Invited Editorial: New Concepts in Peritoneal Dialysis: New Wine in Old Barrels?

Biesen, Wim Van; Veys, Nic; Vanholder, Raymond; Lameire, Norbert

doi:10.1046/j.1525-1594.2003.00965.x

Cited by 8 publications

(8 citation statements)

References 68 publications

(62 reference statements)

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“…Continuous ambulatory peritoneal dialysis is an effective modality of renal replacement therapy for elderly patients (7,14). The therapy had better life quality than HD (15) and preserves residual renal function (6,9,16).…”

Section: Discussionmentioning

confidence: 99%

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Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis

Hung

Chang

Lee

et al. 2009

International Journal of Clinical Practice

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The population of elderly patients entering chronic dialysis programmes is increasing. Elderly patients are susceptible to malnutrition and have multiple complicating disorders in addition to uraemia. Selecting appropriate dialysis modality is particularly critical in elderly patients. Continuous ambulatory peritoneal dialysis (CAPD) has many advantages to elderly patients; however, the clinical outcome varies for elderly CAPD patients. In comparison with Westerners, Southeast Asians have a small body mass index and may be more suited to CAPD therapy. To identify the prognostic predictors in elderly Southeast Asian patients, this historical cohort study analysed 144 patients aged > or = 65 years at initiation of CAPD. A group of haemodialysis (HD) patients aged > or = 65 years was utilised as the control group. Survival curves for patient and technique were derived from Kaplan-Meier analysis and were further analysed by Cox-Mantel log-rank test. To elucidate the impact of individual factors on patient survival, various significant univariables were further subjected to multivariate analysis. No significant increase existed for relative risk of technique failure in elderly patients compared with younger patients. This analytical data indicates that CAPD was as good as HD for elderly uraemic patients regarding to the patient survival. Diabetes, dependent patients, low albumin levels and previous HD history were significant poor prognostic factors for survival of elderly CAPD patients. In conclusion, CAPD is an effective modality of renal replacement therapy for Southeast Asian elderly patients. The technique survival was not affected by patient age.

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Section: Discussionmentioning

confidence: 99%

“…However, a cohort study demonstrated that peritoneal dialysis, compared with HD, is associated with high mortality among elderly patients (6). Some elderly patients have achieved good long‐term outcome and good quality of life using CAPD (7,8). It is probable that only a part of the elderly patients benefited from the CAPD programme.…”

Section: Introductionmentioning

confidence: 99%

Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis

Hung

Chang

Lee

et al. 2009

International Journal of Clinical Practice

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“…The effect of these “artificial organs” on the body depends also on the transport of fluid and solutes across natural transport barriers, as capillary wall and tissue. Peritoneal dialysis (PD) is very unique in this respect because its “membrane” is composed only of natural transport barriers (5). This gives us an opportunity to apply the methods developed for the description of transport processes in artificial organs for blood cleaning mechanisms during PD (6,7).…”

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confidence: 99%

Membrane Transport of Several Ions During Peritoneal Dialysis: Mathematical Modeling

Galach

Waniewski

2012

Artificial Organs

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Peritoneal dialysis utilizes a complex mass exchange device created by natural permselective membranes of the visceral and abdominal muscle tissues. In mathematical modeling of solute transport during peritoneal dialysis, each solute is typically considered as a neutral, independent particle. However, such mathematical models cannot predict transport parameters for small ions. Therefore, the impact of the electrostatic interactions between ions on the estimated transport parameters needs to be investigated. In this study, transport of sodium, chloride, and a third ion through a permselective membrane with characteristics of the peritoneal transport barrier was described using two models: a model with the Nernst-Planck (NP) equations for a set of interacting ions and a model with combined diffusive and convective transport of each ion separately (DC). Transport parameters for the NP model were calculated using the pore theory, while the parameters for the DC model were estimated by fitting the model to the predictions from the NP model. Solute concentration profiles in the membrane obtained by computer simulations based on these two models were similar, whereas the transport parameters (diffusive mass transport parameters and sieving coefficients) were generally different. The presence of the third ion could substantially modify the values of diffusive mass parameter for sodium and chloride ions estimated using the DC model compared with those predicted by NP. The extent of this modification depended on the molecular mass and concentration of the third ion, and the rate of volumetric flow. Closed formulas for the transport parameters of the DC model in terms of the NP model parameters, ion concentration profiles in the membrane, and volumetric flow across the membrane were derived. Their reliable approximations, which include only boundary ion concentrations instead of spatial intramembrane concentration profiles, were formulated. The precision of this approximation was demonstrated by numerical simulations of the investigated three-ion system. Our modeling demonstrated that the fitted transport parameters depend not only on ion molecular weight but also on the characteristics and concentration of all other ions in the fluid as well as on the fluid flow rate through the membrane. Therefore, theoretical predictions of ion transport parameters need to take into account multi-ionic character of dialysis and body fluids. The transport parameters estimated using the DC model for one ion may vary with the ionic composition, ion concentrations in the fluids, and volumetric flow and may not reflect the theoretical description of diffusive and convective characteristics of single ion.

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“…Einen Überblick über derzeitige neue Entwicklungen im Bereich der PD-Lösungen (Icodextrin, Aminosäuren-lösungen, pH-neutrale und Bicarbonat-basierte Lösungen mit geringerem Anteil an toxischen Glukosedegradationsprodukten) sowie Überlegungen zum frühen Einsatz der PD als initiales Dialyseverfahren (im Kontext mit Hämo-dialyse und Transplantation als eine der 3 Säulen der Nierenersatztherapie) finden sich in den Übersichts-artikeln von R. Gokal und W. van Biesen [15,16]. Es wird in diesem Konzept ("integrated care") davon ausgegangen, dass es sich bei PD und Hämodialyse um keine kompetitiven, sondern um ergänzende Methoden handelt, ein konsquenter Therapiewechsel bei Problemen ist in diese Überlegungen mit eingeschlossen.…”

Section: Bedeutung Neuer Entwicklungen An Der Pd Für Den Diabetikerunclassified

Peritonealdialyse bei Patienten mit diabetischer Nephropathie

Auinger¹,

Edlinger²,

Prager³

2005

Wien Klin Wochenschr

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Since the introduction of peritoneal dialysis (PD) into clinical nephrology at the end of the 1970s, many improvements have led to acceptance of this method as renal replacement therapy equivalent to hemodialysis. It is unclear whether the diabetic patient is the ideal candidate for PD and if this procedure should be the preferred method of treatment of renal failure in these patients, especially when kidney transplantation cannot be performed. PD may provide several advantages for diabetic patients with end-stage renal failure; for example, better hemodynamic stability is achieved during peritoneal ultrafiltration and vascular access surgery becomes unnecessary. On the other hand, the continuous glucose absorption may lead to increased insulin requirements, obesity and hyperlipidemia. Furthermore, peritoneal protein loss may aggravate malnutrition, which is frequently present in these patients. However, for a differentiated assessment of outcome in PD, the individual history (diabetes type 1 or type 2) and accompanying comorbidity of diabetic patients have to be considered. Nowadays nephrologists have to be aware of the concept of individualized therapy, which is integrated into an overall plan and takes into account the different conditions of diabetic patients and their treatment options. By improving removal of sodium and water, as well as improving quality of metabolic control, new dialysis solutions (icodextrin, neutral-pH solutions) and automated PD could have a positive impact on outcome in diabetic patients. In contrast, from retrospective studies on PD there is evidence of higher long-term mortality rates in elderly women with diabetes and in patients with cardiac insufficiency than in those on hemodialysis. Further research is necessary in order to optimize individualized therapy for diabetic patients with end-stage renal disease in the future.

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Invited Editorial: New Concepts in Peritoneal Dialysis: New Wine in Old Barrels?

Cited by 8 publications

References 68 publications

Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis

Prognostic predictors of technique and patient survival in elderly Southeast Asian patients undergoing continuous ambulatory peritoneal dialysis

Membrane Transport of Several Ions During Peritoneal Dialysis: Mathematical Modeling

Peritonealdialyse bei Patienten mit diabetischer Nephropathie

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