The history of peritoneal dialysis: Early years at Toronto Western Hospital

Oreopoulos, Dimitrios G.; Thodis, Elias

doi:10.1002/dat.20476

Cited by 18 publications

(18 citation statements)

References 12 publications

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“…During the very early days of PD, the composition of PD solutions varied widely from normal saline to 5% dextrose [1]. Maxwell and colleagues first developed PD solutions akin to currently used conventional PD solutions [2].…”

Section: Conventional Pd Solutionsmentioning

confidence: 99%

Peritoneal Dialysis Solutions

Mahmood¹,

Cho²,

Johnson³

2016

Some Special Problems in Peritoneal Dialysis

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Conventional peritoneal dialysis PD solutions are characterized by several undesirable characteristics, including acidic pH . . , high glucose concentrations . . g/L , hyperosmolarity mOsm/kg and relatively high concentrations of glucose degradation products GDPs . These characteristics have been shown to result in adverse clinical outcomes, including acute peritoneal membrane toxicity manifested as inflow pain , chronic peritoneal toxicity including membrane failure, ultrafiltration failure, peritonitis and encapsulating peritoneal sclerosis and adverse systemic sequelae including hyperglycaemia, dyslipidaemia, metabolic syndrome, cardiovascular disease and residual renal function decline . Consequently, there has been a great interest in manufacturing newer solutions with more biocompatible features to mitigate these adverse effects. This has led to the development of neutral-pH, low or ultralow GDP solutions, glucose-sparing PD solutions icodextrin and amino acid solutions , solutions using alternative osmotic agents such as hyperbranched polyglycerol and low-sodium PD solutions. The aim of this chapter is to provide an up-to-date comprehensive review of all types of PD solutions that are currently available, including their impact on patient-level outcomes.

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Section: Conventional Pd Solutionsmentioning

confidence: 99%

Peritoneal Dialysis Solutions

Mahmood¹,

Cho²,

Johnson³

2016

Some Special Problems in Peritoneal Dialysis

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“…Most of the earlier cyclers were modeled after Lasker’s, and the initial PD cycler was developed in Seattle, 1962. 4 , 5 PD cyclers have evolved since that time with rapidly advancing technology. At present, there are currently two major companies, Baxter and Fresenius, that manufacture PD cyclers in the US and enable this form of dialysis to be available countrywide.…”

Section: Introductionmentioning

confidence: 99%

Automated cyclers used in peritoneal dialysis: technical aspects for the clinician

Chaudhry¹,

Golper²

2015

MDER

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Peritoneal dialysis (PD) is a widely accepted and increasingly popular form of dialysis. The invention and technological advancement of the PD cycler further makes PD a convenient option. Prescription-specific parameters are entered into the cycler, which then automatically carries out the steps involved in continuous cycling PD. We review the basics, technical aspects, challenges, and advancements of the cycler.

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“…First, our estimates of the minimum GFR necessary to achieve weekly clearance targets of approximately (16). In subsequent reviews of this early experience, the investigators acknowledged that, in their opinion, IPD provided adequate dialysis until RKF was significantly lost.…”

Section: Discussionmentioning

confidence: 99%

Intermittent Peritoneal Dialysis: Urea Kinetic Modeling and Implications of Residual Kidney Function

et al. 2012

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♦ Background: Intermittent peritoneal dialysis (IPD) is an old strategy that has generally been eclipsed, in the home setting, by daily peritoneal therapies. However, for a select group of patients with exhausted vascular access or inability to receive PD at home, in-center IPD may remain an option or may serve as an incremental strategy before initiation of full-dose PD. We investigated the residual kidney clearance requirements necessary to allow thrice-weekly IPD regimens to meet current adequacy targets. ♦ Methods: The 3-pore model of peritoneal transport was used to examine 2 thrice-weekly IPD dialysis modalities: 5 -6 dwells with 10 -12 L total volume (low-dose IPD), and 50% tidal with 20 -24 L total volume (high-dose IPD). We assumed an 8-hour dialysis duration and 1.5% dextrose solution, with a 2-L fill volume, except in tidal mode. The PD Adequest application (version 2.0: Baxter Healthcare Corporation, Deerfield, IL, USA) and typical patient kinetic parameters derived from a large dataset [data on file from Treatment Adequacy Review for Gaining Enhanced Therapy (Baxter Healthcare Corporation)] were used to model urea clearances. The minimum glomerular filtration rate (GFR) required to achieve a total weekly urea Kt/V of 1.7 was calculated. ♦ Results: In the absence of any dialysis, the minimum residual GFR necessary to achieve a weekly urea Kt/V of 1.7 was 9.7 mL/min/1.73 m 2 . Depending on membrane transport type, the low-dose IPD modality met urea clearance targets for patients with a GFR between 6.0 mL/ min/1.73 m 2 and 7.6 mL/min/1.73 m 2 . Similarly, the high-dose IPD modality met the urea clearance target for patients with a GFR between 4.7 mL/min/1.73 m 2 and 6.5 mL/min/1.73 m 2 . ♦ Conclusions: In patients with residual GFR of at least 7.6 mL/min/1.73 m 2 , thrice-weekly low-dose IPD (10 L) achieved a Kt/V urea of 1.7 across all transport types. Increasing the IPD volume resulted in a decreased residual GFR requirement of 4.7 mL/min/1.73 m 2 (24 L, 50% tidal). In patients with residual kidney function and dietary compliance, IPD may be a viable strategy in certain clinical situations.

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The history of peritoneal dialysis: Early years at Toronto Western Hospital

Cited by 18 publications

References 12 publications

Peritoneal Dialysis Solutions

Peritoneal Dialysis Solutions

Automated cyclers used in peritoneal dialysis: technical aspects for the clinician

Intermittent Peritoneal Dialysis: Urea Kinetic Modeling and Implications of Residual Kidney Function

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