Short-term effects of low-calcium dialysis solutions on calcium mass transfer, ionized calcium, and parathyroid hormone in CAPD patients.

Patients on CAPD using calcium carbonate (CaCO3) as phosphate binder might benefit from low-calcium (Ca) concentration dialysis solutions; however, no data are available for the effects of this regimen on Ca metabolism. We studied 10 patients on stable CAPD regimens with standard dialysis solutions (Ca 7 mg/dL) who were taking CaCO3 to control hyperphosphatemia (mean daily doses 4.5 +/- 2.4 g). Hypercalcemic episodes had been recorded in 6 patients. Standard dialysis solutions were replaced with solutions containing 5 mg/dL of Ca. Calcium and phosphate peritoneal mass transfer (MT), serum concentrations of total Ca, ionized Ca (Ca++), phosphate, intact PTH, and mid-molecular PTH, were evaluated before and 48 hours after change of dialysate. The switch to low-Ca solutions was accompanied by significant changes in calcium mass transfer (Ca MT) (+9.84 +/- 48.22 versus -96.74 +/- 48.32 mg/day, p less than .001). Ca MT was significantly (p less than .05) correlated with the serum/dialysate Ca gradient. There was no difference in phosphate MT. Serum Ca++ significantly (p less than .05) decreased from 5.20 +/- 0.32 to 4.88 +/- 0.36 mg/dL, and intact PTH significantly increased (81.5 +/- 139 versus 112.4 +/- 168 pg/mL, p less than .05). It is concluded that dialysis solutions with Ca 5 mg/dL result in a negative peritoneal Ca MT and can be useful to prevent and treat hypercalcemia in CAPD patients taking CaCO3 as phosphate binder. A careful monitoring of ionized calcium, PTH, and phosphate is suggested when an extensive and long-term use of this solution is considered.     

Sevelamer hydrochloride in peritoneal dialysis patients: results of a multicenter cross-sectional study.

BACKGROUND: Sevelamer hydrochloride is a phosphate binder widely employed in hemodialysis patients. Until now, information about its efficacy and safety in peritoneal dialysis patients has been scarce. PATIENTS AND METHODS: In September 2005 a cross-sectional study of demographic, biochemical, and therapeutic data of patients from 10 peritoneal dialysis units in Catalonia and the Balearic Islands, Spain, was conducted. RESULTS: We analyzed data from 228 patients. At the time of the study, 128 patients (56%) were receiving sevelamer. Patients receiving sevelamer were younger (p < 0.01), showed a longer period of time on dialysis (p < 0.01), and had a lower Charlson Comorbidity Index (p < 0.01). Serum calcium and intact parathyroid hormone levels were not different between the two groups, while phosphate levels <5.5 mg/dL were observed more frequently in patients not receiving sevelamer (79% vs 61%, p < 0.01). Serum total cholesterol (167 +/- 41 vs 189 +/- 42 mg/dL, p < 0.01) and low density lipoprotein (LDL) cholesterol (90 +/- 34 vs 109 +/- 34 mg/dL, p < 0.01), but not high density lipoprotein cholesterol or triglycerides, were lower in sevelamer-treated patients. Moreover, sevelamer-treated patients displayed a higher serum albumin (38 +/- 5 vs 36 +/- 4 g/L, p < 0.01) and a lower C-reactive protein (4.9 +/- 12.8 vs 8.8 +/- 15.7 mg/L, p < 0.01). Blood bicarbonate levels <22 mmol/L were observed more frequently in patients receiving sevelamer (22% vs 5%, p < 0.01). Logistic regression analysis adjusting by confounding variables confirmed that sevelamer therapy was associated with serum total cholesterol <200 mg/dL [relative risk (RR): 2.77, 95% confidence interval (CI): 1.44 - 5.26, p = 0.002] and blood bicarbonate <22 mmol/L (RR: 8.5, 95% CI: 2.6 - 27.0, p < 0.001), but not with serum phosphate >5.5 mg/dL, calcium-phosphate product >55 mg(2)/dL(2), serum albumin <35 g/L, or C-reactive protein >5 mg/L. CONCLUSIONS: This uncontrolled cross-sectional study in peritoneal dialysis patients showed that sevelamer hydrochloride treatment allows an adequate serum phosphate level in about 60% of patients and significantly reduces total and LDL-cholesterol levels. Since this treatment is associated with metabolic acidosis in 22% of patients, we recommend close monitoring of bicarbonate levels in this group of patients until the clinical significance of this result is clarified.     

连续性非卧床腹膜透析1个月后患者透析充分性评估及电解质变化

目的 观察连续性非卧床腹膜透析(CAPD)患者治疗1个月的疗效,为早期控制尿毒症患者症状提供较好的方法.方法 新插管后进入CAPD 1个月后的终末期肾脏病患者129例,于CAPD治疗1个月末时评估患者的透析充分性,比较腹透前及第1个月末时观察合并症情况及各生化指标.结果 患者CAPD 1个月末时透析充分性良好,与腹透前比较,CAPD 1个月后水肿的发生率显著下降(24.8%与7.8%,χ2=13.765,P＜0.05),恶心、呕吐等胃肠道不适症状发生率显著下降(66.7%与6.2%,χ2=101.821,P＜0.05),皮肤瘙痒发生率显著下降(22.5%与6.2%,χ2=13.914,P＜0.05),合并症较透析前明显减少;治疗前后对比,血红蛋白[(79.10±17.13)g/L与(96.50±18.69)g/L,t=-6.333,P＜0.01]显著改善,血钙[(1.99±0.30)mmol/L与(2.07±0.20)mmol/L,t=-1.920,P＞0.05]、白蛋白[(30.62±5.24)g/L与(31.84±5.64)g/L,t=-0.333,P＞0.05],血磷[(2.06±0.54)mmol/L与(1.72±0.52)mmol/L,t=3.284,P＜0.01]、血钾[(4.30±0.68)mmol/L与(3.84±0.47)mmol/L,t=4.669,P＜0.01]均较透析前降低,尿素氮[22.00(15.87,30.01)mmol/L与17.00(13.91,20.91)mmol/L,Z=-3.717,P＜0.01]、肌酐[864.00(733.00,1046.25)μmol/L与777.50(627.00,1047.75)μmol/L,Z=-2.408,P＜0.05]均较透析前显著降低.甲状旁腺素[184.80(114.21,369.77)ng/L与226.26(124.22,335.92)ng/L,Z=-0.597,P＞0.05]有所上升,但差异无统计学意义.结论 CAPD在透析早期疗效显著,透析充分性良好,低钙、高磷得到改善,血钾降低,患者生活质量明显改善.

Abstract：

Objective To investigate the impact of continued ambulatory peritoneal dialysis (CAPD)for 1 month,thus to provide effective therapy to control the symptoms of uremia in early stage. Methods A total of 129 nephrotic patients in final stage were treated with CAPD ,dialysis adequacy were assessed after 1 month of CAPD. Complications and biochemical indicators were compared between before and after 1 month of CAPD. Results The dialysis adequacy was good at the end of 1 month of CAPD. Compared to before CAPD,The prevalence of edema after 1 month of CAPD significantly decreased compared to before CAPD (7.8%vs. 24.8% ,χ2 = 13.765, P ＜ 0.05 ). After CAPD gastrointestinal, symptom, such as nausea and vomit significantly decreased from 66.7% to 6. 2% ( χ2 = 101. 821, P ＜ 0. 05 ). Itch of skin significantly decreased from 22. 5% before CAPD to 6. 2% after CAPD(χ2 = 13.914,P ＜0. 05) . Hemoglobin increased significantly from (79. 10 ± 17.13 ) g/L to (96. 50 ± 18. 69 ) g/L after CAPD ( t = - 6. 333, P ＜ 0. 01 ), serum calcium was sisilar, ( 1.99 ± 0.30) mmol/L and (2.07 ± 0. 20) mmol/L at before and after CAPD respectively ( t = -1. 920,P ＞0. 05). Albumin was (30. 62 ±5.24) g/L before CAPD and after CAPD(31.84 ±5.64) g/L ,with no significant difference ( t= - 0.333, P ＞ 0. 05 ) . Serum inorganic phosphorus, kalemia, urea nitrogen and creatinine concentration significantly decreased from ( 2. 06 ± 0. 54 ) mmol/L, ( 4.30 ±: 0. 68 ) mmol/L, 22. 00( 15.87,30.03 ) mmol/L and 864. 00 ( 733.00,1046. 25 ) μmol/L to ( 1.72 ± 0. 52) mmol/L, ( 3.84 ± 0.47 )mmol/L , 17.00 ( 13.91,20. 91 ) mmol/L and 777. 50 ( 627.00, 1047.75 ) μnol/L, respectively ( t = 3.284,4. 669, Z = - 3.717 and - 2. 408, respectively,Ps ＜ 0. 01 or 0. 05 ).. The level of serum PTH increased slightly from [ 184. 80 ( 114. 21,369. 77) ng/L to 226. 26 ( 124. 22,335.92 ) ng/L, but the difference was not significant ( Z = - 0. 597, P ＞ 0. 05 ). Conclusion CAPD had significant effect in early stage of dialysis with good dialysis adequacy. Hypocalcemia and hyperphosphatemia can be improved. The levels of serum kalemia decreased. The iatients's quality of life significantly improved.     

Cost-Minimization Analysis of Lanthanum Carbonate Versus Sevelamer Hydrochloride in US Patients With End-stage Renal Disease

Purpose

Sevelamer hydrochloride (SH) and lanthanum carbonate (LC) are calcium-free phosphate binders used in the clinical management of hyperphosphatemia in patients with end-stage renal disease (ESRD). The objective of this analysis was to assess the cost-effectiveness of LC monotherapy compared with SH monotherapy in US patients with ESRD in a clinical practice setting.

Methods

This was a post hoc assessment of phosphate binder costs among US patients with ESRD who converted from SH to LC monotherapy in a previously published, 16-week, Phase IV, real-world study. Calculations of drug costs used both average wholesale price (AWP) and wholesale acquisition cost (WAC).

Findings

There were 953 patients with available baseline SH dose data; 950 also had a recorded LC dose >0 mg at baseline, and 691 had dose data available for both SH at baseline and LC at week 16 (post hoc analysis population). Baseline demographic characteristics were similar in excluded patients and the post hoc analysis population. Mean (SD) serum phosphate levels were 5.91 (1.66) mg/dL at baseline and 5.93 (1.85) mg/dL after conversion to LC monotherapy for 16 weeks. Mean AWP costs were US$35.72 (16.89) per day at baseline and US$24.69 (8.28) per day at week 16, yielding an overall mean cost change (defined as LC cost − SH cost) of −US$11.03 (16.37) per day in favor of LC. The overall mean WAC cost change was −US$9.17 (13.64) per day. Within baseline SH dose subgroups 2400 to 4800, >4800 to 7200, >7200 to 9600, and >9600 mg/d, the mean AWP cost change ranged from US$2.78 (9.26) per day in favor of SH for the 2400- to 4800-mg/d subgroup to −US$33.15 (12.58) per day in favor of LC for the >9600-mg/d subgroup. Mean WAC cost changes showed a similar trend, ranging from US$2.33 (7.72) per day to −US$27.59 (10.48) per day. Linear regression analyses revealed that the inflection SH doses corresponding to a mean cost change of zero were 4905 mg/d (AWP) and 4908 mg/d (WAC). For the 455 (66%) patients in the post hoc analysis population who had baseline SH doses at least as high (≥5600 mg/d) as these point estimates, the mean SH:LC tablet ratio was ≥3.7, indicating a mean reduction in the tablet burden after conversion to LC of ≥73%.

Implications

This real-world assessment of comparative phosphate binder drug costs between SH and LC among US patients with ESRD indicates that average cost savings with LC use increased with increasing SH doses. Conversion to LC from SH ≥5600 mg/d reduced drug costs and tablet burden while maintaining serum phosphate levels.     

Serum magnesium concentration is an independent predictor of parathyroid hormone levels in peritoneal dialysis patients.

BACKGROUND: Parathyroid hormone (PTH) is a cardinal factor in the pathogenesis of bone disease in the dialysis population. The spectrum of renal osteodystrophy has been reported to have changed during the past years, and adynamic bone disease has emerged as the most common bone disorder in these patients. Continuous ambulatory peritoneal dialysis (CAPD) is considered a risk factor for the development of this condition, and furthermore, the adynamic bone lesion is associated with a state of relative hypoparathyroidism (hypo-PTH). Calcium, vitamin D, and phosphorus play a key role in the control of parathyroid gland function in uremic patients. However, magnesium may also be able to modulate PTH secretion in a way similar to calcium. OBJECTIVE: The aims of this study were (1) to analyze the serum Mg concentration in a large group of CAPD patients, (2) to study the relationship between serum Mg and PTH levels, and (3) to investigate whether this relationship is independent of other factors, such as calcium, phosphorus, and calcitriol, that regulate parathyroid function. PATIENTS AND METHODS: We studied 51 stable patients, aged 23-77 years, under maintenance CAPD for more than 6 months (range 8-48 months). Calcium carbonate was used as a phosphate binder in all patients, and 9 subjects also received aluminum hydroxide. No patient had been previously treated with vitamin D. Biochemical parameters were prospectively evaluated over 6 months, and the mean values were computed. RESULTS: The mean serum Mg was 1.08 +/- 0.19 mmol/L, and hypermagnesemia, defined as a Mg level higher than 1.01 mmol/L, was found in 30 patients (59%). Thirty-one subjects (60%) had an intact PTH (iPTH) level lower than 120 pg/mL and were diagnosed as having relative hypo-PTH. Except for the values of iPTH and alkaline phosphatase, the only difference between the two groups was the serum Mg concentration, which was significantly higher in patients with hypo-PTH (1.16 +/- 0.15 mmol/L vs 0.91 +/- 0.14 mmol/L; p< 0.001). Furthermore, iPTH levels were lower in patients with hypermagnesemia than in subjects with normal serum Mg (69 +/- 49 pg/mL vs 190 +/- 89 pg/mL, p < 0.001). There was a significant correlation between serum Mg and PTH levels (r= -0.70, p< 0.01). After controlling for the effect of other variables by partial correlation analysis, a significant positive association between P and PTH (r= 0.25, p < 0.05), and a negative relationship between Mg and PTH (r= -0.57, p < 0.001) were evident. A forward stepwise multiple regression analysis showed that only P and Mg predicted PTH values (multiple r = 0.59, p < 0.001). CONCLUSIONS: Hypermagnesemia and hypoparathyroidism are frequent in CAPD patients. There is a significant inverse relationship between serum Mg concentration and iPTH levels. Furthermore, this association is independent of the most important factors regulating parathyroid gland function (calcium, phosphorus, and calcitriol). These results suggest that hypermagnesemia may have a suppressive effect on PTH synthesis and/or secretion. Therefore, elevated serum Mg levels may play a role in the pathogenesis of adynamic bone disease.     

Real-World Dose-Relativity,Tablet Burden,and Cost Comparison of Conversion Between Sevelamer Hydrochloride/Carbonate and Lanthanum Carbonate Monotherapies

Purpose

Sevelamer hydrochloride/carbonate (SH/C) and lanthanum carbonate (LC) are noncalcium-based phosphate binders used for the management of hyperphosphatemia in patients with end-stage renal disease (ESRD). The objectives of this study were to examine the dose-relativity, tablet burden, and cost difference of bidirectional conversion between SH/C and LC monotherapy in a large cohort of real-world patients with ESRD.

Methods

This retrospective cohort study included three 30-day preconversion periods (days −90 to −61, −60 to −31, and −30 to −1) followed by three 30-day postconversion periods (days 1 to 30, 31 to 60, and 61 to 90); day 0 was the index date of conversion. The full analysis population (FAP) comprised two cohorts: SH/C to LC (S–L) converters and LC to SH/C (L–S) converters. The SH/C:LC dose-relativity ratio was assessed in the dose-relativity subset, defined as patients whose serum phosphate levels fell within a caliper range of ±0.5 mg/dL in the final preconversion (days −30 to −1) and postconversion (days 61 to 90) periods. Tablet burden and phosphate binder costs were assessed in the FAP. Phosphate binder costs were based on average wholesale prices.

Findings

The FAP contained a total of 303 patients, comprising the S–L (128 patients) and L–S (175 patients) converter cohorts. The dose-relativity subset contained 159 patients, 72 from the S–L cohort and 87 from the L–S cohort. The overall mean SH/C:LC dose-relativity ratio was 2.27 (95% CI, 2.04 to 2.52). In SH/C dose strata >800 to 2400, >2400 to 4800, >4800 to 7200, and >7200 mg/d, overall mean dose-relativity ratios were 0.79 (95% CI, 0.57 to 1.10), 1.45 (95% CI, 1.20 to 1.75), 2.05 (95% CI, 1.75 to 2.39), and 3.24 (95% CI, 2.89 to 3.66), respectively. The overall mean tablet burden was 6.6 tablets per day lower with LC monotherapy than with SH/C monotherapy (95% CI, −7.1 to −6.0; P < 0.0001). The overall mean binder cost/patient per month was $1080.40 for SH/C compared with $1006.20 for LC, corresponding to a mean binder cost saving for LC of $74.20/patient per month (95% CI, −141.80 to −6.63; P = 0.032). SH/C >7800 mg/d was the inflection point at which conversion to LC resulted in mean cost savings. Patients requiring SH/C >7800 mg/d comprised 50% of the FAP.

Implications

Converting patients with ESRD and hyperphosphatemia from SH/C to LC monotherapy offers potential drug cost savings and a significant reduction in the daily tablet burden, without compromising the effective management of serum phosphate levels.     

Comparative study between intact PTH and fragments of PTH in patients on hemodialysis and CAPD.

Twenty-nine patients on hemodialysis (HD) and 29 patients on continuous ambulatory peritoneal dialysis (CAPD) were studied. Serum calcium and phosphorous levels were similar in the 2 groups. Serum parathyroid hormone (PTH) levels were determined by 4 different methods. Mid-molecule PTH levels were higher in HD (1099.5 +/- 876.8 pmol/L) than in CAPD patients (541.0 +/- 138.8 pmol/L), p less than 0.001, while intact PTH levels were similar. The ratio MM-PTH/Intact PTH was higher in HD (55.2 +/- 29.0) than in CAPD patients (39.0 +/- 20.0), where p less than 0.01. In patients with similar C-PTH, those on CAPD had higher levels of intact PTH (46.0 +/- 27.0 pmol/L) than those in HD (29.3 +/- 29.0 pmol/L), p less than 0.01. The ratio C-PTH/intact PTH was higher in HD (104.9 +/- 39.6) than in CAPD patients (59.3 +/- 32.3), p less than 0.001. The Peritoneal Saturation Index (PSI) of MM-PTH was 23.4 +/- 12%, and it showed a hyperbolic correlation in respect to MM-PTH serum levels. We concluded that CAPD can modify the plasma C-PTH and MM-PTH serum levels by peritoneal losses of these fragments.     

Efficient monthly subcutaneous administration of darbepoetin in stable CAPD patients.

BACKGROUND: Although subcutaneous administration of recombinant human erythropoietin (rHuEPO) in continuous ambulatory peritoneal dialysis (CAPD) patients is a widely accepted recommendation, the lowest possible frequency of an efficient dosing regimen remains controversial. Darbepoetin alpha, a new erythropoiesis-stimulating protein with a threefold longer serum half-life compared with rHuEPO, has greater in vivo potency and can be administered less frequently to obtain the same biological response. This study assessed the efficacy of darbepoetin administered once monthly in the treatment of anemia in CAPD patients. PATIENTS AND METHODS: In this single-center, prospective cohort study, 11 stable CAPD patients (5 males, 6 females; mean age 68.8 +/- 14.1 years; mean duration on peritoneal dialysis 31.6 +/- 13 months) maintained average hemoglobin and hematocrit levels of 12.09 +/- 1.29 g/dL and 37.29% +/- 3.58%, respectively, while receiving a mean weekly maintenance dose of epoetin alfa of 129 IU/kg. These same patients were assigned to receive the equivalent weekly darbepoetin dose once monthly for 24 consecutive weeks. Hematological response, iron status (transferrin saturation, serum ferritin levels), C-reactive protein (CRP), and the patients' biochemical profiles were evaluated monthly. RESULTS: During the monthly administration of darbepoetin, mean serum levels of Hb and Hct were 12.17 +/- 1.28 g/dL and 37.1% +/- 1.19% respectively. No statistically significant difference was apparent between the previous and monthly dosing values (12.09 +/- 1.29 vs 12.17 +/- 1.28 g/dL, p = 0.769, and 37.29% +/- 3.58% vs 37.1% +/- 1.19%, p = 0.752). Transferrin saturation levels as well as serum ferritin levels also remained unchanged (30.4% +/- 8.6% vs 30.1% +/- 9.4%, NS, and 556 +/- 212 vs 621 +/- 234 ng/mL, respectively, NS). CONCLUSION: These results indicate that darbepoetin alfa can be effectively given subcutaneously at monthly intervals for the treatment of anemia in stable CAPD patients. However, more studies are needed to validate the long-term efficacy of this monthly subcutaneous administration.     

Erythrocyte glutathione peroxidase activity,plasma malondialdehyde and erythrocyte glutathione levels in hemodialysis and CAPD patients

OBJECTIVES: Cardiovascular disease is the major cause of mortality in patients receiving hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) due to chronic renal failure. Increased lipid peroxidation and depletion of antioxidants may contribute to increased risk of atherosclerosis. We have therefore assessed the effect of hemodialysis and CAPD on oxidant and antioxidant status. DESIGN AND METHODS: Plasma malondialdehyde (MDA), Glutathione (GSH) levels and glutathione peroxidase (Gpx) activities were determined in 20 healthy persons (control), 20 patients on HD, 16 patients on CAPD. RESULTS: MDA was elevated in posthemodialysis and CAPD patients in comparison to prehemodialysis and control groups (posthemodialysis 1.39 +/- 0.38 nmol/mL, CAPD 1.26 +/- 0.27 nmol/mL, prehemodilaysis 0.83 +/- 0.22 nmol/mL, controls 0.72 +/- 0.21 nmol/mL p < 0.0001). With respect to antioxidants, glutathione levels were significantly lower in prehemodialysis, posthemodialysis and CAPD groups than those in control group (prehemodialysis 16.82 +/- 6.73 mg/dL RBC, posthemodialysis 31.43 +/- 11.88 mg/dL RBC, CAPD 40 +/- 12.72 mg/dL RBC, controls 62.26 +/- 24.01 mg/dL RBC, p < 0.0001). While erythrocyte GSH levels were significantly lower in the prehemodialysis patients than those in posthemodialysis and CAPD patients (p < 0.0001), it was significantly lower in posthemodialysis patients than those in CAPD patients (p < 0.05). There were no significant differences with respect to erythrocyte Gpx levels among the groups (p > 0.05). CONCLUSIONS: These findings indicate oxidative stress in patients with chronic renal failure which is further exacerbated by hemodialysis and CAPD, as evidenced by increased lipid peroxidation and low antioxidant levels.     

The Real-World Dose-Relativity of Sevelamer Hydrochloride and Lanthanum Carbonate Monotherapy in Patients with End-Stage Renal Disease

Introduction

Sevelamer hydrochloride (SH) and lanthanum carbonate (LC) are calcium-free phosphate binders used for the management of hyperphosphatemia in patients with end-stage renal disease (ESRD). The objective of this analysis was to evaluate the real-world dose-relativity between SH and LC monotherapy in US patients with ESRD.

Methods

This was a post hoc analysis of a 16-week, real-world study (Vemuri et al. in BMC Nephrol 12:49, 2011) of the efficacy of conversion to LC monotherapy from other phosphate binders. The SH:LC dose-relativity ratio, based on the mean daily dose, was calculated in the subset of patients from the Vemuri study who converted from SH to LC monotherapy and had available SH and LC dose data.

Results

A total of 950 patients converted from SH to LC monotherapy and had recorded dose data. The post hoc analysis population comprised 691 patients with available dose data for both SH at baseline and LC at week 16. The mean (SD) serum phosphate level at baseline was 5.91 (1.66) mg/dL. After conversion to LC monotherapy for 16 weeks, the mean (SD) serum phosphate level was 5.93 (1.85) mg/dL. The mean (SD) daily baseline SH dose was 7,703 (3,642) mg and the mean (SD) daily LC dose at week 16 was 2,800 (939) mg (9.6 versus 2.8 tablets, respectively; P < 0.0001), resulting in a SH:LC dose-relativity ratio of 2.8. The median individual patient SH:LC dose-relativity ratio was 2.6 (95% CI 2.6–2.8). Across baseline SH dose subgroups (2,400–4,800, >4,800–7,200, >7,200–9,600, and >9,600 mg/day), the mean daily SH dose was 4,051, 7,047, 9,253, and 13,150 mg, respectively. In comparison, the mean daily LC dose was 2,445–3,156 mg. Thus, patients requiring baseline SH doses >7,200 mg/day (41% of the analysis population) had higher SH:LC dose-relativity ratios of 3.1–4.2 (median individual patient ratios 3.1–4.0).

Conclusion

In this post hoc analysis of real-world dose-relativity, the overall SH:LC dose-relativity ratio was 2.8 (median individual patient ratio 2.6 (95% CI 2.6–2.8). These findings are consistent with the World Health Organization-defined daily dose and previous studies of the relative phosphate binding capacity of the two drugs. Patients requiring SH doses >7,200 mg/day had higher SH:LC dose-relativities of 3.1–4.2 (median individual patient ratios 3.1–4.0). These findings have implications for the tablet burden and cost-effectiveness of SH and LC in the treatment of hyperphosphatemia.     

持续不卧床腹膜透析患者血清铁调素水平与钙磷代谢的相关性

目的研究持续不卧床腹膜透析（CAPD）患者血清铁调素（hepcidin）水平变化以及钙磷代谢状况与铁调素水平的相关性。 方法选取2014年6月至12月在江苏省苏北人民医院血液净化中心进行CAPD治疗的患者45例,将同期该院健康体检中心体检健康者40例作为健康对照组。采用ELISA法检测血清铁调素水平;采用成组t检验比较CAPD组和对照组的年龄、体质量指数（BMI）、血尿素氮（BUN）、肌酐（cr）、白蛋白、磷、钙、25（OH）-维生素D₃、血清铁、总铁结合力（TIBC）、可溶性转铁蛋白受体（sTfR）、血红蛋白、红细胞比容等指标;采用秩和检验（Mann-Whitney rank）比较两组全段甲状旁腺激素（iPTH）、铁蛋白、铁调素等指标;采用χ²检验比较两组性别分布;采用Pearson相关及多元逐步线性回归方法分析铁调素与钙磷代谢指标之间的相关性。 结果CAPD组患者与对照组比较,血清中血红蛋白、红细胞比容、白蛋白、血清铁、TIBC、转铁蛋白饱和度、25（OH）-维生素D₃水平明显降低,差异具有统计学意义［（89.62±20.04）g/L vs（121.53±4.06）g/L,t=-8.72,P<0.001;（26.81±5.68）% vs（40.82±2.04）%,t=-9.64,P<0.001;（43.25±1.23）g/L vs（45.26±1.29）g/L,t=-1.27,P=0.046;（10.27±2.36）μmol/L vs（18.52±4.41）μmol/L,t=-5.71,P<0.001;（65.40±2.89）μmol/L vs（75.84±5.03）μmol/L,t=-2.34,P=0.037;（15.34±5.44）% vs（29.65±4.77）%,t=-9.31,P<0.001;（39.57±7.23）nmol/L vs（79.12±10.38）nmol/L,t=-10.34,P<0.001］;CAPD组患者与对照组比较,BUN、cr、铁蛋白、sTfR、铁调素、iPTH和磷的水平明显升高,差异具有统计学意义［（18.87±7.64）mmol/L vs（4.26±1.18）mmol/L,t=8.27,P<0.001;（647.43±56.78）μmol/L vs（54.81±6.74）μmol/L,t=8.26,P<0.001;260.41（109.31,423.33）μg/L vs 109.33（60.54,159.62）μg/L,Z=-4.24,P=0.001;（4.27±1.45）mg/L vs（2.89±1.22）mg/L,t=1.79,P=0.048;234.24（134.22,437.19）μg/L vs 87.51（40.54,132.57）μg/L,Z=-5.27,P<0.001;26.10（15.04,50.35）ng/L vs 3.30（1.78,6.25）ng/L,Z=-5.61,P<0.001;（2.73±0.47）mmol/L vs （1.24±0.65）mmol/L,t=12.09,P<0.001］;pearson相关分析结果显示CAPD患者血清铁调素与血磷（r=0.300,P=0.003）和iPTH（r=0.313,P=0.02）水平呈正相关,但血清铁调素水平与血钙（r=0.064,P=0.531）及25（OH）-维生素D₃（r=0.007,P=0.943）水平无相关性。 结论血清铁调素水平在CAPD患者体内明显升高,与血清磷和iPTH水平呈正相关,血磷及iPTH可能参与铁调素的调节。     

Evaluation of nutritional status and factors related to malnutrition in children on CAPD.

OBJECTIVE: The aim of this study was to investigate the nutritional status of children on continuous ambulatory peritoneal dialysis (CAPD) and to relate it to the dose of dialysis and serum levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1). PATIENTS: 17 CAPD patients (8 girls, 9 boys; mean age 13.1 +/- 3.5 years, median 15 years) were included in the study. Anthropometric measurements and serum albumin levels were used in the evaluation of nutritional status. Serum interleukin (IL)-1beta, IL-6, tumor necrosis factor alpha, and IGF-1 levels were determined in all CAPD patients and in a healthy control group. Weekly Kt/V and creatinine clearance (CCr) were measured to determine adequacy of dialysis. RESULTS: The mean dialysis period was 23.7 +/- 15.2 months (median 23 months). Anthropometric measurements and serum albumin level were as follows: height 130.2 +/- 15.6 cm, height standard deviation score (HtSDS) -4.2 +/- 2.4, body mass index (BMI) 16.3 +/- 1.6 kg/m2, body mass index standard deviation score (BMISDS) -0.8 +/- 0.9, triceps skinfold thickness (TST) 4.2 +/- 1.4 mm, midarm circumference (MAC) 16.21 +/- 2.3 cm, upper arm muscle area (AMA) 1799.1 +/- 535.7 mm2, upper arm fat area (AFA) 334.5 +/- 143 mm2, and serum albumin 3.1 +/- 0.7 g/dL. The BMI was above the fifth percentile in all patients; TST and MAC were below the fifth percentile in 14 patients (82.4%) and 10 patients (58.8%) respectively. The AMA was below the fifth percentile in 8 patients; however, the AFA was below the fifth percentile in all patients. Mean serum albumin level was under 3.5 g/dL in 70.5% of the children. We found significant positive correlations between BMI and Kt/V (r = 0.69, p < 0.01), CCr (r = 0.64, p < 0.05), and IL-6 (r = 0.61, p < 0.01). There was an inverse correlation between BMISDS and dialysis period (r = -0.58, p < 0.05); and between IL-6 and serum albumin (r = -0.49, p < 0.05). A significant positive correlation between BMISDS and serum IGF-1 level (r = 0.62, p < 0.01) was noted. We also found a significant positive correlation between serum IGF-1 level and both HtSDS (r = 0.57, p < 0.05) and TST (r = 0.52, p < 0.05). Significant positive correlations between AFA and CCr and IGF-1 were also noted (both r = 0.56, p < 0.05). CONCLUSION: Although many factors may be responsible for malnutrition and growth retardation, we found that prolonged period of dialysis, inadequate dialysis, and low IGF-1 levels are the most important risk factors in CAPD patients.     

Effect of polymeric diets in patients on continuous ambulatory peritoneal dialysis.

OBJECTIVE: To determine if a diet complemented with calcium caseinate is better than a natural high protein diet for increasing serum albumin levels in patients on continuous ambulatory peritoneal dialysis (CAPD). PATIENTS AND METHODS: A 4-month clinical trial involving 100 patients older than 18 years was performed. Patients were randomized into two groups: group A, high protein diet (1.4 g natural protein/kg target weight/day and 35 kcal/kg target weight/day); and group B, calcium caseinate (0.7 g calcium caseinate plus 0.7 g natural protein diet/kg target weight/day and 35 kcal/kg target weight/day). Serum levels of albumin, total proteins (TP), BUN, creatinine, glucose, urea, sodium, and potassium, and hematocrit, leukocytes, erythrocytes, and hemoglobin were analyzed at baseline and every 30 days. RESULTS: The final mean albumin value was, for group A, 3.04 +/- 0.39 g/dL, and for group B, 3.12 +/- 0.41 g/dL (p < 0.05); TP for group A, 6.29 +/- 0.47 g/dL, and for group B, 6.49 +/- 0.51 g/dL (p < 0.05); leukocytes for group A, 6888 +/- 1282/mm3, for group B, 7288 +/- 1878/mm3 (p = 0.05); BUN for group A, 47 +/- 11 mg/dL, for group B, 50 +/- 16 mg/dL (p = 0.05). Regression analysis showed a treatment effect in serum albumin and TP levels from the third month in both groups. In group B, a constant elevation of serum albumin of 0.19 mg/dL and TP of 0.27 mg/dL was observed in every month of treatment with calcium caseinate. In the regression analysis of group A we observed a smaller increase in serum albumin, 0.06 mg/dL, and in TP, 0.11 mg/dL, in each month of treatment with the high protein diet. Both differences are significant (p < 0.05). CONCLUSION: Calcium caseinate used in CAPD patients suffering from malnutrition increases serum albumin levels.     

Treatment for dyslipidemias in patients with arterial hypertension

AIM: To evaluate a combination of the effects of non-drug measures and rozuvastatin on the lipid spectrum and blood pressure (BP) in patients with treated arterial hypertension (AH) concurrent with dyslipidemia. MATERIALS AND METHODS: The multicenter open-labeled prospective program included 299 patients from 19 cities and towns of Russia. Two hundred and eighty-eight patients completed phase 1 of the program; out of them 279 patients (149 males and 130 females) aged 58-80 years (56.7 +/- 8.7 years) with a mean AH history of 10.3 +/- 8.4 years. Phase 1 of the program involved 3 visits and it was over 12 weeks after rozuvastatin therapy. Phase 2 (including a visit 12 weeks following the termination of Phase 1) is being continued. RESULTS: Rozuvastatin therapy resulted in a reduction in the levels of total cholesterol (TC) by 2.5 +/- 0.8 mmol/l (p < 0.001), low-density lipoprotein (LDL) cholesterol by 2.2 +/- 0.8 mmol/l (p < 0.001), triglycerides (TG) by 0.8 +/- 0.9 mmol/l (p < 0.001), and atherogenicity index (AI) by 2.8 +/- 1.4 (p < 0.001) and an increase in the content of high-density lipoprotein (HDL) cholesterol by 0.2 +/- 0.2 mmol/l (p < 0.001), which produced the target levels of LDL cholesterol in 61% of the patients, HDL cholesterol in 70%, and TG in 73%. During unaltered antihypertensive therapy there were also decreases in body mass by 1.5 +/- 2.8 mmol/l (p < 0.001), body mass index by 0.5 +/- 1.0 kg/ m2 (p < 0.001), waist circumference by 1.0 +/- 3.2 cm (p < 0.001), and BP by 72 +/- 14.2/4.1 +/- 8.6 mm Hg (p < 0.001). There was an increase in the activity of aspartate aminotransferase and alanine aminotransferase, and creatine phosphokinase; however, this was clinically significant in none patients. CONCLUSION: Rozuvastatin significantly lowers the levels of TC, LDL cholesterol, TG, and AI and elevates the concentration of HDL cholesterol. In the majority (83%) of the patients, rozuvastatin used in a dose of 10 mg/day was sufficient to normalize the lipid profile, which makes it possible to recommend that rozuvastatin therapy should be started from this dose.     

Transport kinetics of pseudouridine during hemodialysis and continuous ambulatory peritoneal dialysis

It has been found that the concentrations of pseudouridine in serum of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are higher than those in patients undergoing hemodialysis. We analyzed whether this could be caused by a lower rate of transport in CAPD when compared with hemodialysis. Mass transfer area coefficients (MTCs) for urea, creatinine, uric acid, and pseudouridine were determined in nine patients undergoing hemodialysis as dialyzer clearances and in 14 patients undergoing CAPD during a 4-hour dwell with 2 L dialysate with glucose, 70 mmol/L. The theoretical MTC of pseudouridine (TPSI), calculated by extrapolation to its molecular weight by use of the MTC of urea, creatinine, and uric acid, was higher than the observed MTC of pseudouridine, both in hemodialysis (136 vs 112 ml/min, p less than 0.025) and in CAPD (6.9 vs 3.4 ml/min, p less than 0.001). The pseudouridine/TPSI MTC ratio was lower during CAPD than during hemodialysis (0.47 vs 0.83, p less than 0.0005), indicating a lower level of transport during CAPD. In vitro experiments with nuclear magnetic resonance spectroscopy supported the hypothesis of glucose-induced molecular association of pseudouridine. Therefore, dialysate containing 10 mmol/L glucose was compared with that containing 70 mmol/L glucose in eight patients undergoing CAPD. The MTC of pseudouridine was higher during the experiments with dialysate containing 10 mmol/L glucose (3.5 +/- 2.0 ml/min vs 2.7 +/- 1.9 ml/min, p less than 0.05). This was also found for the pseudouridine/TPSI MTC ratio (0.61 vs 0.41, p less than 0.02) and the pseudouridine/creatinine MTC ratio (0.33 vs 0.25, p less than 0.02), favoring glucose-induced decrease of MTC-pseudouridine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Patient and technique survival on CAPD in Turkey.

OBJECTIVE: To analyze the status of continuous ambulatory peritoneal dialysis (CAPD) in 12 centers in Turkey. DESIGN: Retrospective study of CAPD technique and patient outcome. SETTING: University hospital renal units. PATIENTS: 334 patients [205 males (61%),129 (39%) females; mean age 42.2 +/- 13.8 years; mean follow-up time 23.5 +/- 18.3 months] beginning CAPD between March 1992 and December 1999, and having a minimum follow-up of 3 months. OUTCOME MEASURE: Patient survival, technique survival, and duration of hospitalization. RESULTS: Mean weekly Kt/V urea was 1.9 +/- 0.8, weekly creatinine clearance was 62.9 +/- 8.5 L/1.73 m2, and mean serum albumin level was 3.7 +/- 0.6 g/dL. 93 patients (28%) were withdrawn from peritoneal dialysis due to death (12.6%), transplantation (3.9%), transfer to hemodialysis (8.7%), patient failure to adapt (1.5%), and other reasons (1.2%). The major causes of death were cardiovascular disease (60%), infection (19%), malignancy (2%), and others (19%). Cox proportional hazard model analysis indicated age, serum albumin levels, comorbidity, and functional status affected survival and hospitalization (p < 0.05), whereas gender and Kt/V did not (p > 0.05). Estimation of patient survival by Kaplan-Meier analysis showed 94.2%, 88.6%, 84.5%, and 68.9% at 1, 2, 3, and 5 years respectively. Technique survival estimate by Kaplan-Meier analysis was 96.6%, 91.1%, 90.4%, and 77.4% at 1, 2, 3, and 5 years respectively. CONCLUSION: Peritoneal dialysis is an acceptable method of renal replacement therapy in Turkey. There is controversy regarding the usefulness of Kt/V in predicting mortality and morbidity.     

Glucocorticoid insufficiency in patients who present to the hospital with severe sepsis: a prospective clinical trial

OBJECTIVE: To identify the incidence of secondary adrenal insufficiency in severe sepsis. DESIGN: Prospective clinical trial testing 100 patients with a 250-microg adrenocorticotropic hormone (ACTH) stimulation test. SETTING: County-university teaching hospital. PATIENTS: One hundred patients with sepsis and septic shock. Forty patients had bacteremia and 17% shock. INTERVENTIONS: ACTH, cortisol, aldosterone, and electrolyte concentrations were measured at baseline. Cortisol and aldosterone were measured 30 and 60 mins after ACTH (250 microg). MEASUREMENTS AND MAIN RESULTS: Nine of the 100 patients (9%) failed the ACTH stimulation test (all serum cortisol <20 microg/dL). The 91 patients with sepsis began with a serum cortisol at 29.3 +/- 2.5, and it increased to 40.1 +/- 2.6 and 46.9 +/- 2.7 microg/dL at times 30 and 60 mins, respectively. Serum cortisol in nine septic patients who failed the ACTH stimulation test had an initial concentration of 11.3 +/- 1.8 microg/dL, and it increased at time 30 mins to 14.0 +/- 1.9 microg/dL and at 60 mins to 15.7 +/- 1.8 microg/dL. Four of the nine patients had secondary adrenal insufficiency as determined by a normal aldosterone response to ACTH. The remaining five patients had an absent aldosterone response to ACTH and baseline ACTH concentrations that were not elevated, suggesting adrenal dysfunction. Serum sodium (128 +/- 4 vs. 138 +/- 1 mmol/L, p <.05) and glucose concentrations (121 +/- 20 vs. 163 +/- 11 mg/dL, p <.05) were reduced in the nine patients. Of the four patients with secondary adrenal insufficiency, two had a history of amenorrhea after birth of their children many years earlier. CONCLUSIONS: These data demonstrate that 9% of adults with sepsis fail the ACTH stimulation test due to a mixture of etiologies. A reduced sodium or glucose concentration may be helpful in identifying glucocorticoid (adrenal) insufficiency in patients with sepsis.     

Association between serum n-terminal pro-brain natriuretic peptide concentration and left ventricular dysfunction and extracellular water in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: This study investigated the association between serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels and extracellular water (ECW%) and left ventricular (LV) dysfunction in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: The study involved 30 stable CAPD patients: 14 males, 16 females; mean age 52 +/- 14 years; mean CAPD duration 34 +/- 12 months; 12 with diabetes mellitus (DM) and 18 non-DM. Serum NT-pro-BNP levels were determined using electrochemiluminescence immunoassay. Baseline echocardiography was performed using a Hewlett-Packard Sonos 1000 (Andover, Massachusetts, USA) device equipped with a 2.25-MHz probe, allowing M-mode, two-dimensional, and pulsed Doppler measurements. Left ventricular mass index (LVMI) was calculated according to the Penn formula. A multifrequency bioimpedance analyzer was used; ECW% was calculated as a percentage of total body water and was considered the index of volume load. RESULTS: (1) Serum NT-pro-BNP level, ECW%, LVMI, and LV ejection fraction in CAPD patients were 3924 (240 - 74460) pg/mL, 36.7% +/- 2.2%, 158 +/- 48 g/m2, and 60.5% +/-11.2%, respectively. (2) Patients were divided into three tertiles (10 patients each) according to their serum NT-proBNP concentration [1st tertile 1168 (240 - 2096), 2nd tertile 4856 (2295 - 20088), 3rd tertile 35012 (20539 -74460) pg/mL]. The tertiles did not differ significantly in terms of age, sex, presence of DM, body mass index, or PD duration. Patients in the 3rd tertile (highest serum NT-proBNP concentration) had the highest LVMI (126 +/- 45 vs 160 +/-41 vs 200 +/- 23 g/m2 for 1st, 2nd, 3rd tertiles, respectively) and the lowest LV ejection fraction (66% +/- 11% vs 62% +/-6% vs 55% +/- 9%). ECW% did not differ significantly between tertiles (35.5% +/- 2.0% vs 37.5% +/- 2.0% vs 36.5% +/-2.0%). (3) In CAPD patients, serum NT-pro-BNP levels correlated positively with LVMI (r = 0.628, p = 0.003) and negatively with LV ejection fraction (r = -0.479, p = 0.033). Serum NT-pro-BNP levels did not correlate with ECW% (r = 0.227, p = 0.25). (4) Stepwise regression analysis showed that LV ejection fraction (beta = -0.610, p = 0.015) and LVMI (beta = 0.415, p = 0.007) were independently associated with the serum NT-pro-BNP concentration. CONCLUSIONS: There was no link between ECW% and serum NT-pro-BNP concentration. Thus, serum NT-pro-BNP levels may not provide objective information with respect to pure hydration status in CAPD patients. In contrast, serum NT-pro-BNP levels were linked to LVMI and LV ejection fraction in CAPD patients. Therefore, while the serum NT-proBNP concentration might not be a useful clinical marker for extracellular fluid volume load, it appears useful for evaluating LV hypertrophy and LV dysfunction in CAPD patients.     

Effects of peritoneal dialysis with an overnight icodextrin dwell on parameters of glucose and lipid metabolism.

OBJECTIVE: To examine whether a reduced daily glucose load by overnight application of the less-absorbed glucose polymer icodextrin would have favorable effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients. STUDY DESIGN: Randomized crossover study with two subsequent periods of 6 weeks. SETTING: Home PD unit of a secondary-care hospital. PATIENTS: Twenty-one nondiabetic CAPD patients (15 male, 6 female; mean age 50.3+/-11.8 years). INTERVENTION: Participants were randomly assigned to receive an overnight dwell with either standard glucose solution or with a 7.5% icodextrin-containing solution. MAIN OUTCOME MEASURES: Relation between reduction in the total amount of intraperitoneal infused glucose and parameters of glucose (plasma glucose, insulin, and HbA1C) and lipid metabolism [free fatty acids, plasma lipids, lipoproteins, and low density lipoprotein (LDL) subfraction profile]. RESULTS: After the icodextrin dwells, a reduction of plasma total cholesterol (from 5.43+/-0.85 to 4.86+/-0.70 mmol/L, p < 0.001) and LDL cholesterol (from 3.38+/-0.87 to 2.93+/-0.73 mmol/L, p = 0.001) was observed. Also, high density lipoprotein (HDL) cholesterol (from 0.95+/-0.27 to 0.90+/-0.24 mmol/L, p = 0.029) was reduced, but the plasma total cholesterol-to-HDL ratio remained similar. Plasma free fatty acids and triglyceride levels tended to decrease (from 0.16+/-0.10 to 0.13+/-0.08 mmol/L, p= 0.06, and from 2.14+/-1.96 to 1.92+/-1.03 mmol/L, respectively). Evaluation of LDL subfraction profiles after ultracentrifugation showed a more buoyant LDL subfraction profile with fewer dense LDL particles in 6 patients and no changes in 14 patients after icodextrin.The effects on lipids were not accompanied by a decrease in fasting plasma glucose (from 5.76+/-1.29 to 5.86+/-0.80 mmol/L) or insulin levels (from 19.5+/-14.4 to 20.3+/-13.0 mU/L). CONCLUSION: These results suggest a beneficial effect on lipid profiles of CAPD patients with the use of an overnight dwell with icodextrin.     

Can the inflammation markers of patients with high peritoneal permeability on continuous ambulatory peritoneal dialysis be reduced on nocturnal intermittent peritoneal dialysis?

BACKGROUND: Patients with high peritoneal permeability have the greatest degree of inflammation on continuous ambulatory peritoneal dialysis (CAPD), which may be associated with their higher mortality. Nocturnal intermittent peritoneal dialysis (NIPD; "dry day") may decrease inflammation by reducing the contact between dialysate and peritoneum and/or providing better fluid overload control. Therefore, the aims of this study were to determine and compare serum and dialysate concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-alpha) of patients with high or high-average peritoneal transport on CAPD, changed to NIPD, and ultimately to continuous cyclic peritoneal dialysis (CCPD). METHODS: Crossover clinical trial in 11 randomly selected patients. All subjects had been on CAPD and were changed to NIPD, and ultimately to CCPD (6.4 +/- 3.1 months after initiation of study). All patients used glucose-based dialysate. Evaluations of clinical and biochemical parameters, dialysis adequacy, and serum and dialysis inflammation markers were performed at baseline on CAPD, 7 - 14 days after changing to NIPD, 7 - 14 days after switching to CCPD, and after 1 year of follow-up. All patients used only 1.5% glucose dialysate during evaluation days. CRP was determined by nephelometry, and IL-6 and TNF-alpha by ELISA. RESULTS: Seven patients were high transporters and 4 high average. Ultrafiltration increased (p < 0.05) when patients changed from CAPD [0.38 L (-0.3 - 1.1 L)] to NIPD [2.64 L (0.7 - 4.7 L)]; it then decreased on CCPD [0.88 L (0.4 - 1.3 L) and at the end of study [0.65 L (0.3 - 1.0 L)]. This better fluid overload control was accompanied by decreased weight and systolic and diastolic blood pressure when patients changed from CAPD (89 +/- 13 kg, 160 +/- 23 and 97 +/-9 mmHg, respectively) to NIPD (86 +/- 17 kg, 145 +/- 14 and 86 +/- 9 mmHg, respectively), and increased weight and systolic and diastolic blood pressure on CCPD (85 +/- 15 kg, 143 +/-23 and 88 +/- 14 mmHg, respectively) and at the end of follow-up (87 +/- 16 kg, 155 +/- 24 and 89 +/- 12 mmHg, respectively). Median serum CRP decreased (p = 0.03), from 3.8 (1.6 - 8.5) mg/L on CAPD to 1.0 (0.4 - 4.4) mg/L on NIPD, but increased on CCPD [1.8 (1.3 - 21) mg/L] and at the end of the study [3.2 (0.3 - 8.2) mg/L]. Dialysate CRP decreased nonsignificantly, from 0.10 (0 - 0.5) mg/L on CAPD to 0 (0 - 0.03) mg/L on NIPD, to 0.01 (0 - 0.08) mg/L on CCPD, and to 0 (0 - 0) mg/L at final evaluation. Serum TNF-alpha concentration decreased, from 0.14 (0.04 - 0.6) pg/mL on CAPD to 0.01 (0 - 0.08) pg/mL on NIPD, and then increased to 0.06 (0 - 0.4) pg/mL on CCPD and to 0.11 (0 - 0.2) pg/mL at the end of the study; whereas dialysate TNF-alpha decreased, from 0.08 (0.03 - 0.2) pg/mL on CAPD to 0.04 (0 - 0.2) pg/mL on NIPD, and to 0 (0 - 0) pg/mL and 0 (0 - 0.05) pg/mL on CCPD and final evaluation respectively. Serum IL-6 decreased (p = 0.07), from 2.5 (2.0 - 4.2) pg/mL on CAPD to 1.0 (0.7 - 2.0) pg/mL on NIPD, and to 1.0 (0.8 - 2.9) pg/mL on CCPD and 1.0 (0.5 - 9.8) pg/mL at the end of the study; whereas dialysate levels remained similar on CAPD [8.0 (3.7 - 13) pg/mL] and NIPD [7.8 (5.1 - 23) pg/mL], and increased on CCPD [11.2 (9.5 - 19) pg/mL] and at final evaluation [11.2 (8.3 - 15) pg/mL]. CONCLUSIONS: NIPD significantly decreased serum CRP and displayed a trend to decrease TNF-alpha and IL-6 serum concentrations compared with CAPD; whereas CCPD tended to reverse these effects. These results did not appear to be due to decreased local peritoneal inflammation, but they could be associated with better control of fluid overload on NIPD. Thus, NIPD, as Long as the residual renal function allows it, may be useful in reducing the systemic inflammation of patients with high peritoneal membrane permeability.