Can one long peritoneal dwell with icodextrin replace two short dwells with glucose?

Background: Due to the slower dissipation of the osmotic gradient, icodextrin-based solutions, compared to glucose-based solutions, can improve water removal. We investigated scenarios where one icodextrin-based long dwell (Extraneal) replaced two glucose-based exchanges.

Methods: The three-pore model with icodextrin hydrolysis was used for numerical simulations of a single exchange to investigate the impact of different peritoneal dialysis schedules on fluid and solute removal in patients with different peritoneal solute transfer rates (PSTRs).

Modelling of icodextrin hydrolysis and kinetics during peritoneal dialysis.

In peritoneal dialysis, ultrafiltration is achieved by adding an osmotic agent into the dialysis fluid. During an exchange with icodextrin-based solution, polysaccharide chains are degraded by α-amylase activity in dialysate, influencing its osmotic properties. We modelled water and solute removal taking into account degradation by α-amylase and absorption of icodextrin from the peritoneal cavity.

Long Peritoneal Dialysis Dwells With Icodextrin: Kinetics of Transperitoneal Fluid and Polyglucose Transport.

During peritoneal dialysis (PD), the period of effective net peritoneal ultrafiltration during long dwells can be extended by using the colloidal osmotic agent icodextrin but there are few detailed studies on ultrafiltration with icodextrin solution exceeding 12 h. We analyzed kinetics of peritoneal ultrafiltration in relation to icodextrin and its metabolites for 16-h dwells with icodextrin. In 20 clinically stable patients (mean age 54 years; 8 women; mean preceding time on PD 26 months), intraperitoneal dialysate volume (V) was estimated from dilution of I-human serum albumin during 16-h dwell studies with icodextrin 7.

Extracorporeal versus peritoneal ultrafiltration in diuretic-resistant congestive heart failure--a review.

Diuretic-resistant congestive heart failure in the form of type 2 cardiorenal syndrome is a problem of growing significance in everyday clinical practice because of high morbidity and mortality. There has been scant progress in the treatment of overhydration, the main cause of symptoms in this group of patients. The aim of our review is to present recent advances in the ultrafiltration therapy of congestive heart failure, with special attention to the new dedicated device for extracorporeal isolated ultrafiltration, as well as modifications of peritoneal dialysis in the form of peritoneal ultrafiltration with icodextrin solution and incremental peritoneal dialysis.

Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment: case report.

This report describes the use of continuous peritoneal dialysis (PD) as an alternative to hemodialysis (HD) in a patient with type 2 cardiorenal syndrome in the course of congestive heart failure resistant to standard pharmacological treatment. A 39-year-old man presented with a 24-year history of progressive heart failure. Ineligibility for heart transplant and previous inefficient treatment with different modifications of HD reduced his treatment options to PD.

Peritoneal dialysis as a therapeutic approach in congestive heart failure resistant to pharmacological treatment.

Given an increasing number of patients with congestive heart failure (CHF) refractory to diuretics, new and more effective therapeutic modalities are sought. Peritoneal dialysis (PD), which provides continuous, slow ultrafiltration, may be an alternative to hemodialysis in this population. The current paper, based on a comprehensive literature review, addresses the role of PD in improving the quality of life of patients with CHF.

The kinetics of water transperitoneal transport during long-term peritoneal dialysis performed using icodextrin dialysis fluid.

Introduction: Dialysis fluid containing icodextrin is used in patients on peritoneal dialysis (PD) because of its significant ultrafiltration properties. The use of the fluid in treating patients with congestive heart failure resistant to diuretics has also been reported.

Objectives: The aim of the study was to evaluate water peritoneal transport during a 16-hour dialysis exchange performed using icodextrin-containing dialysis fluid.

[Biocompatibility of dialysis fluid in peritoneal dialysis--limitations and possibilities of improvement].

Standard glucose dialysis solutions are characterised by low biocompatibility because of hyperosmolality, low pH, lactate buffer and presence of glucose degradation products. These factors cause failure of peritoneum as dialysis membrane. In our paper we present problems of biocompatibility of glucose-based solutions as well as possibilities of improvement in this field thanks to application of alternative solutions.

[Glucose polymer in the long dwell exchanges in peritoneal dialysis--advantages and limitations].

The alternative dialysis solution containing glucose polymer- icodextrin was developed in response to disadvantages of conventional glucose solution such as metabolic disorders, structural changes in the mesothelium and glucose absorption from peritoneum leading to dissipation of the osmotic gradient and decrease of ultrafiltration. Icodextrin is especially indicated in patients with impaired ultrafiltration. In the paper current review of literature referred to the ultrafiltration effect of icodextrin in the long dwell exchanges was presented.

[Schönlein-Henoch purpura--case report].

Schönlein-Henoch purpura is a systemic vasculitis characterised by purpura, joints and gastrointestinal involvement and glomerulonephritis. Organs injuries are associated with the deposition of immune complexes containing IgA in the wall of small vessels. This disease rarely affects adults.

Peritoneal transport in peritoneal dialysis patients using glucose-based and amino acid-based solutions.

Objective: To evaluate peritoneal transport of fluid and solutes in continuous ambulatory peritoneal dialysis (CAPD) patients using amino acid (AA)-based versus glucose-based dialysis solutions.

Methods: Using iodine-labeled human serum albumin ((125)I-HSA) as intraperitoneal volume marker, peritoneal transport was investigated in a group of 20 clinically stable patients (11 females and 9 men, age 53 +/- 15 years) on CAPD for 15 - 101 months. Two paired 4-hour dwells, one with 1.

[Causes and clinical implications of hypervolemia in peritoneal dialysis].

In our paper we present actual data from world literature as well as own experiences with respect to chronic hypervolemia as a very important clinical problem in peritoneal dialysis. We discussed the causes and clinical picture of hypervolemia as well as differential diagnosis of ultrafiltration failure as a potential cause of hypervolemia in peritoneal dialysis patients. Special attention was paid to the kinetic modelling of sodium and water removal in peritoneal dialysis.

["Abdominal catastrophe" in peritoneal dialysis].

Abdominal catastrophe in peritoneal dialysis is defined as peritonitis secondary to visceral injury with enteric organisms in dialysate. This complication is associated with a high mortality rate. Peritonitis associated with abdominal catastrophe is extremely difficult to diagnose.

[Bacteremic shock in the course of urinary tract infection--case report].

On the basis of 51 years old, so far healthy patient with urinary tract infection we present appearance of bacteremic shock of severe clinical course complicated with multiorgan failure. Increased level of cardiac enzymes in the blood followed by sudden cardiac arrest enabled us to differentiate between cardiogenic and bacteremic shock.

[Enoxaparin in haemodialysis].

Using of low-molecular-weight heparins (LMWH) in haemodialysis therapy significantly reduced the incidence of haemorrhagic complications with the same clinical efficacy in comparison to standard unfractionated heparins. Taking enoxaparin as example, we present the mechanisms of action of LMWH paying special attention to efficacy in haemodialysis and adverse effects.

[Diverticulosis as a background of "abdominal catastrophe" in the course of peritoneal dialysis. Care Report].

Peritonitis complicating peritoneal dialysis (PD) may represent a difficult diagnostic and therapeutic problem if it coexists with surgical pathology of intra-abdominal organs defined as "abdominal catastrophe". The illustration of this problem is the case of 70-year-old patient treated with automated PD, in whom recurrent episodes of peritonitis (Escherichia coli) were typical of "abdominal catastrophe" and were probably caused by microperforations of the colon in the course of diverticulosis.

[Sterile peritonitis associated with the use of icodextrin solution. Case report].

Sterile peritonitis after dialysis with the use of icodextrin-containing solution is a rare complication of peritoneal dialysis programme. On the basis of the case of hypersensitivity to icodextrin accompanied by peritonitis, the diagnostic problems were described and a review of literature on this complication is presented.

[Comparison of peritoneal transport of solutes and water during CAPD with glucose or amino acids solutions. Preliminary report].

The aim of the study was the comparison of peritoneal transport of solutes and water during dialysis with presently used 1.1% amino acid solution in relation to 1.36% glucose solution.

[Influence of parathormone level on the doses of human recombinant erythropoietin in haemodialysed patients].

Unlabelled: The purpose of the study was to determine the doses of rHuEPO, which are necessary to obtain the same correction of renal anaemia in chronically haemodialysed patients with different levels of iPTH. 25 haemodialysed patients with stable values of iPTH for at least 6 months (mean age 58 +/- 15.6 years; 6 females and 19 males on haemodialysis from 1 to 126 months) were divided into 3 groups: group 1 (7 patients) with iPTH < 100 pg/ml, group 2 (12 patients) with iPTH 100-300 pg/ml and group 3 (6 patients) with iPTH > 300 pg/ml.

[Bilateral nephrectomy as a life saving procedure in a young woman with recurrent bacteremic shock].

On the basis of the recurrent bacteremic shock in young woman with bilateral reflux nephropathy and recurrent urinary tract infections (UTI) from early childhood we present diagnostic and therapeutic problems of complicated UTI. Negative results of localization diagnosis of UTI and clinical suspicious on renal microabscesses as a cause of recurrence bacteremic shock were the reason of bilateral nephrectomy--as a life saving procedure--and initiation of CAPD programme.

[Survival of patients with diabetic nephropathy on continuous ambulatory peritoneal dialysis. Own experiences].

We analyzed 5 years survival on CAPD diabetics with respect to the type of diabetes (D). There were 24 pts with type 1 D, 13 pts with type 2 D and 29 non diabetic CAPD pts (for comparison of long-term survival). In the D groups we analyzed adequacy of dialysis, nutritional status (albumin level), frequency of peritonitis (PN) as well as character and progression of cardiovascular complications.

[Glycosaminoglycans in diabetic nephropathy].

This review refers to the nephro-protective role of glycosaminoglycans, especially in diabetic nephropathy.

[Continuous ambulatory peritoneal dialysis: is long-term therapy possible?].

The aim of this study was an analysis of long-term results of CAPD. 12 patients treated with CAPD over 5 years were analysed retrospectively. The most common cause of end-stage renal disease, present in 8 patients, was diabetes nephropathy.