Peritoneal dialysis: from bench to bedside

Krediet, Raymond T.

doi:10.1093/ckj/sft122

Cited by 11 publications

(5 citation statements)

References 63 publications

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“…In their study, a total of 91 PD patients were included, and the results showed that the residual GFR declined less in those dialyzed with neutral-pH, low-GDP solution than in those dialyzed with the conventional dialysate. However, the beneficial effects on RRF were mixed in a greater number of later studies and trials [75][76][77][78] . Yohanna et al [79] systematically reviewed 11 trials in which 643 patients were included.…”

Section: Dialysis Techniquesmentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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Background: Residual renal function (RRF), defined as the ability of native kidneys to eliminate water and uremic toxins, is closely correlated with mortality and morbidity rates among patients receiving either peritoneal dialysis (PD) or hemodialysis (HD) via continuous clearance of middle-sized molecules and protein-bound solutes. Therefore, preserving RRF is considered to be one of the primary goals in managing patients with end-stage renal disease (ESRD). Summary and Key Messages: In this article, we provide a review on the understanding and management of RRF in patients on dialysis. RRF may be estimated and measured by calculating the mean 24-hour urine creatinine level and urea clearance. Currently, several middle-sized molecules are reported but rarely used in practice. Many risk factors such as original renal diseases, dietary intake, and nephrotoxic agents impair RRF. Targeting such factors may halt the decline in RRF and offer better outcomes for patients on PD or HD. Except for in PD patients, RRF is a powerful predictor of survival in HD patients. RRF requires more clinical and research attention in the care of patients with ESRD on dialysis.

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Section: Dialysis Techniquesmentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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“…In clinical practice, effluent markers such as IL-6 and CA-125 are used to assess peritoneal functionality and morphology 18 – 20 , but their role as predictors for peritoneal membrane failure is still questioned. Changes in the levels of cytokines detected in peritoneal effluents collected from patients indeed reflect the peritoneal morphological changes, yet only at a very late stage 21 .…”

Section: Introductionmentioning

confidence: 99%

Effluent and serum protein N-glycosylation is associated with inflammation and peritoneal membrane transport characteristics in peritoneal dialysis patients

Ferrantelli

Farhat

Ederveen

et al. 2018

Sci Rep

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Mass spectrometric glycomics was used as an innovative approach to identify biomarkers in serum and dialysate samples from peritoneal dialysis (PD) patients. PD is a life-saving treatment worldwide applied in more than 100,000 patients suffering from chronic kidney disease. PD treatment uses the peritoneum as a natural membrane to exchange waste products from blood to a glucose-based solution. Daily exposure of the peritoneal membrane to these solutions may cause complications such as peritonitis, fibrosis and inflammation which, in the long term, lead to the failure of the treatment. It has been shown in the last years that protein N-glycosylation is related to inflammatory and fibrotic processes. Here, by using a recently developed MALDI-TOF-MS method with linkage-specific sialic acid derivatisation, we showed that alpha2,6-sialylation, especially in triantennary N-glycans from peritoneal effluents, is associated with critical clinical outcomes in a prospective cohort of 94 PD patients. Moreover, we found an association between the levels of presumably immunoglobulin-G-related glycans as well as galactosylation of diantennary glycans with PD-related complications such as peritonitis and loss of peritoneal mesothelial cell mass. The observed glycomic changes point to changes in protein abundance and protein-specific glycosylation, representing candidate functional biomarkers of PD and associated complications.

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“…Our data appear to confirm the hypothesis that FGF-21 plasma levels have a natural history that varies over time on PD. FGF-21 production might be induced by daily peritoneal glucose overload, which is regulated by peritoneal transport characteristics [ 20 , 21 ]. Therefore, patients who absorb more glucose, due to a more permeable peritoneum, could promote greater FGF-21 production.…”

Section: Discussionmentioning

confidence: 99%

Fibroblast Growth Factor 21 (FGF-21) in Peritoneal Dialysis Patients: Natural History and Metabolic Implications

et al. 2016

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BackgroundHuman fibroblast growth factor 21 (FGF-21) is an endocrine liver hormone that stimulates adipocyte glucose uptake independently of insulin, suppresses hepatic glucose production and is involved in the regulation of body fat. Peritoneal dialysis (PD) patients suffer potential interference with FGF-21 status with as yet unknown repercussions.ObjectivesThe aim of this study was to define the natural history of FGF-21 in PD patients, to analyze its relationship with glucose homeostasis parameters and to study the influence of residual renal function and peritoneal functional parameters on FGF-21 levels and their variation over time.MethodsWe studied 48 patients with uremia undergoing PD. Plasma samples were routinely obtained from each patient at baseline and at 1, 2 and 3 years after starting PD therapy.ResultsPlasma FGF-21 levels substantially increased over the first year and were maintained at high levels during the remainder of the study period (253 pg/ml (59; 685) at baseline; 582 pg/ml (60.5–949) at first year and 647 pg/ml (120.5–1116.6) at third year) (p<0.01). We found a positive correlation between time on dialysis and FGF-21 levels (p<0.001), and also, those patients with residual renal function (RRF) had significantly lower levels of FGF-21 than those without RRF (ρ -0.484, p<0.05). Lastly, there was also a significant association between FGF-21 levels and peritoneal protein losses (PPL), independent of the time on dialysis (ρ 0.410, p<0.05).ConclusionOur study shows that FGF-21 plasma levels in incident PD patients significantly increase during the first 3 years. This increment is dependent on or is associated with RRF and PPL (higher levels in patients with lower RRF and higher PPL). FGF-21 might be an important endocrine agent in PD patients and could act as hormonal signaling to maintain glucose homeostasis and prevent potential insulin resistance. These preliminary results suggest that FGF-21 might play a protective role as against the development of insulin resistance over time in patients undergoing a continuous glucose load.

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Peritoneal dialysis: from bench to bedside

Cited by 11 publications

References 63 publications

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Effluent and serum protein N-glycosylation is associated with inflammation and peritoneal membrane transport characteristics in peritoneal dialysis patients

Fibroblast Growth Factor 21 (FGF-21) in Peritoneal Dialysis Patients: Natural History and Metabolic Implications

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