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Claus Peter Schmitt - One of the best experts on this subject based on the ideXlab platform.
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Is there such a thing as biocompatible peritoneal Dialysis Fluid?
Pediatric Nephrology, 2017Co-Authors: Claus Peter Schmitt, Christoph AufrichtAbstract:Introduction of the so-called biocompatible peritoneal Dialysis (PD) Fluids was based on a large body of experimental evidence and various clinical trials suggesting important clinical benefits. Of these, until now, only preservation of residual renal function—likely due to lower glucose degradation product load and, in case of icodextrin, improved Fluid and blood pressure control—have consistently been proven, whereas the impact on important clinical endpoints such as infectious complications, preservation of PD membrane transport function, and patient outcome, are still debated. In view of the high morbidity and mortality rates of PD patients, novel approaches are warranted and comprise the search for alternative osmotic agents and enrichment of PD Fluids with specific pharmacologic agents, such as alanyl-glutamine, potentially counteracting local but also systemic sequelae of uremia and PD.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:Effects of pH-neutral, bicarbonate-buffered Dialysis Fluid on peritoneal transport kinetics in children. Background Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). Methods Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m 2 , dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. Results While intraperitoneal pH was constant at 7.41 ± 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 ± 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, β 2 -microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. Conclusion The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:BACKGROUND: Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). METHODS: Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m2, dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. RESULTS: While intraperitoneal pH was constant at 7.41 +/- 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 +/- 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, beta2-microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. CONCLUSION: The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
Franz Schaefer - One of the best experts on this subject based on the ideXlab platform.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:Effects of pH-neutral, bicarbonate-buffered Dialysis Fluid on peritoneal transport kinetics in children. Background Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). Methods Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m 2 , dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. Results While intraperitoneal pH was constant at 7.41 ± 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 ± 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, β 2 -microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. Conclusion The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:BACKGROUND: Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). METHODS: Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m2, dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. RESULTS: While intraperitoneal pH was constant at 7.41 +/- 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 +/- 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, beta2-microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. CONCLUSION: The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
John D Williams - One of the best experts on this subject based on the ideXlab platform.
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the euro balance trial the effect of a new biocompatible peritoneal Dialysis Fluid balance on the peritoneal membrane
Kidney International, 2004Co-Authors: John D Williams, Nicholas Topley, Kathrine Jane Craig, Ruth Mackenzie, Monika Pischetsrieder, Cristina Lage, Jutta PasslickdeetjenAbstract:The Euro-Balance Trial: The effect of a new biocompatible peritoneal Dialysis Fluid (balance) on the peritoneal membrane. Background Although peritoneal Dialysis (PD) is a widely accepted form of renal replacement therapy (RRT), concerns remain regarding the bioincompatible nature of standard PD Fluid. In order to evaluate whether a newly formulated Fluid of neutral pH, and containing low levels of glucose degradation products (GDP), resulted in improved in vivo biocompatibility, it was compared in a clinical study to a standard PD Fluid. Methods In a multicenter, open, randomized, prospective study with a crossover design and parallel arms, a conventional, acidic, lactate-buffered Fluid (SPDF) was compared with a pH neutral, lactate-buffered, low GDP Fluid (balance). Overnight effluent was collected and assayed for cancer antigen 125 (CA125), hyaluronic acid (HA), procollagen peptide (PICP), vascular endothelial growth factor (VEGF), and tumor necrosis factor alpha (TNFα). Serum samples were assayed for circulating advanced glycosylation end products (AGE), N e -(carboxymethyl)lysine (CML), and imidazolone. Clinical end points were residual renal function (RRF), adequacy of Dialysis, ultrafiltration, and peritoneal membrane function. Eighty-six patients were randomized to either group I starting with SPDF for 12 weeks (Phase I), then switching to "balance" for 12 weeks (Phase II), or group II, which was treated vice versa. Seventy-one patients completed the study with data suitable for entry into the per protocol analysis. Effluent and serum samples, together with peritoneal function tests and adequacy measurements, were undertaken at study centers on three occasions during the study: after the four-week run-in period, after Phase I, and again after Phase II. Results In patients treated with balance there were significantly higher effluent levels of CA125 and PICP in both arms of the study. Conversely, levels of HA were lower in patients exposed to balance, while there was no change in the levels of either VEGF or TNFα. Serum CML and imidazolone levels fell significantly in balance-treated patients. Renal urea and creatinine clearances were higher in both treatment arms after patients were exposed to balance. Urine volume was higher in patients exposed to balance. In contrast, peritoneal ultrafiltration was higher in patients on SPDF. When anuric patients were analyzed as a subgroup, there was no significant difference in peritoneal transport characteristics or in ultrafiltration on either Fluid. There were no changes in peritonitis incidence on either solution. Conclusion This study indicates that the use of balance, a neutral pH, low GDP Fluid, is accompanied by a significant improvement in effluent markers of peritoneal membrane integrity and significantly decreased circulating AGE levels. Clinical parameters suggest an improvement in residual renal function on balance, with an accompanying decrease in peritoneal ultrafiltration. It would appear that balance solution results in an improvement in local peritoneal homeostasis, as well as having a positive impact on systemic parameters, including circulating AGE and residual renal function.
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spurious hyperglycaemia and icodextrin in peritoneal Dialysis Fluid
BMJ, 2003Co-Authors: Stephen George Riley, James Chess, Kieron Donovan, John D WilliamsAbstract:Diabetes mellitus, in particular type 2, has become more common, and the trend is likely to continue.1 Associated comorbidity is also more common—for example, diabetes is now the most common cause of Dialysis dependent renal failure in the Western world.2 In the United Kingdom between 1991 and 1998, the incidence of new patients on Dialysis increased from 67 to more than 90 patients per million population, and the prevalence of diabetes in people receiving Dialysis has increased from 16% to 19%.3 The increasing demand for Dialysis and slower growth in capacity for haemoDialysis has reinforced the need for an integrated approach to providing Dialysis. Peritoneal Dialysis is the preferred option for a proportion of patients with end stage renal failure.4 A subgroup of patients has difficulties with removing Fluid. This can be improved with an alternative osmotic agent based on a polymer of glucose—icodextrin.5 We report a severe potentially clinical consequence of using icodextrin in a diabetic patient, which although mentioned in a specialist journal is still not widely recognised. This issue is even more important given the increasing number of diabetic patients with end stage renal failure. About 500 patients in …
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effect of lactate buffered peritoneal Dialysis Fluids on human peritoneal mesothelial cell interleukin 6 and prostaglandin synthesis
Kidney International, 1995Co-Authors: Janusz Witowski, Nicholas Topley, Achim Jorres, Tomasz Liberek, G A Coles, John D WilliamsAbstract:Effect of lactate-buffered peritoneal Dialysis Fluids on human mesothelial cell interleukin-6 and prostaglandin synthesis. The present study focused on the evaluation of constitutive and cytokine-stimulated human peritoneal mesothelial cell (HPMC) IL-6 and 6-keto-PGF1α, release following pre-exposure to peritoneal Dialysis Fluid (PDF). Exposure of HPMC to PDF pH 5.2 resulted in a time-dependent increase in cell cytotoxicity [as assessed by lactate dehydrogenase (LDH) release] and concomitant inhibition of constitutive and IL-1β stimulated IL-6 and 6-keto-PGF1α synthesis. After 15 minutes of exposure to PDF constitutive and IL-1β stimulated IL-6 release were reduced by 32.0 ± 9.7% and 76.0 ± 7.4% (N = 6, P
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peritoneal Dialysis Fluid inhibition of phagocyte function effects of osmolality and glucose concentration
Journal of The American Society of Nephrology, 1993Co-Authors: Tomasz Liberek, Nicholas Topley, Achim Jorres, Gerhard M Gahl, Gerald A Coles, John D WilliamsAbstract:Solutions were formulated to examine, independently, the roles of osmolality and glucose in the reduction of viability and inhibition of phagocyte function by dextrose-containing peritoneal Dialysis Fluids. The exposure of neutrophils (polymorphonuclear leukocytes) to test Fluids containing > or = 2.7% (wt/vol) glucose resulted in significant cytotoxicity as assessed by the release of lactate dehydrogenase above control values (7.12 +/- 2.65%). At the highest concentration of glucose (4.5%), lactate dehydrogenase release was 15.83 +/- 0.49% (P < 0.05). These effects were directly related to the presence of D-glucose in the test Fluids. In contrast, phagocytosis and the release of leukotriene B4 from PMN stimulated with serum-treated zymosan were significantly inhibited in an osmolality-, but not glucose-, dependent manner. The inhibition of tumor necrosis factor alpha and interleukin-6 release from mononuclear leukocytes was inhibited by a combination of osmolality and monosaccharide concentration. Under the same conditions, PMN respiratory burst activation remained unaffected irrespective of glucose concentration or Fluid osmolality. These data indicate that, in addition to the low pH of peritoneal Dialysis Fluid and its high lactate concentration, its glucose content (either directly or as a consequence of the resulting hyperosmolality of the Fluid) inhibits cell functional parameters. These findings suggest clinically significant inhibition of host defense mechanisms because, in high-glucose Dialysis Fluids, osmolality does not reach physiologic values, even during extended intraperitoneal dwell periods.
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peritoneal Dialysis Fluid inhibition of polymorphonuclear leukocyte respiratory burst activation is related to the lowering of intracellular ph
Nephron, 1993Co-Authors: Tomasz Liberek, Nicholas Topley, Achim Jorres, G A Coles, Meryl M Petersen, Gerhard M Gahl, John D WilliamsAbstract:In order to elucidate the mechanism of peritoneal Dialysis Fluid inhibition of cell functions, laboratory-prepared Fluids were used to investigate the specific influences of low pH and high lactate co
Börje Haraldsson - One of the best experts on this subject based on the ideXlab platform.
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effect of peritoneal Dialysis Fluid composition on peritoneal area available for exchange in children
Nephrology Dialysis Transplantation, 2004Co-Authors: Michel Fischbach, Joelle Terzic, Sylvie Chauve, Vincent Laugel, Audrey Muller, Börje HaraldssonAbstract:Background. Although conventional peritoneal Dialysis Fluids (PDFs), such as Dianeal, are non-physiological in composition, new PDFs including Physioneal have a more neutral pH, are at least partially buffered with bicarbonate and, most importantly, contain low concentrations of glucose degradation products (GDPs). Methods. To evaluate the impact of new PDFs in childcare, we performed a comparative crossover study with Dianeal and Physioneal. We examined both intraperitoneal pressure (IPP), which partly reflects pain induction, and the total pore area available for exchange, which indicates the number of capillaries perfused in the peritoneal membrane at any given moment and therefore partly reflects peritoneal Dialysis capacity. The IPP was determined after inflow of 1000 ml/m 2 body surface area (BSA) of dialysate (intraperitoneal volume; IPV). The steady-state unrestricted area over diffusion distance (A0/x ,i n cm 2 /cm per 1.73 m 2 BSA) was calculated from the three-pore theory. Six children were enrolled in the study. On the first day, two consecutive peritoneal equilibration tests of 90 min each were performed using first Dianeal and then Physioneal. On the second study day, the procedure was repeated with the Fluids given in the opposite order. Results. The mean IPP normalized to IPV (ml/m 2 ) was significantly higher for Dianeal (9.5 ± 0.9 cm/1000 ml/m 2 ) than for Physioneal (7.9 ± 1.2 cm/1000 ml/m 2 , P < 0.01). The mean A0/x was 17 ± 4% larger with Dianeal (36 095 ± 2009 cm 2 /cm per 1.73 m 2 ) than with Physioneal (31 780 ± 2185 cm 2 /cm per 1.73 m 2 , P < 0.001; based on 24 data pairs). Conclusions. These pilot study results suggest a higher biocompatibility for Physioneal than for Dianeal. Less inflow pain associated with Physioneal induced a lower IPP reflecting enhanced fill volume tolerance, and the lower A0/x reflected less capillary recruitment. Taken together, these results suggest that the new more biocompatible PDFs will improve peritoneal Dialysis therapy, although this conclusion will require verification in extended clinical trials.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:Effects of pH-neutral, bicarbonate-buffered Dialysis Fluid on peritoneal transport kinetics in children. Background Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). Methods Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m 2 , dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. Results While intraperitoneal pH was constant at 7.41 ± 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 ± 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, β 2 -microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. Conclusion The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:BACKGROUND: Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). METHODS: Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m2, dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. RESULTS: While intraperitoneal pH was constant at 7.41 +/- 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 +/- 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, beta2-microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. CONCLUSION: The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
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Long-term clinical effects of a peritoneal Dialysis Fluid with less glucose degradation products
Kidney international, 2001Co-Authors: Bengt Rippe, Ole Simonsen, Olle Heimbürger, Anders Christensson, Börje Haraldsson, Gunnar Stelin, Lars Weiss, Finn.-david. Nielsen, Susanne Bro, Michael FriedbergAbstract:Long-term clinical effects of a peritoneal Dialysis Fluid with less glucose degradation products. Background Glucose degradation products (GDPs) are cytotoxic in vitro and potentially toxic in vivo during peritoneal Dialysis (PD). We are presenting the results of a two-year randomized clinical trial of a new PD Fluid, produced in a two-compartment bag and designed to minimize heat-induced glucose degradation while producing a near neutral pH. The effects of the new Fluid over two years of treatment on membrane transport characteristics, ultrafiltration (UF) capacity, and effluent markers of peritoneal membrane integrity were investigated and compared with those obtained during treatment with a standard solution. Design A two-group parallel design with 80 continuous ambulatory peritoneal Dialysis patients was used. The patients were randomly assigned to either the new Fluid ( N = 40) or to a conventional one ( N = 40), and were stratified with respect to age, diabetes, and time on PD. Peritoneal transport characteristics were assessed by the Personal Dialysis Capacity (PDC™) test at 1, 6, 12, 18, and 24 months after inclusion and by weighing the overnight bag daily. Infusion pain and handling were evaluated using a questionnaire. Peritoneal mesothelial and interstitial integrity were evaluated by analyzing overnight effluent dialysate concentrations of CA 125, hyaluronan (HA), procollagen-1-C-terminal peptide (PICP), and procollagen-3-N-terminal peptide (PIIINP) at 1, 6, 12, 18, and 24 months. Results The handling of the new two-compartment bag was considered easy, and there were no indications of increased discomfort with the new system. Furthermore, no changes in peritoneal Fluid or solute transport characteristics were observed during the study period for either Fluid, and neither were there any differences with regard to peritonitis incidence. However, significantly higher dialysate CA 125 (73 ± 41 vs. 25 ± 18 U/mL), PICP (387 ± 163 vs. 244 ± 81 ng/mL), and PIIINP (50 ± 24 vs. 29 ± 13 ng/mL) and significantly lower concentrations of HA (395 ± 185 vs. 530 ± 298 ng/mL) were observed in the overnight effluent during treatment with the new Fluid. Conclusions We conclude that the new Fluid with a higher pH and less GDPs is safe and easy to use and has no negative effects on either the frequency of peritonitis or peritoneal transport characteristics as compared with conventional ones. Our results indicate that the new solution causes less mesothelial and interstitial damage than conventional ones; that is, it may be considered more biocompatible than a number of conventional PD solutions currently in use.
Jutta Passlickdeetjen - One of the best experts on this subject based on the ideXlab platform.
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the euro balance trial the effect of a new biocompatible peritoneal Dialysis Fluid balance on the peritoneal membrane
Kidney International, 2004Co-Authors: John D Williams, Nicholas Topley, Kathrine Jane Craig, Ruth Mackenzie, Monika Pischetsrieder, Cristina Lage, Jutta PasslickdeetjenAbstract:The Euro-Balance Trial: The effect of a new biocompatible peritoneal Dialysis Fluid (balance) on the peritoneal membrane. Background Although peritoneal Dialysis (PD) is a widely accepted form of renal replacement therapy (RRT), concerns remain regarding the bioincompatible nature of standard PD Fluid. In order to evaluate whether a newly formulated Fluid of neutral pH, and containing low levels of glucose degradation products (GDP), resulted in improved in vivo biocompatibility, it was compared in a clinical study to a standard PD Fluid. Methods In a multicenter, open, randomized, prospective study with a crossover design and parallel arms, a conventional, acidic, lactate-buffered Fluid (SPDF) was compared with a pH neutral, lactate-buffered, low GDP Fluid (balance). Overnight effluent was collected and assayed for cancer antigen 125 (CA125), hyaluronic acid (HA), procollagen peptide (PICP), vascular endothelial growth factor (VEGF), and tumor necrosis factor alpha (TNFα). Serum samples were assayed for circulating advanced glycosylation end products (AGE), N e -(carboxymethyl)lysine (CML), and imidazolone. Clinical end points were residual renal function (RRF), adequacy of Dialysis, ultrafiltration, and peritoneal membrane function. Eighty-six patients were randomized to either group I starting with SPDF for 12 weeks (Phase I), then switching to "balance" for 12 weeks (Phase II), or group II, which was treated vice versa. Seventy-one patients completed the study with data suitable for entry into the per protocol analysis. Effluent and serum samples, together with peritoneal function tests and adequacy measurements, were undertaken at study centers on three occasions during the study: after the four-week run-in period, after Phase I, and again after Phase II. Results In patients treated with balance there were significantly higher effluent levels of CA125 and PICP in both arms of the study. Conversely, levels of HA were lower in patients exposed to balance, while there was no change in the levels of either VEGF or TNFα. Serum CML and imidazolone levels fell significantly in balance-treated patients. Renal urea and creatinine clearances were higher in both treatment arms after patients were exposed to balance. Urine volume was higher in patients exposed to balance. In contrast, peritoneal ultrafiltration was higher in patients on SPDF. When anuric patients were analyzed as a subgroup, there was no significant difference in peritoneal transport characteristics or in ultrafiltration on either Fluid. There were no changes in peritonitis incidence on either solution. Conclusion This study indicates that the use of balance, a neutral pH, low GDP Fluid, is accompanied by a significant improvement in effluent markers of peritoneal membrane integrity and significantly decreased circulating AGE levels. Clinical parameters suggest an improvement in residual renal function on balance, with an accompanying decrease in peritoneal ultrafiltration. It would appear that balance solution results in an improvement in local peritoneal homeostasis, as well as having a positive impact on systemic parameters, including circulating AGE and residual renal function.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:Effects of pH-neutral, bicarbonate-buffered Dialysis Fluid on peritoneal transport kinetics in children. Background Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). Methods Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m 2 , dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. Results While intraperitoneal pH was constant at 7.41 ± 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 ± 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, β 2 -microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. Conclusion The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.
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effects of ph neutral bicarbonate buffered Dialysis Fluid on peritoneal transport kinetics in children
Kidney International, 2002Co-Authors: Claus Peter Schmitt, Börje Haraldsson, Jutta Passlickdeetjen, Rouven Doetschmann, Mirjam Zimmering, Christine Greiner, M Boswald, Gunter Klaus, Franz SchaeferAbstract:BACKGROUND: Due to their superior biocompatibility, pH-neutral solutions are beginning to replace acidic lactate-buffered peritoneal Dialysis (PD) Fluids. We hypothesized that pH-neutral and acidic solutions might differentially affect peritoneal transport in the early dwell phase, due to differences in ionic shifts and initial peritoneal vasodilation. Such differences may become clinically relevant in patients with frequent short cycles on automated PD (APD). METHODS: Twenty-five children were treated with a lactate-buffered (35 mmol/L, pH 5.5) or a bicarbonate-buffered PD solution (34 mmol/L, pH 7.4) in randomized order on two sequential days. Each day a four-hour Standardized Permeability Analysis (SPA) was performed, followed by overnight APD (7 cycles, fill volume 1000 mL/m2, dwell time 75 min). Functional peritoneal surface area was dynamically assessed using the three-pore model. RESULTS: While intraperitoneal pH was constant at 7.41 +/- 0.03 throughout the SPA with bicarbonate Fluid, the dialysate remained acidic for more than one hour with lactate solution (pH 7.12 +/- 0.08 at 1 h). Total pore area was 60% higher during the first 30 minutes of the dwell than under steady-state conditions, without a difference between acidic and pH-neutral Fluid. Net base gain, intraperitoneal volume kinetics, glucose absorption, ultrafiltration rate, effective lymphatic absorption and the transport of urea, potassium, beta2-microglobulin and albumin were similar with both Fluids. However, phosphate and creatinine elimination were 10% lower with bicarbonate PD Fluid, resulting in corresponding significant decreases in the 24-hour clearances of these solutes. CONCLUSION: The peritoneal surface area is not measurably influenced by pH-neutral PD Fluid. Creatinine and phosphate elimination appears to be slightly reduced with bicarbonate Fluid; this observation awaits clarification in extended therapeutical trials.