Recent advances in the management of peritoneal dialysis patients

Anjali B Saxena, Anjali B Saxena

Abstract

Peritoneal dialysis is a form of kidney dialysis that is used to remove accumulated metabolic waste products and water in patients with end stage kidney disease. Long-term exposure to high concentrations of glucose and its by-products, both found in peritoneal dialysis fluid, has been implicated in contributing to peritoneal damage over time, in turn limiting long-term use of the technique. Newer peritoneal dialysis solutions have been developed in the hope of reducing the unfavorable effects of peritoneal dialysis solutions. In vitro and in vivo studies have suggested that newer peritoneal dialysis fluids have salutary effects on the peritoneal membrane. Short-term clinical studies have also found some metabolic benefits of glucose-sparing regimens in chronic peritoneal dialysis. Mixed results have been found in studies examining whether newer peritoneal dialysis fluids reduce peritonitis rates. Long-term studies are needed to investigate whether newer peritoneal dialysis fluids provide better peritoneal dialysis technique and/or patient survival, compared to standard glucose-based peritoneal dialysis fluids.

Figures

Figure 1.. Adverse effects of glucose-containing PDF
Figure 1.. Adverse effects of glucose-containing PDF
AGE, advanced glycosylation end product; GDP, glucose degradation product; PD, peritoneal dialysis; PDF, peritoneal dialysis fluid.

References

    1. Jain AK, Blake P, Cordy P, Garg AX. Global trends in rates of peritoneal dialysis. J Am Soc Nephrol. 2012;23:533–44. doi: 10.1681/ASN.2011060607.

    2. http://f1000.com/prime/721439008

    1. Nolph and gokal's textbook of peritoneal dialysis. 3. New York: Springer; 2008.
    1. Gotloib L, Wajsbrot V, Shostak A, Kushnier R. Morphology of the peritoneum: effect of peritoneal dialysis. Perit Dial Int. 1995;15:S9–11. discussion S-2.
    1. Linden T, Cohen A, Deppisch R, Kjellstrand P, Wieslander A. 3,4-Dideoxyglucosone-3-ene (3,4-DGE): a cytotoxic glucose degradation product in fluids for peritoneal dialysis. Kidney Int. 2002;62:697–703. doi: 10.1046/j.1523-1755.2002.00490.x.

    2. http://f1000.com/prime/725194689

    1. Nilsson-Thorell CB, Muscalu N, Andren AH, Kjellstrand PT, Wieslander AP. Heat sterilization of fluids for peritoneal dialysis gives rise to aldehydes. Perit Dial Int. 1993;13:208–13.
    1. Erixon M, Linden T, Kjellstrand P, Carlsson O, Ernebrant M, Forsback G, Wieslander A, Jonsson JA. PD fluids contain high concentrations of cytotoxic GDPs directly after sterilization. Perit Dial Int. 2004;24:392–8.

    2. http://f1000.com/prime/725368699

    1. Krediet RT, Zweers MM, van der Wal AC, Struijk DG. Neoangiogenesis in the peritoneal membrane. Perit Dial Int. 2000;20(Suppl 2):S19–25.

    2. http://f1000.com/prime/725368700

    1. Fusshoeller A. Histomorphological and functional changes of the peritoneal membrane during long-term peritoneal dialysis. Pediatr Nephrol. 2008;23:19–25. doi: 10.1007/s00467-007-0541-z.

    2. http://f1000.com/prime/722941690

    1. Breborowicz A, Pawlaczyk K, Polubinska A, Gorna K, Wieslander A, Carlsson O, Tam P, Wu G. Effect of peritoneal dialysis on renal morphology and function. Nephrol Dial Transplant. 2006;21:3539–44. doi: 10.1093/ndt/gfl402.

    2. http://f1000.com/prime/725072081

    1. Justo P, Sanz AB, Egido J, Ortiz A. 3,4-Dideoxyglucosone-3-ene induces apoptosis in renal tubular epithelial cells. Diabetes. 2005;54:2424–9. doi: 10.2337/diabetes.54.8.2424.

    2. http://f1000.com/prime/725084232

    1. Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, Krediet RT, Group NS. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int. 2002;62:1046–53. doi: 10.1046/j.1523-1755.2002.00505.x.

    2. http://f1000.com/prime/725194649

    1. Rottembourg J, Issad B, Gallego JL, Degoulet P, Aime F, Gueffaf B, Legrain M. Evolution of residual renal function in patients undergoing maintenance haemodialysis or continuous ambulatory peritoneal dialysis. Proc Eur Dial Transplant Assoc. 1983;19:397–403.
    1. Bargman JM, Thorpe KE, Churchill DN. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study. J Am Soc Nephrol. 12:2158–62.

    2. http://f1000.com/prime/721442120

    1. Skubala A, Zywiec J, Zelobowska K, Gumprecht J, Grzeszczak W. Continuous glucose monitoring system in 72-hour glucose profile assessment in patients with end-stage renal disease on maintenance continuous ambulatory peritoneal dialysis. Med Sci Monit. 2010;16:CR75–83.

    2. http://f1000.com/prime/725368701

    1. Holmes CJ, Shockley TR. Strategies to reduce glucose exposure in peritoneal dialysis patients. Perit Dial Int. 2000;20(Suppl 2):S37–41.
    1. Kjellstrand P, Martinson E, Wieslander A, Kjellstrand K, Jeppsson E, Svensson E, Jarkelid L, Linden T, Olsson LF. Degradation in peritoneal dialysis fluids may be avoided by using low pH and high glucose concentration. Perit Dial Int. 2001;21:338–44.

    2. http://f1000.com/prime/725368702

    1. Cho Y, Badve SV, Hawley CM, Wiggins K, Johnson DW. Biocompatible peritoneal dialysis fluids: clinical outcomes. International journal of nephrology. 2012;2012:812609.
    1. Chaudhary K, Khanna R. Biocompatible peritoneal dialysis solutions: do we have one? Clin J Am Soc Nephrol. 2010;5:723–32. doi: 10.2215/CJN.05720809.

    2. http://f1000.com/prime/725368703

    1. Paniagua R, Ventura MD, Avila-Diaz M, Cisneros A, Vicente-Martinez M, Furlong MD, Garcia-Gonzalez Z, Villanueva D, Orihuela O, Prado-Uribe MD, Alcantara G, Amato D. Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients. Perit Dial Int. 2009;29:422–32.

    2. http://f1000.com/prime/725368704

    1. Cho Y, Johnson DW, Craig JC, Strippoli GF, Badve SV, Wiggins KJ. Biocompatible dialysis fluids for peritoneal dialysis. Cochrane Database Syst Rev. 2014;3:CD007554. doi: 10.1002/14651858.CD007554.pub2.

    2. http://f1000.com/prime/718325956

    1. Bargman JM. Slouching towards Bethlehem: the beast of biocompatibility. Nephrol Dial Transplant. 2010;25:2050–1. doi: 10.1093/ndt/gfq213.
    1. Martikainen T, Teppo AM, Gronhagen-Riska C, Ekstrand A. Benefit of glucose-free dialysis solutions on glucose and lipid metabolism in peritoneal dialysis patients. Blood Purif. 2005;23:303–10. doi: 10.1159/000086553.

    2. http://f1000.com/prime/725368705

    1. Li PK, Culleton BF, Ariza A, Do JY, Johnson DW, Sanabria M, Shockley TR, Story K, Vatazin A, Verrelli M, Yu AW, Bargman JM, Impendia, Groups ES Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients. J Am Soc Nephrol. 2013;24:1889–900. doi: 10.1681/ASN.2012100987.

    2. http://f1000.com/prime/718078488

    1. Blake PG, Jain AK, Yohanna S. Biocompatible peritoneal dialysis solutions: many questions but few answers. Kidney Int. 2013;84:864–6. doi: 10.1038/ki.2013.303.

Source: PubMed

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