Augmenting solute clearance in peritoneal dialysis

Krediet, Raymond T.; Douma, Caroline E.; Olden, R. W. van; Ho-dac-Pannekeet, Marja M.; Struijk, Dirk G.

doi:10.1046/j.1523-1755.1998.00181.x

Cited by 36 publications

(27 citation statements)

References 37 publications

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“…Large dialysate volumes are often required to increase solute clearance for patients undergoing peritoneal dialysis (1,2). Theoretically, the increased solute clearance obtained with the use of large volumes (2-4) could be attributable either to an increased blood/dialysate solute concentration gradient or to an increase in the effective peritoneal surface area.…”

Section: ϫ2mentioning

confidence: 99%

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Effect of Increased Dialysate Volume on Peritoneal Surface Area among Peritoneal Dialysis Patients

Chagnac¹,

Herskovitz

Ori³

et al. 2002

Journal of the American Society of Nephrology

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Abstract. Large dialysate volumes are often required to increase solute clearance for peritoneal dialysis patients. The resulting increase in solute clearance might be attributable to an increased plasma-to-dialysate concentration gradient and/or to an increased effective peritoneal surface area. One of the factors affecting the latter is the peritoneal surface area in contact with dialysate (PSA-CD). The aim of this study was to estimate the change in PSA-CD after a 50% increase in the instilled dialysate volume for patients undergoing peritoneal dialysis. PSA-CD was estimated by using a method applying stereologic techniques to computed tomographic (CT) scans of the peritoneal space. The peritoneal cavity of 10 peritoneal dialysis patients was filled with a solution containing dialysate, half-isotonic saline solution, and contrast medium. Peritoneal function tests and CT scanning of the abdomen were performed twice for each patient (with an interval of 1 wk), after instillation of a 2-or 3-L solution. Scanning of thin helical CT sections was performed, and 36 random sections of the abdomen were obtained after reconstruction. A grid was superimposed on the sections. The surface area was estimated by using stereologic methods.

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Section: ϫ2mentioning

confidence: 99%

“…The surface area was estimated by using stereologic methods. After instillation of the 2-L solution, the volume of the peritoneal solution at the time of CT scanning was 2.32 Ϯ 0.05 L. The PSA-CD was 0.57 Ϯ 0.03 m 2 , ranging from 0.41 to 0.76 m 2 . The use of the 3-L solution increased the peritoneal volume by 46 Ϯ 2%.…”

mentioning

confidence: 99%

Effect of Increased Dialysate Volume on Peritoneal Surface Area among Peritoneal Dialysis Patients

Chagnac¹,

Herskovitz

Ori³

et al. 2002

Journal of the American Society of Nephrology

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“…More recently, a randomized controlled trial has been published in abstract form, 38 which showed that long‐term frusemide therapy (250 mg per day) in 60 incident PD patients produced a statistically and clinically significant increase in urine volume over a 6‐month period (+185 ± 117 vs. control −151 ± 100 mL/24 h, P = 0.036) but had no effect on residual renal function 38 . Thus, diuretics may be helpful in controlling fluid overload in PD patients 18,39 . However, there is no high‐level clinical evidence to support their use in maintaining residual renal function.…”

Section: Strategies For Maintaining and Optimizing Residual Renal Clementioning

confidence: 99%

“…urea). On the other hand, peritoneal diffusive capacity is accentuated by the conditions listed in Table 2 and is more important for the clearance of larger weight molecules 18 …”

Section: Determinants Of Peritoneal Clearancementioning

confidence: 99%

Maintaining clearance in peritoneal dialysis

Johnson

2001

Nephrology

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SUMMARY: Numerous studies have now established that there is a strong association between small solute clearance and improved outcomes in peritoneal dialysis (PD) patients. Preservation of both renal and peritoneal clearances is therefore of paramount importance, although very few trials have satisfactorily addressed this critical issue. Observational studies have suggested that the groups most at risk of loss of residual renal function are women, non‐whites, diabetic patients, patients with congestive cardiac failure, patients who experience frequent episodes of peritonitis and, possibly, patients treated with automated PD (APD). There have been no controlled trials of renoprotective therapies in PD patients, but reasonable strategies for preventing renal functional decline include avoidance of nephrotoxins and infection, maintenance of adequate blood pressure, abstinence from smoking and possibly administration of angiotensin‐converting enzyme inhibitors and/or calcium channel blockers. In contrast, peritoneal small solute removal can be maximized by augmenting fill volume, increasing exchange frequency and using either long‐dwell continuous ambulatory PD (CAPD) or short‐dwell (APD) therapies to suit individual patients’ transport characteristics. Tidal PD may additionally increase solute clearance, although studies have reported conflicting findings. Preservation of membrane function may be achieved by minimizing episodes of peritonitis and avoiding hypertonic glucose exchanges. Newer peritoneal dialysates, such as icodextrin, amino acids, bicarbonate‐buffered solutions and aldehyde‐poor fluids, are more biocompatible in experimental models of PD, but their long‐term clinical safety and efficacy have not yet been established by clinical trials. Moreover, no trials have demonstrated an independent effect of peritoneal clearance on patient outcomes. Further studies determining the relative value of renal and peritoneal clearances are therefore urgently required in order to optimize dialytic adequacy for PD patients.

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“…Initially, this type of medication was used with the hope of preserving or even increasing RRF [7]. Recent studies show that even though UV increases after drug administration, the use of these drugs is not actually related to alterations in clearance of solutes [9].…”

Section: Introductionmentioning

confidence: 99%

Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis

et al. 2011

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Augmenting solute clearance in peritoneal dialysis

Abstract: Small solutes clearances cannot be increased by furosemide. Increasing the instilled volume of dialysis fluid and the number of exchanges both affect solute clearance. Studies are necessary on long-term effects of manipulation of the peritoneal membrane with nitroprusside.

Cited by 36 publications

References 37 publications

Effect of Increased Dialysate Volume on Peritoneal Surface Area among Peritoneal Dialysis Patients

Effect of Increased Dialysate Volume on Peritoneal Surface Area among Peritoneal Dialysis Patients

Maintaining clearance in peritoneal dialysis

Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis

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