Nutrition and Delayed Hypersensitivity during Continuous Ambulatory Peritoneal Dialysis in Relation to Peritonitis

Young, Gerald A.; Young, John; Young, Sheila M.; Hobson, Shirley M.; Hildreth, B.; Brownjohn, A. M.; Parsons, F. M.

doi:10.1159/000183826

Cited by 64 publications

(13 citation statements)

References 22 publications

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“…These observations are consistent with the observations made by others [4,19,[49][50][51]. This increased protein wastage during long-term CAPD may lead to a lowered nutritional status [52][53][54][55] and to immune disturbances [52,56], Patients with increased peritoneal loss of plasma pro teins have also reduced levels of HDL and higher levels of triglycerides and VLDL. The low HDL may be ascribed to the increased HDL loss in these patients [17].…”

Section: Discussionsupporting

confidence: 88%

Heterogeneity in Peritoneal Transport during Continuous Ambulatory Peritoneal Dialysis and Its Impact on Ultraf iltration, Loss of Macromolecules and Plasma Level of Proteins, Lipids and Lipoproteins

Kagan

Bar-Khayim²,

Schafer³

et al. 1993

Nephron

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We investigated the effect of heterogeneity in the peritoneal transport of plasma proteins on dialysis efficiency and plasma levels of proteins, lipids and lipoproteins in 32 patients undergoing long-term continuous ambulatory peritoneal dialysis (CAPD; 9 females and 23 males, 18-76 years old). Eleven patients were studied on several occasions (at 0-42 months) and the remainder at 6-60 months on CAPD (n = 49). We have divided our patients arbitrarily into two equal groups according to their protein concentration in the peritoneal effluent at the end of an 8-hour cycle. Patients with a high peritoneal protein concentration ( ≥ 2 g/l/1.73 m²) have lower ultrafiltration capacity, higher glucose absorption rate and increased loss of most plasma proteins [including albumin, immunoglobulins (Ig), complement components and high-density lipoproteins (HDL)] compared to patients with a low peritoneal protein concentration ( < 2 g/l/ 1.73 m²). Consequently, plasma levels of albumin, IgM and HDL were lower in patients with a high peritoneal protein concentration. The latter had also increased levels of plasma triglycerides and very-low-density lipoproteins. The difference observed in peritoneal transport between the groups could be ascribed only in part to the duration of CAPD treatment, and hence to the number of peritonitis episodes but not to medications. Therefore, we suggest that inherent constitutional factors may be responsible for some of the observed heterogeneity in the peritoneal transport of these patients which is already evident at the start of CAPD treatment. Patients with high peritoneal transport are exposed to an augmented atherogenic plasma lipid profile in addition to a reduction in dialysis efficiency (ultrafiltration failure). These patients may become prone also to nutritional and immunological disturbances. Therefore, we suggest taking these effects into consideration before choosing the appropriate dialysis modality in patients with increased peritoneal transport for plasma proteins.

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Section: Discussionsupporting

confidence: 88%

Heterogeneity in Peritoneal Transport during Continuous Ambulatory Peritoneal Dialysis and Its Impact on Ultraf iltration, Loss of Macromolecules and Plasma Level of Proteins, Lipids and Lipoproteins

Kagan

Bar-Khayim²,

Schafer³

et al. 1993

Nephron

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“…This may support the evi dence that peritoneal protein concentrations increase after peritonitis episodes and that this effect may persist for several weeks after the treatment of peritonitis [13], We cannot exclude the possibility that peritonitis could induce long-lasting or persistent damage to peritoneal membranes probably increasing peritoneal membrane permeability to plasma proteins, including IgG. On the other hand, the relationship between peritonitis and dialysate protein losses could be explained by the asso ciation between protein losses and decreased immuno logical activity described by Young et al [14]. The inverse relation observed between peritoneal IgG con centrations and plasma protein levels could be attributed to a large peritoneal loss of proteins, including IgG, in the patients with peritonitis.…”

Section: Discussionmentioning

confidence: 91%

Plasma and Dialysate Immunoglobulin G in Continuous Ambulatory Peritoneal Dialysis Patients: A Multicenter Study

et al. 1990

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Peritoneal dialysate immunoglobin (Ig)G concentrations were measured in 120 continuous ambulatory peritoneal diaysis (CAPD) patients evaluated at four dialysis centers in different countries to assess the normal range for dialysate IgG and to investigate the relationships of this protein levels with peritoneal episodes, For 65 of these patients, plasma IgG levels were determined, and IgG clearances were calculated. The mean dialysate concentration of IgG was 6.9 ± 4.2 mg/dl, and there was no difference between men and women or between patients who had or had not previously undergone hemodialysis. Dialysate IgG concentrations were significantly related to residual renal creatinine clearance and negatively correlated with dialysate volume, plasma albumin and total protein. There were no significant correlations between IgG levels in the dialysate and age, protein losses in the dialysate, time on CAPD or time from the last peritonitis episode. Plasma and dialysate IgG were unrelated to the incidence of peritonitis, statistical analysis being performed with different methods. These results suggest that IgG levels in the dialysate or plasma are not a major factor in the prevention of CAPD peritonitis.

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“…All patients had a surgically implanted Tenckhoff peritoneal catheter. The daily dietary protein intake was around 1.4 g/kg body weight and energy intake 27 keal/kg body weight, but additional calories were assumed to be derived from dextrose in dilaysis fluid (11]. The total daily calorie content o f the fluids used for each patient was calculated as 3.8 keal/g dextrose.…”

Section: Patient Populationmentioning

confidence: 99%

Serial Peritoneal Macrophage Function Studies in New and Established Continuous Ambulatory Peritoneal Dialysis Patients

Lin¹,

Ku²,

Huang³

1990

Am J Nephrol

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Peritoneal macrophages (PM) perform first-line defense activity against peritonitis, the most important complication in continuous ambulatory peritoneal dialysis (CAPD) therapy. Our longitudinal study has compared the PM function in 20 uremic patients during periods free of peritonitis since they started CAPD therapy in January 1987. The results showed that at the initiation of CAPD, there was a higher bactericidal activity, phagocytosis index, H₂O₂ production and interleukin-1 (IL-1), Γ-interferon (IFN-Γ) and tumor necrosis factor (TNF) production ability and MHC expression. As time went on, these progressively decreased, and by 9 months after CAPD therapy had started they were significantly lower than at the beginning. During the 1.5-year follow-up period, there was a significantly increased peritonitis rate in the period 6 months after the beginning of CAPD than in the period before the 6th month (88.3 vs. 11.7% respectively; p < 0.001). These results indicate that PM of new CAPD patients have a more active function than those of established patients. The established patients had a greater risk of peritonitis. A comparison of the immunological profiles of PM from patients who had a peritonitis history shows that phagocytosis index, bactericidal activity and IL-1 and TNF production of PM were significantly decreased during the period free of peritonitis. This result suggests that these parameters may serve as an indicator in developing peritonitis.

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Nutrition and Delayed Hypersensitivity during Continuous Ambulatory Peritoneal Dialysis in Relation to Peritonitis

Cited by 64 publications

References 22 publications

Heterogeneity in Peritoneal Transport during Continuous Ambulatory Peritoneal Dialysis and Its Impact on Ultraf iltration, Loss of Macromolecules and Plasma Level of Proteins, Lipids and Lipoproteins

Heterogeneity in Peritoneal Transport during Continuous Ambulatory Peritoneal Dialysis and Its Impact on Ultraf iltration, Loss of Macromolecules and Plasma Level of Proteins, Lipids and Lipoproteins

Plasma and Dialysate Immunoglobulin G in Continuous Ambulatory Peritoneal Dialysis Patients: A Multicenter Study

Serial Peritoneal Macrophage Function Studies in New and Established Continuous Ambulatory Peritoneal Dialysis Patients

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