scholarly journals Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis: A Longitudinal Study

2017 ◽  
Vol 46 (1) ◽  
pp. 47-54 ◽  
Author(s):  
Ana Fernandes ◽  
Roi Ribera-Sanchez ◽  
Ana Rodríguez-Carmona ◽  
Antía López-Iglesias ◽  
Natacha Leite-Costa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water ◽  
Volume Overload ◽  
Diabetic Patients ◽  
Longitudinal Analyses ◽  
Cross Sectional ◽  
Sodium Removal ◽  
Essential Stability ◽  
Stability Of Water

Background: Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently. Method: Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes. Main Results: We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics. Conclusions: Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.

scholarly journals Customization of Peritoneal Dialysis in Cardiorenal Syndrome by Optimization of Sodium Extraction

2019 ◽  
Vol 9 (2) ◽  
pp. 117-124 ◽  
Author(s):  
Amir Kazory ◽  
Abhilash Koratala ◽  
Claudio Ronco
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Population ◽  
Therapeutic Option ◽  
Free Water ◽  
Volume Overload ◽  
Cardiorenal Syndrome ◽  
Waste Products ◽  
Specific Patient ◽  
Fluid Removal ◽  
Sodium Removal

Background: Peritoneal dialysis (PD) has emerged as a mechanistically relevant therapeutic option for patients with heart failure (HF), volume overload, and varying degrees of renal dysfunction (i.e., chronic cardiorenal syndrome). Congestion has been identified as a potent ominous prognostic factor in this patient population, outperforming a number of established risk factors. As such, excess fluid removal is recognized as a relevant therapeutic target in this setting. Methods: Accumulating evidence points to the importance of sodium removal as part of any decongestive strategy because extraction of sodium-free water has little or no impact on the outcomes of these patients. Hence, optimization of sodium removal by PD should be the primary focus in the setting of HF and cardiorenal syndrome, especially if PD is started when the patient still has adequate residual renal function for clearance of waste products. Results: Herein, we provide an overview of approaches that can tailor PD treatment to the patients’ characteristics and clinical needs (e.g., choice of PD modality) to fully exploit its decongestive properties. Other methods that could prove helpful in the future will also be briefly discussed. Conclusion: While these strategies could help with efficient sodium extraction and volume optimization, future studies are needed to evaluate their impact on the outcomes of this specific patient population.

scholarly journals SGLT2 inhibition does not reduce glucose absorption during experimental peritoneal dialysis

2021 ◽  
pp. 089686082110080
Author(s):  
Giedre Martus ◽  
Karin Bergling ◽  
Javier de Arteaga ◽  
Carl M Öberg
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water ◽  
Glucose Absorption ◽  
Solute Diffusion ◽  
Recent Experimental Data ◽  
Diabetic Patients ◽  
Diffusion Capacity ◽  
Fill Volume ◽  
Sglt2 Inhibition

Introduction: Unwanted glucose absorption during peritoneal dialysis (PD) remains a clinical challenge, especially in diabetic patients. Recent experimental data indicated that inhibitors of the sodium and glucose co-transporter (SGLT)-2 could act to reduce glucose uptake during PD, which raises the question of whether glucose absorption may also occur via intracellular or trans-cellular pathways. Methods: We performed PD in anesthetized Sprague-Dawley rats using a fill volume of 20 mL with either 1.5% glucose fluid or 4.25% glucose fluid for 120 min dwell time to evaluate the effects of SGLT2 inhibition by empagliflozin on peritoneal water and solute transport. To assess the diffusion capacity of glucose, we developed a modified equation to measure small solute diffusion capacity, taking convective- and free water transport into account. Results: SGLT2 inhibition markedly increased the urinary excretion of glucose and lowered plasma glucose after PD compared to sham groups. Glucose absorption for 1.5% glucose was 165 mg 95% CI (145–178) in sham animals and 157 mg 95% CI (137–172) for empagliflozin-treated animals. For 4.25% glucose, absorption of glucose was 474 mg 95% CI (425–494) and 472 mg 95% CI (420–506) for sham and empagliflozin groups, respectively. No significant changes in the transport of sodium or water across the peritoneal barrier could be detected. Conclusion: We could not confirm recent findings that SGLT2 inhibition reduced glucose absorption and increased osmotic water transport during experimental PD.

MO711COMPARISON OF PERITONEAL DIALYSIS EFFICACY MARKERS IN DIABETIC AND NON-DIABETIC PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
João Carvão ◽  
Adriana Paixão Fernandes ◽  
Rita Veríssimo ◽  
Rita Calça ◽  
Ana Rita Martins ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Cardiac Dysfunction ◽  
Fluid Overload ◽  
Volume Overload ◽  
Cross Sectional Study ◽  
Hydration Status ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Lv Mass ◽  
End Stage

Abstract Background and Aims Diabetes mellitus (DM) is the leading cause of end-stage kidney disease. Peritoneal dialysis (PD) is an effective and convenient modality of renal replacement therapy, however in diabetic patients, higher technique failure is feared. This cross sectional study aimed to investigate if diabetic patients are good candidates for peritoneal dialysis in terms of dialysis efficacy and volume overload management when compared with non-diabetic patients. Method We conducted a cross-sectional study including 60 patients with end-stage kidney disease currently in peritoneal dialysis. Echocardiography was performed using HDI 5000, allowing M-mode, two-dimensional measurement. Peritoneal equilibration test exam was used to evaluate transport rate and dialysis efficacy. A multifrequency bioimpedance (BIA) analyzer was used. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. Results A total of 60 patients completed evaluation. Overall, 60% (n=36) were males with a mean age of 55,8 ± 15,3 years, BMI 25.9 ± 3.9 kg/m2, 31,7% (n=19) had DM. Median PD vintage was 21 months, automated PD 30%, 8.3% (n=5) were anuric and 10% (n=6) were overhydrated. The median serum N-terminal pro b-type natriuretic peptide (NT-proBNP) level was 1071 pg/mL. Left ventricule (LV) mass index and LV ejection fraction were 129.0 ± 51.1 g/m2 and 62.8 ± 13.0%, respectively. The median excess volume overload was 0.9L. Patients were divided in 2 groups (diabetic and non-diabetic). No differences were found between the 2 groups in terms of time in PD, peritoneal transportation, dialysis efficacy, diuresis, hemoglobin, albumin, normalized protein catabolic rate, hydration status, weight, body mass index, arterial hypertension, chronic heart failure, LV ejection fraction, LV mass index, CA-125 value, clinical signs of fluid overload, systolic and diastolic blood pressure. However, diabetic patients were younger (51,6 versus 58,0; p=0,02), more likely to have peripheral arterial disease (42,1 versus 7,3%, p=0,03), ischemic heart disease (52,6 versus 7,3%, p<0,001) and had higher levels of NT-proBNP (5932 versus 4216 pg/mL, p=0.04). However, when using a multivariable analysis, in a model adjusted to age, residual dialysis, efficacy of dialysis, diabetic patients did not have a significant difference in volume overload, dialysis efficacy and markers of cardiac dysfunction when compared with non-diabetic patients. Conclusion In this population, diabetes was associated with higher levels of NT-proBNP, however it did not translate in higher fluid overload, lower dialysis efficacy or worst cardiac dysfunction, when compared with non-diabetic patients. We conclude that PD is able to control hydration status, dialysis efficacy and cardiac dysfunction in diabetic patients with similar efficiency as in non-diabetic patients.

Validation by Computer Simulation of Two Indirect Methods for Quantification of Free Water Transport in Peritoneal Dialysis

2005 ◽  
Vol 25 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Daniele Venturoli ◽  
Bengt Rippe
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water ◽  
Hydraulic Permeability ◽  
Nephrol Dial Transplant ◽  
Peritoneal Equilibration Test ◽  
Simple Method ◽  
Sodium Removal ◽  
Relative Contribution ◽  
Small Pore

Background In peritoneal dialysis, approximately 40% of the total osmotic ultrafiltration (UF) induced by glucose can be predicted to be due to “free” water transport across aquaporin-1 (APQ-1). Theoretically, it would be possible to assess the fraction of free water transport in the early phase of a hypertonic dwell, when UF rate is high and the relative contribution of Na+ diffusion is low. La Milia et al. [La Milia V. et al. Fast-fast peritoneal equilibration test (FAST-FAST-PET): a simple method for peritoneal hydraulic permeability study [Abstract]. Nephrol Dial Transplant 2002; 17 (Suppl 1):17–18] suggested a technique to assess sodium-associated water transport based on sodium removal (Na+R) divided by the plasma Na+ concentration during a “fast-fast” (60 minute) peritoneal equilibration test (PET) for 3.86% glucose, yielding an estimate of the UF passing through the small pores (UFSP). Free water transport (UF through ultrasmall pores; UFUSP) was obtained by subtracting UFSP from total UF. Although peritoneal Na+ transport is almost totally convective, this technique will slightly overestimate small-pore UF due to the presence of some small-pore Na+ diffusion from the circulation during the dwell. A way of dealing with this problem was presented recently by Smit (Smit W. et al. Quantification of free water transport in peritoneal dialysis. Kidney Int 2004; 66:849–854). Methods In the present study we used the three-pore model of peritoneal transport to predict the degree of overestimation of UFSP for the technique presented by La Milia et al., and any potential deviations from theory for the technique presented by Smit et al. Simulations were performed under ordinary conditions and during simulated UF failure for 3.86% glucose. The fractional UF coefficient accounted for by APQ-1 was set at 2%. Results Estimating the UFSP from the sodium-associated water transport according to the method by La Milia et al. consistently overestimated UFSP and underestimated UFUSP. These errors were, however, minimal for dwells lasting between 30 and 80 minutes. The technique by Smit et al. to calculate aquaporin-mediated water flow (UFUSP), using an elaborate correction for Na+ diffusion from the circulation during the dwell, seemed accurate in most situations but, in general, tended to moderately overestimate UFUSP at early dwell times (<30 minutes) and underestimate UFUSP at long dwell times (4 hours). Conclusions The technique presented by La Milia et al. to calculate free water transport during a fast-fast PET was found to be surprisingly accurate, although the procedure would further improve by the introduction of a correction algorithm. The technique by Smit is even more accurate for dwells up to 4 hours’ duration. However, since the Smit technique is elaborate, it is less practical for routine determinations of aquaporin-mediated water transport in peritoneal dialysis.

scholarly journals Sodium removal in peritoneal dialysis: is there room for a new parameter in dialysis adequacy?

2019 ◽  
Vol 2 (3) ◽  
pp. 151-157
Author(s):  
Anna Lima ◽  
Joana Tavares ◽  
Nicole Pestana ◽  
Maria João Carvalho ◽  
António Cabrita ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Volume Overload ◽  
Residual Renal Function ◽  
Dialysis Adequacy ◽  
Sodium Removal ◽  
Low Sodium ◽  
Major Attention ◽  
New Strategies ◽  
Small Solute ◽  
Solute Clearance

In peritoneal dialysis (PD) (as well as in hemodialysis) small solute clearance measured as Kt/v urea has long been used as a surrogate of dialysis adequacy. A better urea clearance was initially thought to increase survival in dialysis patients (as shown in the CANUSA trial)(1), but  reanalysis of the data showed a superior contribution of residual renal function as a predictor of patient survival. Two randomized controlled trials (RCT)(2, 3)  supported this observation, demonstrating no survival benefit in patients with higher achieved Kt/v. Then guidelines were revised and a minimum Kt/v of 1,7/week was recommended but little emphasis was given to additional parameters of dialysis adequacy. As such, volume overload and sodium removal have gained major attention, since their optimization has been associated with decreased mortality in PD patients(4, 5). Inadequate sodium removal is associated with fluid overload which leads to ventricular hypertrophy and increased cardiovascular mortality(6). Individualized prescription is key for optimal sodium removal as there are differences between PD techniques (CAPD versus APD) and new strategies for sodium removal have emerged (low sodium solutions and adapted PD). In conclusion, future guidelines should address parameters associated with increased survival outcomes (sodium removal playing an important role) and abandon the current one fit all prescription model.

scholarly journals The cellular contribution to effluent potassium and its relation to free water transport during peritoneal dialysis

2007 ◽  
Vol 22 (12) ◽  
pp. 3593-3600 ◽  
Author(s):  
A. M. Coester ◽  
D. G. Struijk ◽  
W. Smit ◽  
D. R. de Waart ◽  
R. T. Krediet
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Free Water

Factors Contributing to Formation of Edema in Volume Overloaded Continuous Ambulatory Peritoneal Dialysis Patients

2011 ◽  
Vol 31 (2) ◽  
pp. 160-167 ◽  
Author(s):  
Wen Tang ◽  
Tian Xue ◽  
Xin-Hong Lu ◽  
Ya-Jun Luo ◽  
Tao Wang
Keyword(s):  
Peritoneal Dialysis ◽  
Endothelial Function ◽  
Serum Albumin ◽  
Volume Overload ◽  
Nutrition Status ◽  
Volume Control ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Significant Volume ◽  
Pitting Edema

BackgroundVolume control is critical for the success of peritoneal dialysis (PD) but dry weight in PD has been difficult to obtain. Edema free is, in general, accepted clinically as a target for volume control in PD patients. However, PD patients can be free of edema despite significant volume overload. The present study investigates the possible factors that influence the formation of pitting edema in volume-overloaded PD patients.MethodsIn this cross-sectional study, patients’ fluid status was evaluated by multifrequency bioelectrical impedance spectroscopy analysis. Values for overhydration were obtained. Patients with overhydration ≥ 2.0 kg were considered volume overloaded and were eligible for inclusion. From 1 March 2009 to 1 December 2009, a total of 96 patients on continuous ambulatory PD were included. Endothelial function was evaluated by flow-mediated dilatation (FMD). Other clinical indicators, such as blood pressure, dialysis adequacy, nutrition status, and biochemical parameters, were recorded. Patients were divided into 2 groups based on edema status: the edema group ( n = 35 volume-overloaded patients with bilateral pitting edema) and the non-edema group ( n = 61 volume-overloaded patients without bilateral pitting edema).ResultsOverhydration in the edema group was significantly higher than in the non-edema group (4.28 ± 1.75 kg vs 3.12 ± 0.81 kg, p < 0.001), whereas both FMD and serum albumin in the edema group were significantly lower than in the non-edema group (6.65% ± 5.2% vs 10.3% ± 5.1%, p = 0.001; 37.6 ± 4.2 g/L vs 39.3 ± 3.5 g/L, p = 0.047, respectively). Edema status (edema = 1, non-edema = 0) was positively correlated with overhydration ( r = 0.341, p < 0.001), gender (male = 1, female = 2: r = 0.184, p = 0.072), and total fluid removal ( r = 0.188, p = 0.074) and negatively correlated with endothelial function, as assessed by FMD ( r = -0.33, p = 0.001), and serum albumin ( r = -0.18, p = 0.055). Logistic regression analysis showed that FMD [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.81 - 0.99; p = 0.036], gender (male = 1, female = 2: OR 4.06, 95% CI 1.23 - 13.35; p = 0.021), overhydration (OR 3.06, 95% CI 1.53 - 6.13; p = 0.002), and serum albumin (OR 0.86, 95% CI 0.75 - 0.99; p = 0.035) were independent factors affecting the edema status of the study population.ConclusionOur study showed that endothelial function (assessed by FMD), gender, serum albumin, and over hydration are independent determinants of edema status in PD patients. This may explain why some PD patients can maintain free of edema despite significant volume overload.

Free Water Transport and its Association with Cardiovascular Status in Children on Peritoneal Dialysis

2019 ◽  
Vol 39 (4) ◽  
pp. 323-329
Author(s):  
Lilian Bolte ◽  
Maria Jose Ibacache ◽  
Iris Delgado ◽  
Francisco Cano
Keyword(s):  
Peritoneal Dialysis ◽  
Left Ventricular Hypertrophy ◽  
Water Transport ◽  
Ventricular Hypertrophy ◽  
Roc Analysis ◽  
Characteristic Curve ◽  
Negative Relationship ◽  
Free Water ◽  
Inverse Correlation ◽  
Left Ventricular

BackgroundVolume overload is one of the most important factors associated with left ventricular hypertrophy (LVH) and cardiovascular disease in chronic peritoneal dialysis (PD) patients. MiniPET is a reliable tool to evaluate free water transport (FWT). In a clinical setting, the significance of FWT has not been evaluated in terms of outcome in children on PD. The objective was to define a FWT value of clinical significance in children on PD, fixing its relationship to left ventricular mass index (LVMI) as a well-known outcome parameter.MethodsMiniPET was performed with 3.86% glucose, 1-h long, to measure FWT in PD patients > 6 years old. An echocardiogram (ECG) was performed within 2 months of the MiniPET. Left ventricular hypertrophy was defined as LVMI ≥ 38.6 g/height2.7(95th percentile). Receiver operating characteristic curve (ROC) analysis was used to determine the cut-off value of FWT searching the highest sensitivity and specificity to differentiate patients with normal/abnormal LVMI. A p < 0.05 was considered significant.ResultsForty-six studies were performed on 32 patients, 16 males; mean age 11.59 ± 3.07 years. Mean normalized FWT (nFWT) was 144.4 ± 84.8 mL/m2, corresponding to 46.7% of total ultrafiltration. Mean LVMI was 42 ± 11.3 g/m2.7with a negative correlation to nFWT ( p < 0.01). Eighteen out of 32 patients had LVH. The ROC analysis (nFWT vs LVMI) showed an area under the curve of 0.71 (95% confidence interval [CI], 0.53 – 0.89; p = 0.04), allowing a cut-off nFWT value of 110 mL/m2to be defined, dividing the population into 2 groups of patients according to the LVMI cut-off value of 38,6 g/m2.7.ConclusionsThe nFWT showed an inverse correlation to LVMI. A nFWT value < 110 mL/m2was significantly associated with LVH. The negative relationship observed between nFWT and LVMI, and the cut-off level for nFWT according to the 95th percentile of LVMI, suggest that the regular evaluation of nFWT could become a useful tool in assessing the capacity of PD treatment to keep patients’ volume status under control, avoiding cardiovascular impairment.

scholarly journals Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis

2017 ◽  
Vol 46 (1) ◽  
pp. 18-25 ◽  
Author(s):  
Aniema Udo ◽  
Catriona Goodlad ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Pulse Pressure ◽  
Extracellular Volume ◽  
Volume Overload ◽  
Glycated Haemoglobin ◽  
Diabetic Patients ◽  
Membrane Function ◽  
Arterial Blood ◽  
Increased Risk

Background: Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. Methods: We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. Results: Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). Conclusion: Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.

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