Clinical experience with two physiologic bicarbonate/lactate peritoneal dialysis solutions in automated peritoneal dialysis

Dratwa, Max; Wilkie, Martin; Ryckelynck, J. P.; Wee, Pieter M. ter; Rutherford, Peter; Michel, Catherine; Hopwood, Alexandra M.; Curtis, Lynne; Denys, Nicolas; Filho, José C. Divino; Faict, Dirk

doi:10.1046/j.1523-1755.2003.08812.x

Cited by 25 publications

(10 citation statements)

References 10 publications

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“…The study by Dratwa et al showed that the B/L solution may be used safely and effectively in patients on APD too. They also reported an improvement in infusion pain and improved sleep with use of these solutions [53]. The B/L solutions have also been reported to be associated with a lower incidence of CAPD peritonitis [54].…”

Section: New Dialysis Solutionsmentioning

confidence: 99%

Glucose Degradation Products (GDP’s) and Peritoneal Changes in Patients on Chronic Peritoneal Dialysis: Will New Dialysis Solutions Prevent these Changes?

Krishnan

Tam

et al. 2005

Int Urol Nephrol

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As peritonitis rates are declining, the rate of technique failure due to ultrafiltration failure and inadequate solute removal is becoming more important. The failure of the peritoneal membrane to provide adequate dialysis increases with longer duration on PD and correlates with the structural changes in the peritoneal membrane. The exact mechanism responsible for these structural changes is unclear. Conventional PD fluids with glucose as the osmotic agent and more importantly the glucose degradation products (GDP) generated during the heat sterilization of these solutions seems to be responsible for inducing many of these changes in the peritoneum. GDP's in addition to causing structural and functional alterations of the peritoneal cells is also a leading cause of advanced glycation end-products (AGE) production. There is evidence to suggest that the GDP's and AGE's are not limited to the peritoneal cavity and the membrane. They have been shown to get deposited in the vascular walls. In addition they also interact with receptors on endothelial cells and smooth muscle. Thus they could contribute to the vascular dysfunction similar to that seen in diabetes. Formation of GDP's can be reduced and even be avoided with the use of newer "biocompatible" solutions by sterilizing the glucose and the buffer in separate chambers. These newer solutions have been shown to have several local and systemic advantages over the conventional PD solutions. It remains to be seen whether their chronic use from the start of peritoneal dialysis will prevent the development of peritoneal damage thus allowing these patients to remain on this modality for longer periods.

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Section: New Dialysis Solutionsmentioning

confidence: 99%

Glucose Degradation Products (GDP’s) and Peritoneal Changes in Patients on Chronic Peritoneal Dialysis: Will New Dialysis Solutions Prevent these Changes?

Krishnan

Tam

et al. 2005

Int Urol Nephrol

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“…Klinische Studien mit fabriksfertigen Lösungen wurden inzwischen sowohl im Bereich der Pädiatrie als auch bei erwachsenen Patienten publiziert. In einer prospektiven, nicht-randomisierten, multizentrischen Studie fand sich bei APD-Patienten nach einem Wechsel von einer konventionellen Laktatlösung zu einer Bikarbonat/Laktatlösung (mit physiologischem pH-Wert) ein signifikanter Anstieg der Plasma-Bikarbonatkonzentration [83]. Allerdings stieg bei Verwendung einer Bikarbonat/Laktat-Konzentration von 40 mmol/l, wie auch in einer anderen retrospektiven pädiatrischen Arbeit [84], die Zahl der APD-Patienten mit einer Überkorrektur der Azidose in den alkalischen Bereich von 16,5% auf 36,1% an, sodass vor allem bei Verwendung hoher Dialysatvolumina eine niedrigere Pufferkonzentration verwendet werden sollte.…”

Section: Neue Dialysatlösungen An Der Apdunclassified

“…Allerdings stieg bei Verwendung einer Bikarbonat/Laktat-Konzentration von 40 mmol/l, wie auch in einer anderen retrospektiven pädiatrischen Arbeit [84], die Zahl der APD-Patienten mit einer Überkorrektur der Azidose in den alkalischen Bereich von 16,5% auf 36,1% an, sodass vor allem bei Verwendung hoher Dialysatvolumina eine niedrigere Pufferkonzentration verwendet werden sollte. Die Patienten gaben bei Verwendung der pH-neutralen Lösung eine Reduktion des Dialysat-Einlaufschmerzes sowie auch eine Verbesserung des Appetites an [83]. Haas et al konnten in einer randomisierten, kontrollierten Studie mit cross-overDesign ebenfalls zeigen, dass der Blut-pH bei Verwendung einer reinen Bikarbonatlösung während der nächt-lichen Cyclertherapie signifikant höher war als bei Verwendung einer Laktatlösung mit saurem pH [85].…”

Section: Neue Dialysatlösungen An Der Apdunclassified

Automated peritoneal dialysis – recent aspects

Vychytil

2005

Wien Klin Wochenschr

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Automated peritoneal dialysis (APD) is an important treatment option in PD patients with high peritoneal transport rates, in patients with inadequate small-solute clearances during continuous ambulatory peritoneal dialysis (CAPD) treatment, and in patients with complications associated with high intraperitoneal pressure. Because APD offers better flexibility during the daytime, patients often have a better quality of life and are able to go to work or school. However, APD is more expensive and technically more complex than CAPD and there are controversial results on the course of residual renal function and the risk of peritonitis in the two types of treatment. The increased elimination of antibiotic drugs during cycler therapy has to be considered in patients with peritonitis, especially in those using high treatment volumes. When used during the daytime dwell, polyglucose solution has been shown to improve ultrafiltration and reduce the extracellular fluid volume in PD patients. In comparison with conventional dialysis solutions, treatment with pH-neutral solutions allows better correction of metabolic acidosis and is associated with an increase of CA-125 dialysate concentrations and a reduction of infusion pain. Tidal PD has its place in patients with mechanical outflow problems; however, compared with conventional APD, there is no improvement of clearances when the dialysate flow is kept constant. Continuous-flow PD using a double-lumen catheter is more effective but also more expensive than conventional APD. Most studies report a similar or even better patient survival with APD than with CAPD; however, a selection bias cannot be excluded from these mainly retrospective studies. In summary, APD is an established method of PD treatment that provides several advantages to patients and contributes to decreased technical drop-out rates.

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“…De même, la prescription de solutions plus biocompatibles à pH physiologique avec une moindre teneur en produits de dégradation du glucose doit être élargie. La solution associant bicarbonate (25 mmol/L) et lactate (15 mmol/L) ou bicarbonate seul (34 mmol/L) à pH 7,4 en poche bicompartimentale paraît idéale[12,13]. Elle permet un meilleur contrôle de l'acidose, facteur d'hypercatabolisme.…”

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