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Mujais S, Nolph K, Gokal R, Blake P, Burkart J, Coles G, Kawaguchi Y, Kawanishi H, Korbet S, Krediet R, Lindholm B, Oreopoulos D, Rippe B, Selgas R. Evaluation and Management of Ultrafiltration Problems in Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080002004s02] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Salim Mujais
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Karl Nolph
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Ram Gokal
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Peter Blake
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - John Burkart
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Gerald Coles
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Yoshindo Kawaguchi
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Hideki Kawanishi
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Stephen Korbet
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Raymond Krediet
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Bengt Lindholm
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Dimitrios Oreopoulos
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Bengt Rippe
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
| | - Rafael Selgas
- International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis
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Krediet RT, Zweers MM, Van Westrhenen R, Ho-dac-Pannekeet MM, Struijk DG. What Can We Do to Preserve the Peritoneum? Perit Dial Int 2020. [DOI: 10.1177/089686080302302s03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundLong-term peritoneal dialysis may lead to peritoneal membrane failure. Loss of ultrafiltration is the most important clinical abnormality. Loss of ultrafiltration is associated with an increased number of peritoneal blood vessels, with fibrotic alterations, and with loss of mesothelium. Continuous exposure to bioincompatible dialysis solutions is likely to be important in the pathogenesis of these alterations.MethodsThis article reviews the toxicity of various constituents of dialysate, current assessments of interventions, and the results of interventions aimed at preserving the peritoneum.ResultsGlucose, possibly in combination with lactate, and glucose degradation products (GDPs) are likely to be the most toxic constituents of dialysate. Diabetiform peritoneal neoangiogenesis is likely to be mediated by vascular endothelial growth factor (VEGF). Release of VEGF might be influenced by glucose-induced cellular pseudohypoxia, which is likely to be increased by exposure to lactate. Glucose and GDPs are both toxic to peritoneal cells. Glucose degradation products induce the formation of advanced glycosylation end-products at a much faster rate than does glucose itself, but the relative importance of GDPs and glucose in clinical PD has not been clarified. The effects of interventions should first be assessed in long-term animal models, followed by clinical studies on peritoneal transport and on effluent markers that may reflect the status of the peritoneum. Possible interventions aim at reducing peritoneal exposure to glucose, GDPs, and lactate. Techniques include peritoneal resting, replacing some glucose-based exchanges with amino acid–based and icodextrin-based dialysate, using bicarbonate as a buffer, and administering solutions that have a low GDP content. Exposure to various dialysis solutions with a reduced GDP content has resulted in an increase in the effluent concentration of the mesothelial cell marker CA125, irrespective of the buffer used. Experimental studies in a long-term peritoneal exposure model in rats showed that the combination of a reduction in the concentration of lactate and replacement of lactate with pyruvate resulted in a reduction of the number of peritoneal blood vessels. Results of drug therapy have been studied in various animal models. Their use in patients is still experimental.ConclusionsStrategies to preserve the peritoneum aim at reducing membrane exposure to bioincompatible solutions. Currently available dialysis fluids that are more biocompatible are likely to have some beneficial effects. Further research on the development of dialysis solutions that use combinations of osmotic agents and alternative buffers is necessary.
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
| | - Machteld M. Zweers
- Division of Nephrology, Department of Medicine, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
| | - Roos Van Westrhenen
- Division of Nephrology, Department of Medicine, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
| | - Marja M. Ho-dac-Pannekeet
- Division of Nephrology, Department of Medicine, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
| | - Dirk G. Struijk
- Division of Nephrology, Department of Medicine, Academic Medical Center University of Amsterdam, Amsterdam, Netherlands
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Krediet RT, Zweers MM, Van Der Wal AC, Struijk DG. Neoangiogenesis in the Peritoneal Membrane. Perit Dial Int 2020. [DOI: 10.1177/089686080002002s05] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study reviews relevant publications on the peritoneal vasculature and tries to establish morphological–functional relationships. Design The design is a review article. Results Recent morphological studies in peritoneal dialysis (PD) patients have shown the presence of diabetiform neoangiogenesis in long-term peritoneal dialysis. The same abnormalities could be induced in rats administered a high glucose dialysis solution daily for 20 weeks. The animals showed functional abnormalities in peritoneal transport similar to those found in long-term PD patients. Evidence was obtained in patients that vascular endothelial growth factor could be involved in glucose-induced peritoneal neoangiogenesis. Conclusions Diabetiform peritoneal neoangiogenesis is an important pathogenetic factor in ultrafiltration failure in long-term peritoneal dialysis patients.
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Affiliation(s)
| | | | - Allard C. Van Der Wal
- Division of Cardiovascular Pathology, Department of Pathology, Academic Medical Centre, University of Amsterdam
| | - Dirk G. Struijk
- Division of Nephrology, Department of Medicine
- Dianet Foundation, Amsterdam, Utrecht, The Netherlands
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Krediet RT. Dialysate Cancer Antigen 125 Concentration as Marker of Peritoneal Membrane Status in Patients Treated with Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080102100605] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
ObjectiveThis study reviews publications on the history of cancer antigen 125 (CA125), the background of its use as a marker of mesothelial cell mass, determination in peritoneal effluent, and its practical use in both the follow-up of peritoneal dialysis (PD) patients and as a marker of in vivo biocompatibility of dialysis solutions.DesignReview article.ResultsCA125 is a high molecular weight glycoprotein. Previous studies in ascites suggested its release by mesothelial cells. In vitro studies with cultured mesothelial cells showed constitutive production, the majority of which was dependent on mesothelial cell mass. Serum CA125 is normal in PD patients, but its concentration in peritoneal dialysate suggests local release, probably from mesothelial cells. Effluent CA125 can be considered a marker of mesothelial cell mass in stable PD patients, but large amounts are found during peritonitis, due probably to necrosis of mesothelial cells. The majority of studies found no relationship between dialysate CA125 and peritoneal transport parameters. Some cross-sectional studies reported a relationship with duration of PD, but others were unable to confirm this, due probably to the large interindividual variability. Longitudinal follow-up has shown a decrease in dialysate CA125, indicating loss of mesothelial cell mass. Application of theoretically morebiocompatible PD solutions causes an increase in dialysate CA125.ConclusionsDialysate CA125 is a mesothelial cell mass marker. The concentration of CA125 should be determined after a standardized dwell. A single low value is not informative. A decrease with time on PD suggests loss of mesothelial cell mass. Dialysate CA125 is a marker of in vivo biocompatibility of (new) dialysis solutions. More research is necessary on the best methodology for measuring low concentrations and establishing normal values and a significant change.
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Affiliation(s)
- Raymond T. Krediet
- Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Diaz-Buxo JA. Case report of encapsulating peritoneal sclerosis: the interpretation of functional and structural peritoneal changes. Blood Purif 2008; 26:12-7. [PMID: 18182789 DOI: 10.1159/000110557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A case report describing the evolution of encapsulating peritoneal sclerosis is presented to illustrate some of the functional and structural peritoneal membrane changes characteristic of this complication of peritoneal dialysis. The appropriate monitoring of peritoneal transport rates and ultrafiltration, together with attention to clinical signs and symptoms, are essential to the early diagnosis of peritoneal membrane deterioration. Recent reports suggest that timely interventions such as a peritoneal membrane rest period may effectively halt the progression of these functional and structural changes. While the optimal surgical and pharmacological treatment of encapsulating peritoneal sclerosis remains uncertain, the latest literature provides a certain degree of optimism.
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