Ultrafiltration Failure in Continuous Ambulatory Peritoneal Dialysis

Krediet, Raymond T.; Imholz, Alexander L.T.; Struijk, Dirk G.; Koomen, G. C. M.; Arisz, L.

doi:10.1177/089686089301302s15

Cited by 44 publications

(15 citation statements)

References 55 publications

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“…Krediet et al investigated the association of SP and changes in dialytic efficiency in a series of studies (6,9,(227)(228)(229)(230)(231). SP was found to be accompanied by an increase in the mass transfer area coefficient of creatinine, a measure of peritoneal vascular surface area, and a decrease in ultrafiltration with solutions containing 1.36% glucose.…”

Section: Sclerosing Peritonitismentioning

confidence: 99%

Peritoneal Sclerosis: One or Two Nosological Entities?

Garosi

Paolo

2000

Seminars in Dialysis

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The frequency, pathology, animal models, pathogenesis, clinical manifestations, diagnostic criteria, therapy and prevention of peritoneal sclerosis are reviewed. Many of these aspects have a bimodal configuration which suggests that peritoneal sclerosis, usually considered a single pathology in peritoneal dialysis, is actually two distinct nosological entities: simple sclerosis and sclerosing peritonitis. The former is very frequent, with minor anatomical alterations and low clinical impact; it is reproducible in animals by means of peritoneal dialysis, and is clearly due to the poor biocompatibility of peritoneal dialysis solutions. The latter is rare, with radical anatomical alterations and high mortality requiring valid methods of diagnosis, therapy and prevention; it can only be reproduced in animal models by means other than peritoneal dialysis and seems to be due to factors both related and unrelated to peritoneal dialysis.

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Section: Sclerosing Peritonitismentioning

confidence: 99%

Peritoneal Sclerosis: One or Two Nosological Entities?

Garosi

Paolo

2000

Seminars in Dialysis

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“…The relationship between reduced survival on PD and high transport status may relate to properties of the peritoneal membrane that predispose to the development of conditions associated with a poor prognosis. This is more common in high transporters [21], as rapid solute transport leads to early dissipation of the osmotic gradient for fluid removal [22] hence, reduced drain volumes [5], left ventricular hypertrophy and hypertension are more common in high transporters [23], and are both interrelated with intravascular volume overload [24,25]. We found that high transporters had lower amounts of daily urine volume and ultrafiltration volume even though there was no statistical significance.…”

Section: Discussionmentioning

confidence: 78%

Effect of Initial PET Status on Clinical Course in Peritoneal Dialysis Patients

et al. 2015

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Introduction. To investigate the effect on mortality of initial peritoneal equilibration test (PET) in PD patients (pts). Methods. We included patients who initiated therapy between 2001-2014. Patients underwent initial PET in the first three months. They were divided into four groups according to the initial PET (high, high-average, lowaverage, low transport). Sociodemographic data, clinical courses and infectious complications between groups were compared, and the reasons for PD withdrawal were obtained. Technique survival analyses of patients were done. Results. In a total of 367 pts were PD was started, 104 pts were excluded. Data of the remaining 263 patients were evaluated. Thirty-seven pts (23F, mean age 44.6±16.5 years, mean follow-up 30.5±20.8 months) had high transport, 90 pts (49F, mean age 41.5±16 years, mean followup 42.6±27.7 months) had high-average transport, 91 pts (55F, mean age 44.5±14.9 years, mean follow-up 50±29.2 months) had low-average transport and 45 pts (17F, mean age 43.5±14 years, mean follow-up (63.4±34.5 months) had low transport. There was no difference between groups in terms of age, gender, body mass index, initial daily urine and ultrafiltration volume, initial albumin levels, presence of diabetes mellitus (p>0.05). Peritonitis and catheter exit-site/tunnel infection attacks were higher in patients with high transport (p=0.01 and 0.008, respectively). There was a difference between groups with respect to the last status of patients (p< 0.009). The major causes of deaths were peritonitis and/or sepsis and cardiovascular causes in all patients. The mortality and technique survival rate was found higher in patients with high transport (log rank: 0.004 and 0.027, respectively). Age (OR:1.045, p<0.001), initial albumin (OR: 0.482, p= 0.007), daily urine volume (OR: 1.045, p<0.001) and presence of catheter exit-site/tunnel infection (OR: 0.249, p<0.001) were found to predict patient survival. Only presence of catheter exit-site/tunnel infection (OR: 0.452, p=0.013) were found to predict patient survival. Conclusions. Initial PET has effects on PD patient survival; patients with high transport have the worst survival and frequent infectious complications.

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“…Comparison of the osmotic effects of a 1.36% glucose with a 3.86% glucose dialysis solution in patients showed similar results as in the animals [ 13 , 14 ]. The obvious discrepancy between the very low reflection coefficients for glucose, found in experimental and clinical studies, led to the assumption that the vascular wall of peritoneal capillaries did not consist of small interendothelial pores and an occasional large pore only, but that there had to be an additional system of ultrasmall intracellular pores that would allow the transport of water, but not of solutes with radii exceeding 5 Ǻ [ 15 , 16 ], such as glucose which has a radius of ∼3 Ǻ.…”

Section: Mechanisms Of Fluid Transport and An Assessment In Patientsmentioning

confidence: 69%

Peritoneal dialysis: from bench to bedside

Krediet

2013

Clinical Kidney Journal

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Peritoneal dialysis was first employed in patients with acute renal failure in the 1940s and since the 1960s for those with end-stage renal disease. Its popularity increased enormously after the introduction of continuous ambulatory peritoneal dialysis in the end of 1970s. This stimulated both clinical and basic research. In an ideal situation, this should lead to cross-fertilization between the two. The present review describes two examples of interactions: one where it worked out very well and another where basic science missed the link with clinical findings. Those on fluid transport are examples of how old physiological findings on absorption of saline and glucose solutions were adopted in peritoneal dialysis by the use of glucose as an osmotic agent. The mechanism behind this in patients was first solved mathematically by the assumption of ultrasmall intracellular pores allowing water transport only. At the same time, basic science discovered the water channel aquaporin-1 (AQP-1), and a few years later, studies in transgenic mice confirmed that AQP-1 was the ultrasmall pore. In clinical medicine, this led to its assessment in patients and the notion of its impairment. Drugs for treatment have been developed. Research on biocompatibility is not a success story. Basic science has focussed on dialysis solutions with a low pH and lactate, and effects of glucose degradation products, although the first is irrelevant in patients and effects of continuous exposure to high glucose concentrations were largely neglected. Industry believed the bench more than the bedside, resulting in ‘biocompatible’ dialysis solutions. These solutions have some beneficial effects, but are evidently not the final answer.

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Ultrafiltration Failure in Continuous Ambulatory Peritoneal Dialysis

Cited by 44 publications

References 55 publications

Peritoneal Sclerosis: One or Two Nosological Entities?

Peritoneal Sclerosis: One or Two Nosological Entities?

Effect of Initial PET Status on Clinical Course in Peritoneal Dialysis Patients

Peritoneal dialysis: from bench to bedside

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