged BIA assistance to a 3-month interval. The dry-weight reduction process had no negative effect on residual renal function or peritoneal-membrane function. We concluded that peritoneal-membrane characteristics affect fluid and nutritional status in patients on PD, and BIA is a helpful objective technique for fluid assessment for PD.

Beyond prevalence: significance and differential impact of echocardiographic abnormalities in dialysis patients

“…There is concern that removing too much fluid may result in residual renal function loss in PD [32]. However, it is worth mentioning that with cautious ultrafiltration, or by using objective measurements like bioimpedance, PD patients can reach their desired dry weight and blood pressure without compromising residual kidney function [33,34].…”

Glycosylation and Characterization of Human Transferrin in an End-Stage Kidney Disease

“…Substitution was carried out by administering heme and nonheme Fe orally, considering that PD is a form of home treatment [24,25]. Given that the level of Fe absorption in the duodenum is affected by the various drugs that this group of patients takes (proton pump inhibitors, phosphate binders), as well as the edema of the intestinal mucosa due to hypervolemia [26], it is necessary to maintain the patients' dry body weight, which was fulfilled in our group; the patients were euvolemic, and according to the parameters of dialysis, they underwent a competent method of KRT, which corresponds to the literature data [27,28].…”