Categorization of sodium sieving by 2.27% and 3.86% peritoneal equilibration tests--a comparative analysis in the clinical setting

Gomes, Ana Marta; Fontán, Miguel Pérez; Rodríguez‐Carmona, Ana; Sastre, Aránzazu; Cambre, Helena Díaz; Muñiz, Andrés López; Falcón, Teresa García

doi:10.1093/ndt/gfp319

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…The difference between drainage and instillation volumes was recorded as ultrafiltration (correcting for sample volume removed during PET, bag over-fill with fresh PDF, and empty bag weight). The 3.86% PET allows calculation of peritoneal transport rates with accuracy comparable to the 2.27% PET, while providing more information on peritoneal membrane function such as sodium sieving [ 34 , 35 ].…”

Section: Methodsmentioning

confidence: 99%

Addition of Alanyl-Glutamine to Dialysis Fluid Restores Peritoneal Cellular Stress Responses – A First-In-Man Trial

et al. 2016

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BackgroundPeritonitis and ultrafiltration failure remain serious complications of chronic peritoneal dialysis (PD). Dysfunctional cellular stress responses aggravate peritoneal injury associated with PD fluid exposure, potentially due to peritoneal glutamine depletion. In this randomized cross-over phase I/II trial we investigated cytoprotective effects of alanyl-glutamine (AlaGln) addition to glucose-based PDF.MethodsIn a prospective randomized cross-over design, 20 stable PD outpatients underwent paired peritoneal equilibration tests 4 weeks apart, using conventional acidic, single chamber 3.86% glucose PD fluid, with and without 8 mM supplemental AlaGln. Heat-shock protein 72 expression was assessed in peritoneal effluent cells as surrogate parameter of cellular stress responses, complemented by metabolomics and functional immunocompetence assays.ResultsAlaGln restored peritoneal glutamine levels and increased the primary outcome heat-shock protein expression (effect 1.51-fold, CI 1.07–2.14; p = 0.022), without changes in peritoneal ultrafiltration, small solute transport, or biomarkers reflecting cell mass and inflammation. Further effects were glutamine-like metabolomic changes and increased ex-vivo LPS-stimulated cytokine release from healthy donor peripheral blood monocytes. In patients with a history of peritonitis (5 of 20), AlaGln supplementation decreased dialysate interleukin-8 levels. Supplemented PD fluid also attenuated inflammation and enhanced stimulated cytokine release in a mouse model of PD-associated peritonitis.ConclusionWe conclude that AlaGln-supplemented, glucose-based PD fluid can restore peritoneal cellular stress responses with attenuation of sterile inflammation, and may improve peritoneal host-defense in the setting of PD.

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Section: Methodsmentioning

confidence: 99%

Addition of Alanyl-Glutamine to Dialysis Fluid Restores Peritoneal Cellular Stress Responses – A First-In-Man Trial

et al. 2016

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“…In these cases, the PD cycler can be set up for one 24-hour treatment and 60-240 -minute exchanges used as clinically indicated. With excessively short APD dwell times and hypertonic dialysate, there is a greater risk of sodium sieving particularly with hypertonic solutions leading to excessive free water loss (in the absence of sodium removal) and biochemistry should be reviewed for rises in serum sodium 5,34 . With frequent automated PD cycling: hypokalemia may also ensue necessitating intraperitoneal and/or intravenous potassium supplementation.…”

Section: Acute Pd Protocol and Prescription Considerationsmentioning

confidence: 99%

Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

et al. 2020

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“…During a PET test, water initially moves faster into the peritoneal cavity due to the large osmotic gradient, created by the fresh hypertonic glucose dialysate, whereas convective sodium movement into the peritoneal cavity moves slower through so called “small pores” . This leads to a relative fall in the ratio of dialysate sodium to serum sodium, which is termed sodium sieving, and is a measure of the hydraulic permeability .…”

Section: Discussionmentioning

confidence: 99%

“…Loss of sodium sieving has been linked to loss of aquaporin channels . Sodium sieving is greatest during the first 90 min of the PET test .…”

Section: Discussionmentioning

confidence: 99%

Indirect Ion Selective Electrode Methods Potentially Overestimate Peritoneal Dialysate Sodium Losses

2013

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Measurements of dialysate sodium are used to estimate peritoneal dialysis sodium losses and sodium sieving, a measure of hydraulic permeability of the peritoneum. Peritoneal dialysates differ from serum samples in terms of pH, osmolality, protein and glucose concentration. We wished to determine whether these factors affected sodium measurement. Dialysate samples were taken from 52 consecutive peritoneal dialysis patients attending for a standard peritoneal dialysis equilibrium test (PET), 20 with standard lactate dialysate and 32 with neutral pH dialysate and sodium was measured by both flame photometry and indirect ion selective electrode (ISE). Sodium measured by ISE consistently overestimated that measured by flame photometer, mean bias 1.5 mmol/L (95% confidence limits 1.2 to 1.8), P < 0.001. Sodium was lower in fresh neutral pH dialysates by both methods - flame 125.3 ± 1.17 vs. 131.6 ± 0.39 mmol/L, than standard lactate dialysates ISE 127.4 ± 1.05 vs 132.7 ± 0.27 mmol/L, P < 0.001. Glucose was higher in fresh neutral pH dialysates 122.7 ± 1.1 vs. standard lactate dialysates 116.7 ± 0.4 mmol/L, P < 0.001. On multiple regression analysis, only glucose was found to be an independent factor for sodium measurement, F = 14.78, β = -0.0851, SEM 0.022, 95% confidence limits -1.28 to -0.042. In this study there was a small but consistent difference between sodium measurements by ISE and flame photometry during the PET. Sodium measurements by either method appeared to be affected by hypertonic dialysates, but there were differences with pH. This may potentially lead to errors in both overestimating peritoneal sodium losses and the proportion of patients with ultrafiltration failure due to loss of sodium sieving.

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Categorization of sodium sieving by 2.27% and 3.86% peritoneal equilibration tests--a comparative analysis in the clinical setting

Cited by 12 publications

References 26 publications

Addition of Alanyl-Glutamine to Dialysis Fluid Restores Peritoneal Cellular Stress Responses – A First-In-Man Trial

Addition of Alanyl-Glutamine to Dialysis Fluid Restores Peritoneal Cellular Stress Responses – A First-In-Man Trial

Peritoneal Dialysis for Acute Kidney Injury Treatment in the United States: Brought to You by the COVID-19 Pandemic

Indirect Ion Selective Electrode Methods Potentially Overestimate Peritoneal Dialysate Sodium Losses

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