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Chen JHC, Johnson DW, Cho Y, Cheetham M, Sud K, Hayat A, Stallard B, Clayton P, Davies CE, Borlace M, Boudville N. Associations of neutral pH, low-GDP peritoneal dialysis solutions with patient survival, transfer to haemodialysis and peritonitis. Nephrol Dial Transplant 2024; 39:222-232. [PMID: 37429598 PMCID: PMC10828214 DOI: 10.1093/ndt/gfad153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) solutions containing low levels of glucose degradation products (GDPs) are associated with attenuation of peritoneal membrane injury and vascular complications. However, clinical benefits associated with neutral-pH, low-GDP (N-pH/L-GDP) solutions remain unclear. METHODS Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the associations between N-pH/L-GDP solutions and all-cause mortality, cause-specific mortality, transfer to haemodialysis (HD) for ≥30 days and PD peritonitis in adult incident PD patients in Australia and New Zealand between 1 January 2005 and 31 December 2020 using adjusted Cox regression analyses. RESULTS Of 12 814 incident PD patients, 2282 (18%) were on N-pH/L-GDP solutions. The proportion of patients on N-pH/L-GDP solutions each year increased from 11% in 2005 to 33% in 2017. During the study period, 5330 (42%) patients died, 4977 (39%) experienced transfer to HD and 5502 (43%) experienced PD peritonitis. Compared with the use of conventional solutions only, the use of any form of N-pH/L-GDP solution was associated with reduced risks of all-cause mortality {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61-0.74]}, cardiovascular mortality [aHR 0.65 (95% CI 0.56-0.77)], infection-related mortality [aHR 0.62 (95% CI 0.47-0.83)] and transfer to HD [aHR 0.79 (95% CI 0.72-0.86)] but an increased risk of PD peritonitis [aHR 1.16 (95% CI 1.07-1.26)]. CONCLUSIONS Patients who received N-pH/L-GDP solutions had decreased risks of all-cause and cause-specific mortality despite an increased risk of PD peritonitis. Studies assessing the causal relationships are warranted to determine the clinical benefits of N-pH/L-GDP solutions.
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Affiliation(s)
- Jenny H C Chen
- Department of Renal Medicine, Wollongong Hospital, Wollongong, NSW, Australia
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - David W Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, University of Queensland, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Brisbane, QLD, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Brisbane, QLD, Australia
| | - Melissa Cheetham
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Department of Nephrology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia
- Sunshine Coast Health Institute, Birtinya, QLD, Australia
| | - Kamal Sud
- Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Ashik Hayat
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Brisbane, QLD, Australia
| | - Belinda Stallard
- Department of Nephrology, Tweed Hospital, Tweed Heads, NSW, Australia
| | - Philip Clayton
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, SA, Australia
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Christopher E Davies
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, SA, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Monique Borlace
- Department of Nephrology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
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2
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Chua AN, Kumar R, Warady BA. Care of the pediatric patient on chronic peritoneal dialysis. Pediatr Nephrol 2022; 37:3043-3055. [PMID: 35589990 DOI: 10.1007/s00467-022-05605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 01/10/2023]
Abstract
Peritoneal dialysis is the most commonly prescribed dialysis modality for infants and young children with kidney failure worldwide. Provision of high-quality care for the pediatric patient on chronic peritoneal dialysis requires a multidisciplinary approach and a strong collaboration with the patient and their caregiver. This article not only reviews current recommendations and advances in the care of pediatric patients on peritoneal dialysis with a focus on the provision of high-quality care and improvement in outcomes, but it also draws attention to health care disparities that exist locally and globally.
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Affiliation(s)
- Annabelle N Chua
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Box 3959, Durham, NC, 27710, USA.
| | - Reeti Kumar
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Box 3959, Durham, NC, 27710, USA
| | - Bradley A Warady
- Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
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3
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Kopytina V, Pascual-Antón L, Toggweiler N, Arriero-País EM, Strahl L, Albar-Vizcaíno P, Sucunza D, Vaquero JJ, Steppan S, Piecha D, López-Cabrera M, González-Mateo GT. Steviol glycosides as an alternative osmotic agent for peritoneal dialysis fluid. Front Pharmacol 2022; 13:868374. [PMID: 36052133 PMCID: PMC9424724 DOI: 10.3389/fphar.2022.868374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Peritoneal dialysis (PD) is a renal replacement technique that requires repeated exposure of the peritoneum to hyperosmolar PD fluids (PDFs). Unfortunately, it promotes alterations of the peritoneal membrane (PM) that affects its functionality, including mesothelial-mesenchymal transition (MMT) of mesothelial cells (MCs), inflammation, angiogenesis, and fibrosis. Glucose is the most used osmotic agent, but it is known to be at least partially responsible, together with its degradation products (GDP), for those changes. Therefore, there is a need for more biocompatible osmotic agents to better maintain the PM. Herein we evaluated the biocompatibility of Steviol glycosides (SG)-based fluids. Methods: The ultrafiltration and transport capacities of SG-containing and glucose-based fluids were analyzed using artificial membranes and an in vivo mouse model, respectively. To investigate the biocompatibility of the fluids, Met-5A and human omental peritoneal MCs (HOMCs) were exposed in vitro to different types of glucose-based PDFs (conventional 4.25% glucose solution with high-GDP level and biocompatible 2.3% glucose solution with low-GDP level), SG-based fluids or treated with TGF-β1. Mice submitted to surgery of intraperitoneal catheter insertion were treated for 40 days with SG- or glucose-based fluids. Peritoneal tissues were collected to determine thickness, MMT, angiogenesis, as well as peritoneal washings to analyze inflammation. Results: Dialysis membrane experiments demonstrated that SG-based fluids at 1.5%, 1%, and 0.75% had a similar trend in weight gain, based on curve slope, as glucose-based fluids. Analyzing transport capacity in vivo, 1% and 0.75% SG-based fluid-exposed nephrectomized mice extracted a similar amount of urea as the glucose 2.3% group. In vitro, PDF with high-glucose (4.25%) and high-GDP content induced mesenchymal markers and angiogenic factors (Snail1, Fibronectin, VEGF-A, FGF-2) and downregulates the epithelial marker E-Cadherin. In contrast, exposition to low-glucose-based fluids with low-GDP content or SG-based fluids showed higher viability and had less MMT. In vivo, SG-based fluids preserved MC monolayer, induced less PM thickness, angiogenesis, leukocyte infiltration, inflammatory cytokines release, and MMT compared with glucose-based fluids. Conclusion: SG showed better biocompatibility as an osmotic agent than glucose in vitro and in vivo, therefore, it could alternatively substitute glucose in PDF.
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Affiliation(s)
- Valeria Kopytina
- Department of Immunology, Molecular Biology Research Center Severo Ochoa (CBMSO), Spanish National Research Council (CSIC), Madrid, Spain
| | - Lucía Pascual-Antón
- Department of Immunology, Molecular Biology Research Center Severo Ochoa (CBMSO), Spanish National Research Council (CSIC), Madrid, Spain
| | - Nora Toggweiler
- Fresenius Medical Care Deutschland GmbH, Frankfurter, St. Wendel, Germany
| | - Eva-María Arriero-País
- Department of Immunology, Molecular Biology Research Center Severo Ochoa (CBMSO), Spanish National Research Council (CSIC), Madrid, Spain
| | - Lisa Strahl
- Fresenius Medical Care Deutschland GmbH, Frankfurter, St. Wendel, Germany
| | - Patricia Albar-Vizcaíno
- Department of Nephrology, IdiPAZ Research Institute, La Paz University Hospital, Madrid, Spain
| | - David Sucunza
- Department of Organic and Inorganic Chemistry, Faculty of Pharmacy, University of Alcalá (IRYCIS), Madrid, Spain
| | - Juan J. Vaquero
- Department of Organic and Inorganic Chemistry, Faculty of Pharmacy, University of Alcalá (IRYCIS), Madrid, Spain
| | - Sonja Steppan
- Fresenius Medical Care Deutschland GmbH, St. Wendel, Germany
| | - Dorothea Piecha
- Fresenius Medical Care Deutschland GmbH, St. Wendel, Germany
| | - Manuel López-Cabrera
- Department of Immunology, Molecular Biology Research Center Severo Ochoa (CBMSO), Spanish National Research Council (CSIC), Madrid, Spain
- *Correspondence: Manuel López-Cabrera, ; Guadalupe-Tirma González-Mateo,
| | - Guadalupe-Tirma González-Mateo
- Department of Immunology, Molecular Biology Research Center Severo Ochoa (CBMSO), Spanish National Research Council (CSIC), Madrid, Spain
- Department of Nephrology, IdiPAZ Research Institute, La Paz University Hospital, Madrid, Spain
- *Correspondence: Manuel López-Cabrera, ; Guadalupe-Tirma González-Mateo,
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4
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Chang Y, Chang JT, Lee MY, Huang MZ, Chao YFCC, Shih YL, Hwang YR. Does Far-Infrared Therapy Improve Peritoneal Function and Reduce Recurrent Peritonitis in Peritoneal Dialysis Patients? J Clin Med 2022; 11:jcm11061624. [PMID: 35329948 PMCID: PMC8955287 DOI: 10.3390/jcm11061624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/08/2022] [Indexed: 01/30/2023] Open
Abstract
The use of peritoneal dialysis in end-stage renal disease is increasing in clinical practice. The main purpose of this study was to evaluate the effect of far-infrared radiation therapy on inflammation and the cellular immunity of patients undergoing peritoneal dialysis. We recruited 56 patients undergoing peritoneal dialysis, and we included 32 patients for the experimental group and 24 patients from the control group in the final analysis. The experimental evaluation in our study was as follows: (1) We used abdominal computed tomography to explore the changes in abdominal blood vessels. (2) We compared the effects of peritoneal dialysis using blood glucose, HbAlC, albumin, urea nitrogen, creatinine, white blood cells, hs-CRP; peritoneal Kt/V of peritoneal function, and eGFR. (3) We compared the cytokines’ concentrations in the two groups while controlling for the other cytokines. Results and Discussion: (1) There was no significant difference in the abdominal blood vessels of the experimental group relative to the control group according to abdominal CT over the 6 months. (2) Our study demonstrates statistically significant effects of FIR therapy on the following parameters: creatinine (p = 0.039 *) and hs-CRP (p < 0.001 **) levels decreased significantly, and eGFR (p = 0.043 *), glucose (p < 0.001 **), and albumin (p = 0.048 *) levels increased significantly. Our study found that in the experimental group, creatinine and hs-CRP levels decreased significantly due to FIR therapy for 6 months. However, our study also found that the glucose level was significantly different after FIR therapy for 6 months. Peritoneal dialysis combined with FIR can reduce the side effects of the glucose in the dialysis buffer, which interferes with peritoneal inflammation and peritoneal mesothelial cell fibrosis. (3) In addition, we also found that no statistically significant difference in any inflammatory cytokine after FIR therapy. IFN-γ (p = 0.124), IL-12p70 (p = 0.093), IL-18 (p = 0.213), and TNF-α (p = 0.254) did not exhibit significant improvements after peritoneal dialysis with FIR treatment over 6 months. Conclusions: We found that the effectiveness of peritoneal dialysis was improved significantly with FIR therapy, and significant improvements in the peritoneal permeability and inflammatory response were observed.
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Affiliation(s)
- Yuanmay Chang
- Institute of Long-Term Care, MacKay Medical College, New Taipei 25245, Taiwan;
- Correspondence: ; Tel.: +886-919991261
| | - Jui-Ting Chang
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan;
| | - Mei-Yi Lee
- Department of Physical Therapy, Fooyin University, Kaohsiung 83102, Taiwan;
| | - Mei-Zen Huang
- Department of Nursing, National Tainan Junior College of Nursing, Tainan 70007, Taiwan;
| | | | - Yung-Luen Shih
- Laboratory Medicine, Department of Pathology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan;
| | - Yao-Rong Hwang
- Institute of Long-Term Care, MacKay Medical College, New Taipei 25245, Taiwan;
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5
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Xi J, Chen Y. Effects of tetrahydro-curcumin on the formation of β-carboline heterocyclic amines in dry-heated soy protein isolate in the presence of glucose. Lebensm Wiss Technol 2021. [DOI: 10.1016/j.lwt.2021.112362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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6
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van Gelder MK, Vollenbroek JC, Lentferink BH, Hazenbrink DHM, Besseling PJ, Simonis F, Giovanella S, Ligabue G, Bajo Rubio MA, Cappelli G, Joles JA, Verhaar MC, Gerritsen KGF. Safety of electrooxidation for urea removal in a wearable artificial kidney is compromised by formation of glucose degradation products. Artif Organs 2021; 45:1422-1428. [PMID: 34251693 PMCID: PMC8597045 DOI: 10.1111/aor.14040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/08/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
A major challenge for the development of a wearable artificial kidney (WAK) is the removal of urea from the spent dialysate, as urea is the waste solute with the highest daily molar production and is difficult to adsorb. Here we present results on glucose degradation products (GDPs) formed during electrooxidation (EO), a technique that applies a current to the dialysate to convert urea into nitrogen, carbon dioxide, and hydrogen gas. Uremic plasma and peritoneal effluent were dialyzed for 8 hours with a WAK with and without EO‐based dialysate regeneration. Samples were taken regularly during treatment. GDPs (glyoxal, methylglyoxal, and 3‐deoxyglucosone) were measured in EO‐ and non‐EO‐treated fluids. Glyoxal and methylglyoxal concentrations increased 26‐ and 11‐fold, respectively, in uremic plasma (at [glucose] 7 mmol/L) and 209‐ and 353‐fold, respectively, in peritoneal effluent (at [glucose] 100 mmol/L) during treatment with EO, whereas no change was observed in GDP concentrations during dialysate regeneration without EO. EO for dialysate regeneration in a WAK is currently not safe due to the generation of GDPs which are not biocompatible.
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Affiliation(s)
- Maaike K van Gelder
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen C Vollenbroek
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Babette H Lentferink
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Diënty H M Hazenbrink
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul J Besseling
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Silvia Giovanella
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Ligabue
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria A Bajo Rubio
- Nephrology Service, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital and IRSIN, Madrid, Spain
| | - Gianni Cappelli
- Surgical, Medical and Dental Department of Morphological Sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy
| | - Jaap A Joles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin G F Gerritsen
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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The Effect of Far-Infrared Therapy on the Peritoneal Expression of Glucose Degradation Products in Diabetic Patients on Peritoneal Dialysis. Int J Mol Sci 2021; 22:ijms22073732. [PMID: 33918516 PMCID: PMC8038268 DOI: 10.3390/ijms22073732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 02/06/2023] Open
Abstract
Peritoneal dialysis (PD) is a treatment modality for end-stage renal disease (ESRD) patients. Dextrose is a common osmotic agent used in PD solutions and its absorption may exacerbate diabetes mellitus, a common complication of ESRD. PD solutions also contain glucose degradation products (GDPs) that may lead to encapsulating peritoneal sclerosis (EPS), a severe complication of PD. A previous study showed that far-infrared (FIR) therapy improved a patient’s gastrointestinal symptoms due to EPS. Due to limited literature on the matter, this study aims to investigate dialysate GDPs and peritoneal function in diabetic patients on PD. Thirty-one PD patients were enrolled and underwent 40 min of FIR therapy twice daily for six months. We demonstrated the effect of FIR therapy on the following: (1) decrease of methylglyoxal (p = 0.02), furfural (p = 0.005), and 5-hydroxymethylfurfural (p = 0.03), (2) increase of D/D0 glucose ratio (p = 0.03), and (3) decrease of potassium levels (p = 0.008) in both DM and non-DM patients, as well as (4) maintenance and increase of peritoneal Kt/V in DM and non-DM patients, respectively (p = 0.03). FIR therapy is a non-invasive intervention that can decrease dialysate GDPs in PD patients by improving peritoneal transport rate and solute removal clearance, while also maintaining dialysis adequacy.
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8
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Aguilera A, Aroeira LS, Ramirez-Huesca M, Perez-Lozano ML, Cirugeda A, Bajo MA, Del Peso G, Valenzuela-Fernandez A, Sanchez-Tomero JA, Lopez-Cabrera M, Selgas R. Effects of Rapamycin on the Epithelial-to-mesenchymal Transition of Human Peritoneal Mesothelial Cells. Int J Artif Organs 2018; 28:164-9. [PMID: 15770593 DOI: 10.1177/039139880502800213] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The preservation of the peritoneal membrane is crucial for long-term survival in peritoneal dialysis. Epithelial-to-mesenchymal transition (EMT) is a process demonstrated in mesothelial cells (MC), responsible for negative peritoneal changes and directly related to PD. EMT enables neovascularization and fibrogenic capabilities in MC. Vascular endothelial growth factor (VEGF) is the mediator for neo-vascularization. Rapamycin is a potent immunosuppressor with antifibrotic action in renal allografts and has a demonstrated anti-VEGF effect. We performed this study with the hypothesis that rapamycin may regulate the EMT of MC. MC from human omentum were cultured. When mesothelial cells reached confluence, some of them were stimulated with r-TGF-ß (1 ng/mL) to induce EMT, co-administered with rapamycin (0.2, 2, 4, 20 and 40 nM). Other groups of cells received similar doses of rapamycin or r-TGF-ß, separately. Cells were analyzed at 6, 24, 48 hours and 7 days. As markers of EMT we included α-SMA, E-cadherin and snail nuclear factor by quantitative RT-PCR. EMT markers and regulators demonstrated the following changes with rapamycin: E-cadherin (a protective gene for EMT) increased 2.5-fold relative to controls under 40 nM, at 24h. Importantly, rapamycin inhibited snail expression induced by TGF-ß at 6h, whereas TGF-ß increased snail 10fold. At day 7, rapamycin showed no anti-EMT properties. An important decrease in α-SMA expression by MC after rapamycin addition was observed. In conclusion, rapamycin shows a mild protective effect on EMT, as it increases E-cadherin and decreases α-SMA expression. Consequently, rapamycin might partially regulate the epithelial-to-mesenchymal transition of mesothelial cells.
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Affiliation(s)
- A Aguilera
- Department of Nephrology, University Hospital La Princesa, 28006 Madrid, Spain.
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9
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Kanda R, Io H, Nakata J, Makita Y, Sasaki Y, Matsumoto M, Wakabayashi K, Tomino Y, Suzuki Y. Evaluation of Long-Term Combination Therapy With Peritoneal Dialysis and Hemodialysis. Ther Apher Dial 2017; 21:180-184. [PMID: 28185405 DOI: 10.1111/1744-9987.12517] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 10/13/2016] [Accepted: 11/11/2016] [Indexed: 11/30/2022]
Abstract
It is well known that a combination therapy with peritoneal dialysis (PD) and hemodialysis (HD) is feasible and may improve clinical status in patients for whom adequate solute and fluid removal is difficult to achieve with PD alone. The objective of the present study was to evaluate whether the therapy is useful in the likelihood of long-term peritoneal membrane and cardiac function. The therapy was 6 days of PD and one session of HD per week. Physical, biochemical, dialysate-to-plasma ratio of creatinine (D/P Cr), arteriovenous fistula (AVF) blood flow, and left ventricular mass index (LVMI) data were prospectively analyzed in 30 patients with measurements performed at 0 and 6 months, and for 21 patients, 12 or 18 months after initiation of the therapy. The levels of hemoglobin (Hb) after therapy were significantly higher than those at the initiation of therapy. The levels of LVMI and human atrial natriuretic peptide (hANP) after therapy were significantly lower than those at the initiation of therapy, whereas AVF blood flow did not change significantly. D/P Cr levels at 6 months after the therapy were significantly lower than those at the initiation of therapy. D/P Cr levels at 12 or 18 months after the therapy were not aggravated. It appears that the therapy improves Hb levels and cardiac function because of adjusting body fluid status. It was indicated that peritoneal function after therapy may be improved. Therefore, combination therapy is useful from the lifestyle viewpoint of patients in the transition period of PD to HD with end-stage kidney disease.
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Affiliation(s)
- Reo Kanda
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Hiroaki Io
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Junichiro Nakata
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Yuko Makita
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Yu Sasaki
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Mayumi Matsumoto
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Keiichi Wakabayashi
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Yasuhiko Tomino
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
| | - Yusuke Suzuki
- Division of Nephrology, Department of Internal Medicine, Juntendo, University Faculty of Medicine, Tokyo, Japan
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10
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Al-Hwiesh AK, Shawarby MA, Abdul-Rahman IS, Al-Oudah N, Al-Dhofairy B, Divino-Filho JC, Abdelrahman A, Zakaria H, Nasr El-Din MA, Eldamati A, El-Salamony T, Al-Muhanna FA. Changes in peritoneal membrane with different peritoneal dialysis solutions: Is there a difference? Int J Organ Transplant Med 2016. [DOI: 10.1016/j.hkjn.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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11
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Mori Y, Kakuta T, Miyakogawa T, Takekoshi S, Yuzawa H, Kobayashi H, Kawakami A, Miyata T, Fukagawa M. Effect of Scavenging Circulating Reactive Carbonyls by Oral Pyridoxamine in Uremic Rats on Peritoneal Dialysis. Ther Apher Dial 2016; 20:645-654. [PMID: 27620210 DOI: 10.1111/1744-9987.12446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 11/30/2022]
Abstract
Pyridoxamine, a reactive carbonyl (RCO) scavenger, can ameliorate peritoneal deterioration in uremic peritoneal dialysis (PD) rats when given via dialysate. We examined the effects of scavenging circulating RCOs by oral pyridoxamine. Rats underwent nephrectomy and 3 weeks of twice daily PD either alone or with once daily oral pyridoxamine. PD solution was supplemented with methylglyoxal, a major glucose-derived RCO, to quench intraperitoneal pyridoxamine. Oral pyridoxamine achieved comparable blood and dialysate pyridoxamine concentrations, suppressed pentosidine accumulation in the blood but not in the mesenterium or dialysate, and reduced the increases in small solute transport and mesenteric vessel densities, with no effects on submesothelial matrix layer thickening or serum creatinine. Thus, reducing circulating RCOs by giving oral pyridoxamine with PD provides limited peritoneal protection. However, orally given pyridoxamine efficiently reaches the peritoneal cavity and would eliminate intraperitoneal RCOs. Oral pyridoxamine is more clinically favorable and may be as protective as intraperitoneal administration.
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Affiliation(s)
- Yoshitaka Mori
- Department of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.,Unit of Translational Medicine, Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takatoshi Kakuta
- Department of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan.,Department of Nephrology, Endocrinology and Metabolism, Tokai University Hachioji Hospital, Hachioji, Tokyo, Japan
| | - Takayo Miyakogawa
- Department of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
| | - Susumu Takekoshi
- Division of Basic Molecular Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Hiroko Yuzawa
- Department of Neurology, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Kobayashi
- Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Japan
| | - Atsushi Kawakami
- Unit of Translational Medicine, Department of Endocrinology and Metabolism, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshio Miyata
- United Centers for Advanced Research and Translational Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Masafumi Fukagawa
- Department of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Isehara, Japan
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12
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Maruyama Y, Yokoyama K. Clinical efficacy of combined therapy with peritoneal dialysis and hemodialysis. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0023-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Cross-omics comparison of stress responses in mesothelial cells exposed to heat- versus filter-sterilized peritoneal dialysis fluids. BIOMED RESEARCH INTERNATIONAL 2015; 2015:628158. [PMID: 26495307 PMCID: PMC4606138 DOI: 10.1155/2015/628158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023]
Abstract
Recent research suggests that cytoprotective responses, such as expression of heat-shock proteins, might be inadequately induced in mesothelial cells by heat-sterilized peritoneal dialysis (PD) fluids. This study compares transcriptome data and multiple protein expression profiles for providing new insight into regulatory mechanisms. Two-dimensional difference gel electrophoresis (2D-DIGE) based proteomics and topic defined gene expression microarray-based transcriptomics techniques were used to evaluate stress responses in human omental peritoneal mesothelial cells in response to heat- or filter-sterilized PD fluids. Data from selected heat-shock proteins were validated by 2D western-blot analysis. Comparison of proteomics and transcriptomics data discriminated differentially regulated protein abundance into groups depending on correlating or noncorrelating transcripts. Inadequate abundance of several heat-shock proteins following exposure to heat-sterilized PD fluids is not reflected on the mRNA level indicating interference beyond transcriptional regulation. For the first time, this study describes evidence for posttranscriptional inadequacy of heat-shock protein expression by heat-sterilized PD fluids as a novel cytotoxic property. Cross-omics technologies introduce a novel way of understanding PDF bioincompatibility and searching for new interventions to reestablish adequate cytoprotective responses.
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14
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Park WY, Kim SH, Kim YO, Jin DC, Song HC, Choi EJ, Kim YL, Kim YS, Kang SW, Kim NH, Yang CW, Kim YK. Serum Gamma-Glutamyltransferase Levels Predict Mortality in Patients With Peritoneal Dialysis. Medicine (Baltimore) 2015; 94:e1249. [PMID: 26252286 PMCID: PMC4616583 DOI: 10.1097/md.0000000000001249] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Serum gamma-glutamyltransferase (GGT) level has been considered marker of oxidative stress as well as liver function. Serum GGT level has been reported to be associated with the mortality in hemodialysis patients. However, it is not well established whether serum GGT level is associated with all-cause mortality in peritoneal dialysis (PD) patients. The aim of this study was to determine the association between serum GGT levels and all-cause mortality in PD patients.PD patients were included from the Clinical Research Center registry for end-stage renal disease cohort, a multicenter prospective observational cohort study in Korea. Patients were categorized into 3 groups by tertile of serum GGT levels as follows: tertile 1, GGT < 16 IU/L; tertile 2, GGT = 16 to 27 IU/L; and tertile 3, GGT > 27 IU/L. Primary outcome was all-cause mortality.A total of 820 PD patients were included. The median follow-up period was 34 months. Kaplan-Meier analysis showed that the all-cause mortality rate was significantly different according to tertiles of GGT (P = 0.001, log-rank). The multivariate Cox regression analysis showed that higher tertiles significantly associated with higher risk for all-cause mortality (tertile 2: hazard ratio [HR] 2.08, 95% confidence interval [CI], 1.17-3.72, P = 0.013; tertile 3: HR 1.83, 95% CI, 1.04-3.22, P = 0.035) in using tertile 1 as the reference group after adjusting for clinical variables.Our study demonstrated that high serum GGT levels were an independent risk factor for all-cause mortality in PD patients. Our findings suggest that serum GGT levels might be a useful biomarker to predict all-cause mortality in PD patients.
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Affiliation(s)
- Woo-Yeong Park
- From the Department of Internal Medicine (W-YP, YOK, DCJ, HCS, EJC, CWY, YKK), College of Medicine, The Catholic University of Korea, Seoul; Department of Internal Medicine (S-HK), College of Medicine, Chung-Ang University, Seoul; Department of Internal Medicine (YLK), School of Medicine, Kyungpook National University, Daegu; Department of Internal Medicine (YSK), College of Medicine, Seoul National University, Seoul; Department of Internal Medicine (SWK), College of Medicine, Yonsei University, Seoul; Department of Internal Medicine (NHK), Chonnam National University Medical School, Gwangju; and Cell Death Disease Research Center (YKK), College of Medicine, The Catholic University of Korea, Seoul, Korea
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15
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Maruyama Y, Yokoyama K, Nakayama M, Higuchi C, Sanaka T, Tanaka Y, Sakai K, Mizuiri S, Otsuka Y, Kuriyama S, Maeba T, Iwasawa H, Nakao T, Hosoya T. Combined therapy with peritoneal dialysis and hemodialysis: a multicenter retrospective observational cohort study in Japan. Blood Purif 2014; 38:149-53. [PMID: 25471451 DOI: 10.1159/000368389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 09/16/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Combining peritoneal dialysis (PD) and hemodialysis (HD) has been common treatment option in Japan. METHODS In this retrospective, multicenter, observational study, the clinical characteristics and outcomes of 104 patients (57 ± 11 years, males 72%) who had switched from PD alone to combined therapy with PD and HD were studied. Clinical parameters were measured at baseline and after 3 months of combined therapy. RESULTS At baseline, urine volume, dialysate-to-plasma ratio of creatinine (D/P Cr), and total Kt/V were 150 ml/day (range: 0-2,000 ml/day), 0.67 ± 0.11, and 1.8 ± 0.4, respectively. During the first 3 months of combined therapy, body weight, urine volume, serum creatinine level, and D/P Cr decreased, whereas hemoglobin levels increased. CONCLUSIONS In patients where PD does not result in acceptable outcomes, combined therapy with PD and HD may have potential benefits in terms of dialysis adequacy and hydration status. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=368389
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Affiliation(s)
- Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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16
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Strategies for the preservation of residual renal function in pediatric dialysis patients. Pediatr Nephrol 2014; 29:825-36; quiz 832. [PMID: 23868107 DOI: 10.1007/s00467-013-2554-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 06/05/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
Abstract
In adults with end-stage renal disease (ESRD), the preservation of residual renal function (RRF) has been shown to be associated with decreased mortality and improved control of complications of chronic kidney disease. However, less is known on the benefits of RRF in the pediatric dialysis population. The purpose of this article is to review the clinical significance of RRF and to discuss strategies for the preservation of RRF in children with ESRD.
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17
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Johnson DW, Cho Y, Brown FG. Trials (and tribulations) of biocompatible peritoneal dialysis fluids. Perit Dial Int 2012; 32:247-51. [PMID: 22641733 DOI: 10.3747/pdi.2012.00044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- David W Johnson
- Department of Renal Medicine, Princess Alexandra Hospital School of Medicine, University of Queensland, Brisbane, Australia.
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18
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Jiang J, Chen P, Chen J, Yu X, Xie D, Mei C, Xiong F, Shi W, Zhou W, Liu X, Sun S, Zhang P, Yang X, Zhang Y, Zhang Y, Liang X, Zhang Z, Lin Q, Yu Y, Miyata T, Tian J, Liang M, Luo W, Xu X, Hou F. Accumulation of tissue advanced glycation end products correlated with glucose exposure dose and associated with cardiovascular morbidity in patients on peritoneal dialysis. Atherosclerosis 2012; 224:187-94. [PMID: 22857897 DOI: 10.1016/j.atherosclerosis.2012.06.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 06/08/2012] [Accepted: 06/12/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Accumulation of tissue advanced glycation end products (AGEs) is a marker of cumulative glycemic and/or oxidative stress. Cutaneous AGEs levels measured by skin autofluorescence correlate well with cardiovascular outcomes in diabetes and hemodialysis (HD) patients. The present study aimed to compare tissue AGEs levels with peritoneal dialysis (PD) and HD patients and to evaluate the relationship between skin autofluorescence and cardiovascular morbidity in patients on PD. METHODS A total of 2388 maintenance dialysis patients (613 PD and 1775 HD) were enrolled in this cross-sectional study. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Cardiovascular morbidity was defined as clinically diagnosed ischemic heart disease, heart failure, stroke or peripheral vascular disease from initiation of dialysis. RESULTS More than 90% of patients on both PD and HD had met current dialysis adequacy targets. Compared to HD group, PD patients receiving conventional glucose-containing dialyzate had significantly higher skin autofluorescence values in each category of age and dialysis duration, irrespective of the presence or absence of diabetes. In PD patients, skin autofluorescence values were strongly correlated with the duration of PD and glucose exposure dose and independently associated with cardiovascular morbidity. Multivariate analysis revealed that glucose exposure dose and skin autofluorescence were the strongest risk factors for cardiovascular morbidity in PD patients after adjustment by age, gender, and other classic- or uremic-related risk factors. CONCLUSIONS Accumulation of tissue AGEs provides a potential link between PD exposure of metabolic stress and progression of cardiovascular disease in patients on PD.
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Affiliation(s)
- Jianping Jiang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, China
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19
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Chaudhary K. Peritoneal Dialysis Drop-out: Causes and Prevention Strategies. Int J Nephrol 2011; 2011:434608. [PMID: 22121484 PMCID: PMC3205769 DOI: 10.4061/2011/434608] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/22/2011] [Accepted: 08/28/2011] [Indexed: 11/26/2022] Open
Abstract
Peritoneal dialysis (PD) as a renal replacement therapy (RRT) has become wide spread since its inception more than twenty-five years back. Since then, several advances have been made and PD has been accepted as an alternative therapy to hemodialysis (HD), with excellent survival, lower cost, and improved quality of life. In spite of comparable survival of HD and PD, improved PD techniques over the last few years, and lower health care costs with PD, PD prevalence remains low in many countries. An important reason for the low PD prevalence is patient dropouts, that is, transfer to HD. The reasons for dropouts are multifactorial, that is, modality related, system related, and patient related. These include episodes of peritonitis, catheter-related problems, ultrafiltration failure, patient fatigue, and provider comfort. This review discusses the various factors that contribute to PD dropout and the strategies to prevent it.
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Affiliation(s)
- Kunal Chaudhary
- Division of Nephrology, Harry S. Truman Veterans Medical Center, Columbia, MO 65203, USA
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20
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Abstract
Peritoneal dialysis is a modality of renal replacement therapy that is commonly used in human medicine for treatment of chronic kidney disease and end-stage kidney failure. Peritoneal dialysis uses the peritoneum as a membrane across which fluids and uremic solutes are exchanged. In this process, dialysate is instilled into the peritoneal cavity and, through the process of diffusion and osmosis, water, toxins, electrolytes, and other small molecules, are allowed to equilibrate.
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Affiliation(s)
- Rachel L Cooper
- Department of Clinical Sciences, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104, USA
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21
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Abstract
The use of peritoneal dialysis (PD) has become wide spread since the introduction of continuous ambulatory PD more than 25 years ago. Over this time, many advances have been made and PD is an alternative to hemodialysis (HD), with excellent comparable survival, lower cost, and improved quality of life. The percentage of prevalent PD patients in the United States is approximately 7%, which is significantly lower compared with the 15% PD prevalence from the mid-1980s. Despite comparable survival of HD and PD and improved PD technique survival over the last few years, the percentage of patients performing PD in the United States has declined. The increased numbers of in-center HD units, physician comfort with the modality, perceived superiority of HD, and reimbursement incentives have all contributed to the underutilization of PD. In addition to a higher transplantation rate among patients treated with PD in the United States, an important reason for the low PD prevalence is the transfer to HD. There are various reasons for the transfer (e.g., episodes of peritonitis, membrane failure, patient fatigue, etc.). This review discusses the various factors that contribute to PD underutilization and the rationale and strategies to implement "PD first" and how to maintain it. The PD first concept implies that when feasible, PD should be offered as the first dialysis modality. This concept of PD first and HD second must not be seen as a competition between therapies, but rather that they are complementary, keeping in mind the long-term goals for the patient.
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Affiliation(s)
- Kunal Chaudhary
- Harry S. Truman VA Hospital, and Division of Nephrology, Department of Internal Medicine, University of Missouri, 1 Hospital Drive, CE 422, Columbia, MO 65212, USA.
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22
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Chaudhary K, Khanna R. Biocompatible Peritoneal Dialysis Solutions: Do We Have One?: Table 1. Clin J Am Soc Nephrol 2010; 5:723-32. [DOI: 10.2215/cjn.05720809] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Nouri-Majalan N, Najafi I, Sanadgol H, Ganji MR, Atabak S, Hakemi M, Soleymanian T. Description of an outbreak of acute sterile peritonitis in Iran. Perit Dial Int 2010; 30:19-22. [PMID: 20056974 DOI: 10.3747/pdi.2008.00170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outbreaks of sterile or chemical peritonitis are uncommon and often not well documented. It is therefore important to describe the characteristics of sterile peritonitis in continuous peritoneal dialysis (PD) patients. METHODS Characteristics of acute chemical peritonitis (ACP) are described in 20 patients (5 males, 15 females; mean age 50 +/- 15 years; range 29 - 72 years). Cultures and Gram stains were negative for micro-organisms. All patients with symptoms of peritonitis were using glucose bags with the same lot number and resolution of peritonitis occurred only after changing the suspicious bags. The first measurements of dialysate-to-plasma creatinine (D/P creat) and glomerular filtration rate (GFR) before and after ACP were compared in 14 patients with no separate episode of bacterial peritonitis during that time. RESULTS Cloudy dialysate was observed in 19 patients and 13 experienced abdominal pain. Mean dialysate white blood cell count and percentage neutrophils were 520/mm(3) (range 100 - 1600/mm(3)) and 65% (range 14% - 98%) respectively. Analysis of the unused PD solution showed that endotoxin (0.06 endotoxin unit/mL), 5-hydroxymethyl furaldehyde (8 microg/mL), and acetaldehyde (0.4 microg/mL) concentrations were within acceptable ranges. In 14 patients without episodes of bacterial peritonitis, D/P creat was significantly higher after than before ACP (0.77 +/- 0.07 vs 0.55 +/- 0.1, p = 0.036), whereas GFR was not (4.5 +/- 2.9 vs 4.9 +/- 2.53 mL/minute, p = 0.62). CONCLUSION Although chemical peritonitis in glucose-based PD solution is uncommon, it should be distinguished from bacterial peritonitis in outbreaks of peritonitis. Facilities to measure glucose degradation products are required, especially in developing countries. Acute chemical peritonitis increases small-molecule transport in the short term.
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Affiliation(s)
- Nader Nouri-Majalan
- Department of Nephrology, Shahid Sadoughy University of Medical Sciences, Yazd, Iran
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24
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McIntyre NJ, Chesterton LJ, John SG, Jefferies HJ, Burton JO, Taal MW, Fluck RJ, McIntyre CW. Tissue-advanced glycation end product concentration in dialysis patients. Clin J Am Soc Nephrol 2009; 5:51-5. [PMID: 19965551 DOI: 10.2215/cjn.05350709] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Tissue-advanced glycation end products (AGE) are a measure of cumulative metabolic stress. Assessment of tissue AGE by skin autofluoresence (AF) correlates well with cardiovascular outcomes in hemodialysis (HD) patients. This study aimed to measure and compare tissue AGE levels in HD and peritoneal dialysis (PD) patients and to evaluate the impact of systemic PD glucose exposure. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Tissue AGE were measured in 115 established dialysis patients (62 HD and 53 PD) using a cutaneous AF device (AGE Reader; DiagnOptics). Values were compared with an age-matched non-chronic kidney disease database. Review of all previous PD solution delivery/prescription data determined PD glucose exposure. RESULTS PD patients were similar in age to HD patients but had a shorter dialysis vintage. There were no differences in ischemic heart disease or smoking history, statin or angiotensin-converting enzyme inhibitor (ACEi) use, lipids, biochemistry, or prevalence of diabetes. More than 90% of both groups had met current dialysis adequacy targets. Skin AF values in PD and HD patients were similar and strongly correlated with historical PD glucose exposure. Skin AF correlated with age in both groups but with dialysis vintage only in PD patients CONCLUSIONS Cumulative metabolic stress and transient hyperglycemia results in grossly elevated levels of tissue AGE in dialysis patients. In PD patients, this high level of AGE deposition is associated with historical glucose exposure. This observation provides a previously unappreciated potential link between PD exposure to glucose and systemic cardiovascular disease.
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Affiliation(s)
- Natasha J McIntyre
- Department of Renal Medicine, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
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25
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Verrina E, Cappelli V, Perfumo F. Selection of modalities, prescription, and technical issues in children on peritoneal dialysis. Pediatr Nephrol 2009; 24:1453-64. [PMID: 18521632 PMCID: PMC2697927 DOI: 10.1007/s00467-008-0848-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/31/2008] [Accepted: 03/31/2008] [Indexed: 11/08/2022]
Abstract
Peritoneal dialysis (PD) is widely employed as a dialytic therapy for uraemic children, especially in its automated form (APD), that is associated with less burden of care on patient and family than continuous ambulatory PD. Since APD offers a wide range of treatment options, based on intermittent and continuous regimens, prescription can be individualized according to patient's age, body size, residual renal function, nutritional intake, and growth-related metabolic needs. Transport capacity of the peritoneal membrane of each individual patient should be assessed, and regularly monitored, by means of standardized peritoneal function tests validated in pediatric patients. To ensure maximum recruitment of peritoneal exchange area, fill volume should be scaled to body surface area and adapted to each patient, according to clinical tolerance and intraperitoneal pressure. PD solutions should be employed according to their biocompatibility and potential ultrafiltration capacity; new pH-neutral, glucose-free solutions can be used in an integrated way in separate dwells, or by appropriately mixing during the same dialytic session. Kinetic modelling software programs may help in the tailoring of PD prescription to individual patients' characteristics and needs. Owing to advances in the technology of new APD machines, greater programming flexibility, memorized delivery control, and tele-dialysis are currently possible.
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Affiliation(s)
- Enrico Verrina
- Dialysis Unit, Nephrology and Dialysis Division, Giannina Gaslini Institute, Largo G. Gaslini, 5, 16148, Genoa, Italy.
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26
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Sundl I, Roob JM, Meinitzer A, Tiran B, Khoschsorur G, Haditsch B, Holzer H, Winklhofer–Roob BM. Antioxidant Status of Patients on Peritoneal Dialysis: Associations with Inflammation and Glycoxidative Stress. Perit Dial Int 2009. [DOI: 10.1177/089686080902900113] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patients on peritoneal dialysis (PD) frequently exhibit oxidant–antioxidant imbalance, advanced glycation end-product overload, and subclinical inflammation but the interrelations between these pathophysiological changes have not been fully elucidated. Subjects and Methods To study possible associations, a cross-sectional study of antioxidant status, glycoxidative stress, and inflammation, using HPLC and ELISA methods, was undertaken in 37 PD patients and age- and sex-matched healthy controls. Results Plasma ascorbate concentrations were low in patients not taking at least low-dose vitamin C supplements. In patients taking vitamin C supplements, there was a positive relation between ascorbate and pentosidine concentrations. Vitamin E and carotenoid concentrations were comparable between patients and controls, while lycopene and lutein/zeaxanthin concentrations were lower. Interleukin-6, C-reactive protein (CRP), and pentosidine concentrations were elevated in PD patients. β–Cryptoxanthin, lycopene, and lutein/zeaxanthin concentrations were inversely related to interleukin-6 concentrations. β–Cryptoxanthin concentrations were also inversely related to CRP concentrations. Pentosidine showed a low dialysate-to-plasma ratio, indicating low peritoneal clearance. Pentosidine concentrations increased with duration of PD therapy, while α– and β–carotene concentrations decreased. Malondialdehyde concentrations were elevated compared to controls but remained within the normal range. Retinol concentrations decreased with PD therapy and were inversely related to interleukin-6 and CRP concentrations. Conclusions Low-dose vitamin C supplements and a carotenoid-rich diet should be recommended for PD patients to maintain normal antioxidant status and efficiently counteract the chronic inflammatory response, rather than high doses of vitamin C, which could play a role as a precursor of pentosidine.
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Affiliation(s)
- Isabella Sundl
- Human Nutrition & Metabolism Research and Training Center Graz, Institute of Molecular Biosciences, Karl-Franzens University, Graz, Austria
| | - Johannes M. Roob
- Division of Clinical Nephrology and Hemodialysis, Medical University, Graz, Austria
| | - Andreas Meinitzer
- Department of Internal Medicine, and Clinical Institute of Medical & Chemical Laboratory Diagnostics, Medical University, Graz, Austria
| | - Beate Tiran
- Department of Internal Medicine, and Clinical Institute of Medical & Chemical Laboratory Diagnostics, Medical University, Graz, Austria
| | - Gholamali Khoschsorur
- Department of Internal Medicine, and Clinical Institute of Medical & Chemical Laboratory Diagnostics, Medical University, Graz, Austria
| | - Bernd Haditsch
- Division of Clinical Nephrology and Hemodialysis, Medical University, Graz, Austria
| | - Herwig Holzer
- Division of Clinical Nephrology and Hemodialysis, Medical University, Graz, Austria
| | - Brigitte M. Winklhofer–Roob
- Human Nutrition & Metabolism Research and Training Center Graz, Institute of Molecular Biosciences, Karl-Franzens University, Graz, Austria
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27
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Furkert J, Zeier M, Schwenger V. Effects of Peritoneal Dialysis Solutions Low in GDPs on Peritonitis and Exit-Site Infection Rates. Perit Dial Int 2008. [DOI: 10.1177/089686080802800616] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Peritoneal dialysis (PD) solutions sterilized at a low pH level contain only minimal amounts of glucose degradation products (GDPs). The latter are known to have an adverse effect on the peritoneal membrane. The present study retrospectively analyzes the effects on the incidences of peritonitis and exit-site infections. Materials and Methods Data concerning the frequency of peritonitis and exit-site infections for 120 patients treated with PD were collected. Before 2000, 67 of these patients received conventional dialysates and from 2000 on, 53 patients were treated with the new dialysis fluids. Furthermore, a correlation between the incidence of infections and the duration of treatment with dialysis was established. Results It was observed that the use of dialysis solutions low in GDPs resulted in significantly lower rates of peritonitis ( p = 0.002) and exit-site infections ( p = 0.02). When using the new treatment, peritonitis occurred, on average, after 48 months of treatment and exit-site infections after 34 months of treatment. Discussion The result supports the hypothesis that the use of the new, biocompatible, PD solutions contributes to considerable reduction in the rates of peritonitis and exit-site infections. As it is not expected that randomized prospective studies will be conducted in the future, further observational studies should be carried out in order to affirm the observed tendencies.
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Affiliation(s)
- Jürgen Furkert
- Nephrology and Gastroenterology, SLK-Kliniken Heilbronn, Bad Friedrichshall
| | - Martin Zeier
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Vedat Schwenger
- Department of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
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28
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Abstract
Standard peritoneal dialysis (PD) solutions with low pH and containing high concentrations of lactate and glucose have been demonstrated to negatively affect the peritoneal membrane, mesothelial cell viability, residential peritoneal cells, and also to inhibit phagocytic functions. An increasing body of experimental evidence supports the idea that the peritoneal hypervascularization and fibrosis observed in long-term PD are causally related to the acute and chronic toxicity of conventional PD solutions. A Physioneal (lactate/bicarbonate mixed buffer pH 7-7.4), Physioneal, Extraneal (7.5% icodextrin), Nutrineal (1.1% amino-acid-containing solution) regimen, for example, offers a significant reduction in carbohydrate load (approximately 40-50%), lower exposure to and absorption of glucose degradation products, reduced oxidative stress, and improved volume control when compared with a first-generation DDDD (4 x Dianeal) regimen. The positive aspects of each solution that we have observed in our patients allow a recommendation on the potential benefit of using these solutions in children treated with PD. In fact, data from the literature as well as the results of the studies reported in this paper show that in children the application of neutral pH bicarbonate/lactate-buffered solution for the standard nighttime APD prescription, icodextrin solution for a long daytime dwell, and AA-based solution in malnourished patients is safe and effective. Extended clinical trials should be encouraged to better define the PD schedules for the combined use of these solutions that may be associated with the best clinical efficacy and the highest level of biocompatibility.
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29
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Abstract
Since the widespread introduction of peritoneal dialysis (PD) into the standard care of patients with chronic kidney disease there has been a shift from the initial focus on technique survival to refinement of the therapy to enhance biocompatibility and improve both the local peritoneal and systemic consequences of PD. One of the most significant contributions to these advances has been the development of novel PD solutions. The use of new manufacturing techniques, buffer presentation, and new osmotic alternatives to glucose have allowed potentially improved peritoneal survival (in terms of structure and function) and improved subjective patient experience. Additional benefits have also included, enhanced management of salt and water removal, supported nutritional status and improvement in the systemic metabolic derangements associated with conventional PD treatment, based on glucose-containing lactate-buffered solutions. The selection of suitable targets for modulation of therapy continues to be hampered by our continued relative ignorance of the local and particularly systemic effects of PD compounded by the dearth of quality, outcome-based studies. The aim of this review is to summarize the characteristics of the next generation of PD fluids currently available, and then to evaluate their possible place in treatment by considering the difference in their effects in a series of structural and functional areas potentially relevant to improving patient outcomes.
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Affiliation(s)
- C W McIntyre
- Division of Vascular Medicine, School of Medical and Surgical Sciences, University of Nottingham Medical School, Derby, UK.
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30
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Krishnan M, Tam P, Wu G, Breborowicz A, Oreopoulos DG. Glucose degradation products (GDP's) and peritoneal changes in patients on chronic peritoneal dialysis: will new dialysis solutions prevent these changes? Int Urol Nephrol 2006; 37:409-18. [PMID: 16142577 DOI: 10.1007/s11255-004-1392-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As peritonitis rates are declining, the rate of technique failure due to ultrafiltration failure and inadequate solute removal is becoming more important. The failure of the peritoneal membrane to provide adequate dialysis increases with longer duration on PD and correlates with the structural changes in the peritoneal membrane. The exact mechanism responsible for these structural changes is unclear. Conventional PD fluids with glucose as the osmotic agent and more importantly the glucose degradation products (GDP) generated during the heat sterilization of these solutions seems to be responsible for inducing many of these changes in the peritoneum. GDP's in addition to causing structural and functional alterations of the peritoneal cells is also a leading cause of advanced glycation end-products (AGE) production. There is evidence to suggest that the GDP's and AGE's are not limited to the peritoneal cavity and the membrane. They have been shown to get deposited in the vascular walls. In addition they also interact with receptors on endothelial cells and smooth muscle. Thus they could contribute to the vascular dysfunction similar to that seen in diabetes. Formation of GDP's can be reduced and even be avoided with the use of newer "biocompatible" solutions by sterilizing the glucose and the buffer in separate chambers. These newer solutions have been shown to have several local and systemic advantages over the conventional PD solutions. It remains to be seen whether their chronic use from the start of peritoneal dialysis will prevent the development of peritoneal damage thus allowing these patients to remain on this modality for longer periods.
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Affiliation(s)
- Murali Krishnan
- The Division of Nephrology, University Health Network and University of Toronto, Toronto, ON, Canada
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Abstract
The number of patients with end-stage renal disease requiring dialysis has increased markedly over the last decade and continues to grow at an alarming rate in the United States. Of the currently available dialysis options for end-stage renal disease (hemodialysis and peritoneal dialysis), peritoneal dialysis (PD) is underutilized in the United States for nonmedical reasons. In fact, PD is the less expensive dialysis modality and may provide a survival advantage over hemodialysis in first 2 to 4 years of treatment, but that advantage is not as robust with increasing age and with the presence of diabetes. Moreover, the initial survival advantage is lost in long-term PD, mainly owing to changes in the peritoneal membrane from the use of conventional bio-incompatible PD solutions. Current data suggest that not many patients continue on PD beyond 10 years. The recent development of a more biocompatible PD solution should help to preserve membrane function, promote ultrafiltration, improve nutritional status, and, it is hoped, prolong the survival advantage of PD. Identification of molecular mechanisms involved in cellular responses leading to peritoneal fibrosis and angiogenesis evokes new therapeutic strategies that might protect the peritoneal membrane against the consequences of long-term PD.
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Affiliation(s)
- Ramesh Saxena
- Department of Internal Medicine, Division of Nephrology, UT Southwestern Medical Center, Dallas, Texas 75390-8856, USA.
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Lai KN, Leung JCK, Chan LYY, Li FFK, Tang SCW, Lam MF, Tse KC, Yip TP, Chan TM, Wieslander A, Vlassara H. Differential expression of receptors for advanced glycation end-products in peritoneal mesothelial cells exposed to glucose degradation products. Clin Exp Immunol 2005; 138:466-75. [PMID: 15544624 PMCID: PMC1809241 DOI: 10.1111/j.1365-2249.2004.02629.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Autoclaving peritoneal dialysate fluid (PDF) degrades glucose into glucose degradation products (GDPs) that impair peritoneal mesothelial cell functions. While glycation processes leading to formation of advanced glycation end-products (AGE) were viewed commonly as being mediated by glucose present in the PDF, recent evidence indicates that certain GDPs are even more powerful inducers of AGE formation than glucose per se. In the present study, we examined the expression and modulation of AGE receptors on human peritoneal mesothelial cells (HPMC) cultured with GDPs, conventional PDF or PDF with low GDP content. HPMC cultured with GDPs differentially modulated AGE receptors (including RAGE, AGE-R1, AGE-R2 and AGE-R3) expression in a dose-dependent manner. At subtoxic concentrations, GDPs increased RAGE mRNA expression in HPMC. 2-furaldehyde (FurA), methylglyoxal (M-Glx) and 3,4-dideoxy-glucosone-3-Ene (3,4-DGE) increased the expression of AGE-R1 and RAGE, the receptors that are associated with toxic effects. These three GDPs up-regulated the AGE synthesis by cultured HPMC. In parallel, these GDPs also increased the expression of vascular endothelial growth factor (VEGF) in HPMC. PDF with lower GDP content exerted less cytotoxic effect than traditional heat-sterilized PDF. Both PDF preparations up-regulated the protein expression of RAGE and VEGF. However, the up-regulation of VEGF in HPMC following 24-h culture with conventional PDF was higher than values from HPMC cultured with PDF containing low GDP. We have demonstrated, for the first time, that in addition to RAGE, other AGE receptors including AGE-R1, AGE-R2 and AGE-R3 are expressed on HPMC. Different GDPs exert differential regulation on the expression of these receptors on HPMC. The interactions between GDPs and AGE receptors may bear biological relevance to the intraperitoneal homeostasis and membrane integrity.
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Affiliation(s)
- K N Lai
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
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Williams JD, Topley N, Craig KJ, Mackenzie RK, Pischetsrieder M, Lage C, Passlick-Deetjen J. The Euro-Balance Trial: The effect of a new biocompatible peritoneal dialysis fluid (balance) on the peritoneal membrane. Kidney Int 2004; 66:408-18. [PMID: 15200450 DOI: 10.1111/j.1523-1755.2004.00747.x] [Citation(s) in RCA: 252] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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 (TNFalpha). Serum samples were assayed for circulating advanced glycosylation end products (AGE), N(epsilon)-(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 TNFalpha. 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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Affiliation(s)
- John D Williams
- Institute of Nephrology, University Hospital of Wales College of Medicine, Heath Park, Cardiff, Wales, UK.
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