Sodium Balance in Automated Peritoneal Dialysis

Struijk, Dirk G.; Krediet, Raymond T.

doi:10.1177/089686080002002s20

Cited by 26 publications

(21 citation statements)

References 20 publications

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“…Our study had a high proportion of patients prescribed icodextrin and APD cyclers, and yet we found that faster transport was still associated with increased SBP, ECW expansion and raised NTproBNP. Although APD cyclers allow faster transporters to achieve greater ultrafiltration, the shorter cycle dwell times result in a relative greater water transport through aquaporin channels compared to sodium removal by active Na/K ATPase transporters and Na cotransporters, so increasing the risk of sodium retention and systolic hypertension [33].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with systolic hypertension in peritoneal dialysis patients

Vongsanim

Davenport

2019

J Nephrol

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Background Hypertension is common in peritoneal dialysis (PD) patients and associated with adverse outcomes. Besides solute clearance, PD convective clearance is used to control extracellular water (ECW) volume and sodium balance. Previous studies have reported on hypertension in PD patients treated with continuous ambulatory peritoneal dialysis (CAPD) using hypertonic glucose dialysates. However, increasing numbers of PD patients are now treated with automated peritoneal dialysis (APD) and icodextrin dialysates. As such, we wished to explore factors associated with systolic blood pressure (SBP) in a modern cohort to identify targets to improve blood pressure control in PD patients. Methods We retrospectively reviewed the results from PD patients attending for peritoneal membrane assessment who had corresponding bioimpedance ECW and brain natriuretic peptide (NT-proBNP) measurements. Results We studied 510 PD patients: 317 (72.2%) male, 216 (42.4%) diabetics, median age 59 (47-72) years, and 51% treated by APD with a daytime icodextrin exchange. Mean systolic blood pressure (SBP) was 140 ± 24.8 mmHg. SBP was independently associated with 4-hour dialysate to plasma creatinine ratio (β = 29.5 (95% confidence limits 11.4-47.5, p = 0.001), N-terminal brain natriuretic peptide [β = 11.9 (7.2-16.7), p < 0.001], and daily urine sodium excretion [β = 1.7 (1.0-2.3), p < 0.001]. Conclusion In the era of APD cyclers and icodextrin, SBP is associated with increased NT-proBNP, a marker of ECW expansion, and faster peritoneal transport, a risk factor for a positive sodium balance, and increased urinary sodium suggestive of higher dietary sodium intake. Patients should be encouraged to restrict sodium intake and PD prescriptions targeted to control ECW to improve SBP control.

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Section: Discussionmentioning

confidence: 99%

Factors associated with systolic hypertension in peritoneal dialysis patients

Vongsanim

Davenport

2019

J Nephrol

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“…Rodriguez-Carmona et al have shown that standard APD schedules are frequently associated with poor Na removal rates and this may influence the cardiovascular outcomes in APD patients [ 36 ].This low sodium removal is justified, due to the short dwell schedule during the night session that may result in significant Na sieving and less efficient Na removal of this cation [ 37 ]. They have also suggested that longer nocturnal dwell times and supplementary diurnal exchanges, can improve Na removal in APD [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients

Vega-Díaz

Gonzalez-Cabrera

Marrero-Robayna

et al. 2015

JCM

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Background: In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD), a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF) in patients on peritoneal dialysis (PD) is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD) patients, with end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in comparison to non-diabetic nephropathy (NDN), using different PD solutions in combination. Design: Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. Results: The fraction of renal urea clearance (Kt) relative to distribution volume (V) (or total body water) (Kt/V), or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl) decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively), and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively). Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0.22, 12 months 1.63 ± 0.39, 24 months 1.73 ± 0.47; NDN: baseline 1.59 ± 0.40, 12 months 1.76 ± 0.47, 24 months 1.80 ± 0.46), in order to maintain the net water balance. The daytime dwell contribution, the fraction of day and the renal fraction of studies parameters provide sustained benefit in the follow-up time, above 30%. Conclusions: The wet day and residual renal function are determinants in the achievement of the objective dose of dialysis, as well as in the water and sodium balance. The cause of chronic kidney disease (CKD) does not seem to influence the cleansing effectiveness of the technique.

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“…4 PDI This hindrance in the removal of sodium compared with the removal of water is not clinically important during CAPD because the increment in the concentration gradient is counteracted by increased diffusion of sodium. However, during short dwells, as are often applied in APD, much more water than sodium can be removed from the extracellular volume (60,61). In this context, it is likely that the dialysate sodium concentration does not have time to equilibrate with the plasma concentration given the short dwell times used in HVPD.…”

Section: Sodium Disordersmentioning

confidence: 99%

Approach to the Metabolic Implications of Peritoneal Dialysis in Acute Kidney Injury

et al. 2015

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During the 1970s and 1980s, peritoneal dialysis (PD) was widely accepted as the standard treatment for acute kidney injury (AKI). However, advances in the techniques of extracorporeal blood purification gradually reduced its use, making PD an underused modality in this context. Although PD for AKI is an underutilized modality worldwide, it is frequently used in developing countries because of its lower cost and minimal infrastructure requirements. Recent studies have shown that PD administered continuously through a flexible catheter and cycler is an effective treatment in AKI because it ensures adequate fluid status and metabolic control. However, the use of PD in AKI has several limitations, such as the need for an intact peritoneal cavity and, in emergency situations such as severe fluid overload and severe hyperkalemia, an efficacy that is lower than that with extracorporeal blood purification techniques. Metabolic, infectious, and mechanical disorders related to PD are also limitations.Among the metabolic complications of PD are hyperglycemia, hypernatremia, protein loss into the dialysate, and hypercatabolism. Hyperglycemia is caused by the use of dialysate containing high concentrations of glucose. Hypernatremia is a result of short dialysate dwell times during the rapid exchanges of high-volume PD. Protein loss into the dialysate can reach 48 g daily, worsening the nutrition status of patients already depleted by AKI. Severe hypercatabolism caused by PD remains controversial and occurs because PD methods cannot provide an adequate dialysis dose for AKI patients.Few studies have assessed the metabolic implications of PD in AKI patients. Evaluation of these implications is relatively simple, imposes no additional costs, and can provide information about the severity of the disease. Evaluation could also guide the selection of therapeutic, dialytic, and nutrition measures, preventing metabolic complications. The present manuscript describes the metabolic implications of PD and reviews the literature on how to prevent metabolic complications.

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Sodium Balance in Automated Peritoneal Dialysis

Cited by 26 publications

References 20 publications

Factors associated with systolic hypertension in peritoneal dialysis patients

Factors associated with systolic hypertension in peritoneal dialysis patients

Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients

Approach to the Metabolic Implications of Peritoneal Dialysis in Acute Kidney Injury

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