糖尿病与非糖尿病患者腹膜透析时机的比较研究

目的比较糖尿病终末期肾病（DNESRD）与非糖尿病终末期肾病（NDNESRD）患者开始透析时的生理指标与生活状况，为制定糖尿病患者透析前教育计划提供依据。方法调查2007年1月至2008年12月于北京大学第一医院腹膜透析中心治疗的180例终末期肾脏病（ESRD）患者开始透析的时机，其中90例DNESRD，90例NDNESRD。比较两组不同透析时机患者间肾功能、血生化、血红蛋白指标及生活状况的差别。结果DNESRD患者的肌酐清除率、血红蛋白显著高于NDNESRD患者，而血肌酐、尿素氮、血白蛋白、血磷显著低于NDNESRD患者。DNESRD患者的症状评分、自评生活质量、睡眠状况均显著比NDNESRD组差。64．4％的DNESRD患者透析较晚，并伴有明显的并发症（容量负荷或心衰），其中29．3％需要紧急透析。NDNESRD患者透析较晚者占46．7％（P〈0．05）。适时进入透析的ESRD患者中有89．1％经历了慢性肾脏病（CKD）教育或透析前教育和咨询。结论尽管DNESRD患者毒素水平相比NDNESRD患者相对较低，但是多数DNESRD患者透析较晚，有64．4％的患者合并有明显的水负荷问题或心衰。应关注他们透析前CKD教育。     

授权赋能教育在糖尿病肾病腹膜透析患者干预中的应用

目的探究在糖尿病肾病腹膜透析患者干预中使用授权赋能教育的应用效果。方法选取2016年3月至2017年3月我院收治的60例糖尿病肾病腹膜透析患者为研究对象,随机将其分为对照组26例和观察组34例,对照组给予常规健康教育,观察组予以授权赋能教育,比较两组患者糖代谢指标、容量负荷情况。结果观察组糖代谢指标明显优于对照组(P0.05);观察组舒张压、收缩压、体质量和透析液超滤量低于对照组(P0.05),两组尿量、透析液浓度比较差异无统计学意义(P0.05)。结论授权赋能教育用于糖尿病肾病腹膜透析患者健康宣教中,可有效降低血糖水平,改善其容量负荷,减少并发症发生率,值得推广。     

容量控制对腹膜透析患者体液平衡的影响

目的探讨容量负荷控制对持续性腹膜透析(CAPD)患者体液平衡的影响。方法选择山东中医药大学第二附属医院肾内科CAPD治疗患者32例,限制水盐摄入1-3个月,测定限制水盐前后体重、平均动脉压、超滤量、下腔静脉直径(IVCD)等相关指标。结果CAPD患者限制水盐后水肿程度、体重、平均动脉压、透析液糖浓度、透析液糖总量、透析液总剂量、每日平均超滤量及总液体清除量与限制水盐以前比较明显降低,P<0．05差异有显著性。IVCD与收缩压值有直线相关关系(r前=0．407,P<0．01;r后=0．413,P<0．01)。限制水盐前后患者的尿量无明显变化,P>0．05。结论严格限制腹膜透析患者水钠摄入,可降低容量负荷,从而降低血压、减轻水肿,改善患者的一般状况;下腔静脉直径能精确评估体液负荷状况。     

基于跨理论模型的动机性访谈对糖尿病肾病透析患者血糖控制与容量负荷的影响

目的:观察基于跨理论模型的动机性访谈对糖尿病肾病透析患者血糖控制与容量负荷的影响。方法:选取2017年3月～2018年3月我院收治的76例糖尿病肾病透析患者作为研究对象,按照随机数字表法分为对照组和观察组各38例。对照组给予常规护理干预,观察组在对照组的基础上进行基于跨理论模型的动机性访谈,比较两组血糖控制情况和容量负荷差异。结果:干预后,观察组的FBG、2 hPBG和Hb A1c均明显低于对照组,差异有统计学意义,P0.05;观察组的收缩压、舒张压、水肿程度和透析液超滤量均明显低于对照组,尿量高于对照组,差异均有统计学意义,P0.05;两组透析液浓度相比较,差异无统计学意义,P0.05。结论:基于跨理论模型的动机性访谈可有效促进糖尿病肾病透析患者饮食、运动等方面的行为改变,提高血糖控制效率,改善容量负荷。     

糖尿病与非糖尿病腹膜透析患者容量负荷状况及其相关因素分析

目的探讨糖尿病与非糖尿病持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者容量负荷状况及其相关因素。方法对2015年10月至12月在本院门诊随访的133例CAPD患者进行调查,按其基础肾脏病是否为糖尿病肾病,将其分为糖尿病CAPD组(28例)和非糖尿病CAPD组(105例)。调查两组患者的容量负荷状况及其相关影响因素。结果糖尿病CAPD组在体重、体质量指数(body mass index,BMI)、收缩压、透析液糖浓度、浮肿比例指标明显高于非糖尿病CAPD组,总蛋白、白蛋白指标明显低于非糖尿病CAPD组,组间比较,均P0.05,差异具有统计学意义。糖尿病CAPD组在细胞外液(extracellular water,ECW)、细胞外液/身高(extracellular water/height,ECW/Height)、浮肿指数(ECW/TBW)指标明显数高于非糖尿病CAPD组,组间比较,均P0.05,差异具有统计学意义。结论容量超负荷在腹膜透析患者中较为常见,且糖尿病CAPD患者较非糖尿病CAPD患者存在明显的容量超负荷;糖尿病CAPD患者容量超负荷可能与摄入过多的液体及较低的白蛋白水平有关。     

日间小剂量递增腹膜透析在终末期肾病患者的应用研究

目的：研究并探讨终末期肾病患者非卧床腹膜透析不同透析模式的临床疗效。方法通过对终末期肾病腹膜透析患者残肾功能较好的患者采取不同的透析模式,将患者随机分为两组：日间小剂量递增组（26例）,透析液总量每日4.5～8 L,夜间不留腹;持续标准透析剂量组（24例）,每日透析液量8 L,夜间留腹,比较两组研究开始与终点的营养指标、血生化指标、透析充分性、残肾功能、胱抑素 C。结果两组患者至观察终点血浆白蛋白、24 h尿量、残肾功能、胱抑素C比较差异有统计学意义（P＜0.05）。两组血K＋、血P3＋、二氧化碳结合力（CO2CP）、24 h超滤量、透析充分性指标每周总尿素氮清除率（Kt/V）、每周总肌苷清除率（Ccr）,比较差异无统计学意义（P＞0.05）,两组置管后1个月内导管堵管、渗漏发生率比较差异无统计学意义（P＞0.05）。两组的每日透析液总量和透析时间均有统计学差异（P＜0.05）。结论（1）残肾功能较好的终末期肾病患者,置管后早期采用日间小剂量递增式腹膜透析可使患者尽早得到治疗,并且不增加早期导管堵管与渗漏;（2）初期应用小剂量递增式腹膜透析可减少残肾功能的丢失,并维持相对较好的营养状况。（3）与持续标准剂量组比较,小剂量递增式腹膜透析可减少腹膜透析初期透析液的用量。     

跨理论模型及动机性访谈对糖尿病肾病腹膜透析病人血糖管理与容量负荷的影响

[目的]探讨跨理论模型及动机性访谈对糖尿病肾病腹膜透析病人血糖管理与容量负荷的影响。[方法]将125例糖尿病肾病持续腹膜透析病人随机分为干预组与对照组,干预组基于跨理论模型及动机性访谈进行护理干预,对照组进行常规护理干预。评估两组病人的血糖管理情况及容量负荷。[结果]干预6个月干预组病人空腹血糖(FBG)、糖化血红蛋白(HbAlc)较对照组明显降低,收缩压、尿量、24h超滤量较对照组有明显改善(P0.05)。[结论]跨理论模型及动机性访谈护理干预能帮助糖尿病肾病腹膜透析病人管理血糖,改善其容量负荷情况,提高病人的生活质量。     

协同护理模式对老年糖尿病肾病腹膜透析病人容量负荷和自护行为的影响

[目的]探讨协同护理模式对老年糖尿病肾病行腹膜透析病人的容量负荷和自护行为的影响。[方法]选择104例老年糖尿病肾病持续腹膜透析病人为研究对象,采用随机数字表法分为试验组和对照组,试验组采用协同护理模式,对照组采用常规护理。干预6个月后,采用临床评估法与自我护理能力测定量表比较两组病人的容量负荷情况与自护行为。[结果]试验组病人血压、体重、透析液超滤量较对照组有明显改善,差异有统计学意义(P0.05);试验组自护行为总体饮食、运动、血糖监测3个维度较对照组有明显提高,差异有统计学意义(P0.05)。[结论]采用协同护理模式对老年糖尿病肾病行腹膜透析病人进行护理干预能有效改善病人容量负荷与自护行为。     

有氧运动联合饮食干预对控制腹膜透析患者容量负荷的效果观察

目的探讨有氧运动联合饮食干预对腹膜透析（PD）患者容量负荷的影响。方法将68例PD患者随机分为治疗组和对照组,各34例。对照组采用饮食干预,治疗组在饮食干预的基础上进行有氧运动。比较干预前及干预6个月后水肿发生率、血压控制不达标例数、透析液平均浓度、体重、血压、24h尿量、超滤量、左心室质量指数（LVMI）的变化。结果两组干预后水肿发生率、血压控制不达标例数、透析液平均浓度、体重等明显下降,收缩压（SBP）、舒张压（DBP）均有所下降,LVMI较前明显下降;超滤量、尿量变化无显著性差异（P〉0.05）。两组干预后比较治疗组优于对照组,有显著性差异（P〈0.05）。结论有氧运动联合饮食干预有效控制PD患者容量负荷,提高PD患者的生活质量。     

糖尿病肾病患者2694例次血液透析中并发症的观察与护理

糖尿病肾病是糖尿病全身性微血管病变之一。随着人口老龄化及饮食结构的改变，终末期肾病透析患者中糖尿病肾病患者所占比例逐年增加。据美国肾脏数据库统计，糖尿病终末期肾病(DNESRD)人数占终末期肾病(ESRD)的27．3％，发病率为33．6％。由此发展为DNESRD患者，常合并有高血压和／或伴有心、脑血管疾病。糖尿病肾病患者透     

Clinical factors associated with sodium removal in peritoneal dialysis patients

A cross-sectional study was conducted in 156 clinically-stable peritoneal dialysis patients to identify the factors associated with sodium removal. Serum biochemistry, peritoneal function (modified peritoneal equilibration test [PET]) and the adequacy of dialysis were analysed in relation to sodium removal using multivariate linear regression. Factors significantly affecting peritoneal sodium removal included infusion volume and ultrafiltration volume per 24 h, sodium dip in the first hour of PET and sodium difference between serum and fresh dialysate. Factors significantly affecting total sodium removal included ultrafiltration and urine volume per 24 h, sodium dip in the first hour of PET and sodium difference between serum and fresh dialysate. With traditional dialysate, adequate fluid removal is required to ensure sufficient sodium removal, but a low-sodium dialysate may prevent sodium retention. Sodium removal should be included in evaluation of the adequacy of dialysis.     

Peritoneal accumulation of AGE and peritoneal membrane permeability.

BACKGROUND: In continuous ambulatory peritoneal dialysis (CAPD), the peritoneal membrane is continuously exposed to high-glucose-containing dialysis solutions. Abnormally high glucose concentration in the peritoneal cavity may enhance advanced glycosylation end-product (AGE) formation and accumulation in the peritoneum. Increased AGE accumulation in the peritoneum, decreased ultrafiltration volume, and increased peritoneal permeability in long-term dialysis patients have been reported. AIM: The purpose of the study was to evaluate the relation between peritoneal membrane permeability and peritoneal accumulation of AGE. METHODS: Peritoneal membrane permeability was evaluated by peritoneal equilibration test (PET) using dialysis solutions containing 4.25% glucose. Serum, dialysate, and peritoneal tissue levels of AGE were measured by ELISA method using polyclonal anti-AGE antibody. Peritoneal biopsy was performed during peritoneal catheter insertion [new group (group N), n = 18] and removal [long-term group (group LT), n = 10]. Peritoneal catheters were removed due to exit-site infection not extended into the internal cuff (n = 6) and ultrafiltration failure (n = 4) after 51.6+/-31.5 months (13 - 101 months) of dialysis. PET data obtained within 3 months after the initiation of CAPD or before catheter removal were included in this study. Ten patients in group N and 4 patients in group LT were diabetic. Patients in group LT were significantly younger (46.5+/-11.1 years vs 57.5+/-1.3 years) and experienced more episodes of peritonitis (3.5+/-2.1 vs 0.2+/-0.7) than group N. RESULTS: Peritoneal tissue AGE level in group LT was significantly higher than in group N, in both nondiabetic (0.187+/-0.108 U/mg vs 0.093+/-0.08 U/mg of hydroxyproline, p < 0.03) and diabetic patients (0.384+/-0.035 U/mg vs 0.152+/-0.082 U/mg of hydroxyproline, p < 0.03), while serum and dialysate levels did not differ between the groups in both nondiabetic and diabetic patients. Drain volume (2600+/-237 mL vs 2766+/-222 mL, p = 0.07) and D4/D0 glucose (0.229+/-0.066 vs 0.298+/-0.081, p < 0.009) were lower, and D4/P4 creatinine (0.807+/-0.100 vs 0.653+/-0.144, p< 0.0001) and D1/P1 sodium (0.886+/-0.040 vs 0.822+/-0.032, p < 0.0003) were significantly higher in group LT than in group N. On linear regression analysis, AGE level in the peritoneum was directly correlated with duration of CAPD (r = 0.476, p = 0.012), number of peritonitis episodes (r = 0.433, p = 0.0215), D4/P4 creatinine (r = 0.546, p < 0.027), and D1/P1 sodium (r = 0.422, p = 0.0254), and inversely correlated with drain volume (r = 0.432, p = 0.022) and D4/D0 glucose (r = 0.552, p < 0.0023). AGE level in the peritoneal tissue and dialysate were significantly higher in diabetics than in nondiabetics in group LT, while these differences were not found in group N. Serum AGE level did not differ between nondiabetics and diabetics in either group N or group LT. Drain volume and D4/D0 glucose were lower and D4/P4 creatinine and D1/P1 sodium higher in diabetics than in nondiabetics in both groups. CONCLUSION: Peritoneal accumulation of AGE increased with time on CAPD and number of peritonitis episodes, and was directly related with peritoneal permeability. Peritoneal AGE accumulation and peritoneal permeability in diabetic patients were higher than in nondiabetic patients from the beginning of CAPD.     

Effects of peritoneal resting on peritoneal fluid transport kinetics.

BACKGROUND: Peritoneal resting has been used to restore peritoneal ultrafiltration capacity in peritoneal dialysis patients. Therefore, in the present study, we made a detailed investigation on the effects of peritoneal resting on peritoneal fluid transport characteristics in patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS: A temporary transfer to daytime ambulatory peritoneal dialysis with a nocturnal "empty belly" was applied to let the peritoneal membrane rest overnight in patients with poor ultrafiltration capacity. All included patients were asked to record appropriately their dialysis exchanges for the assessment of peritoneal fluid transport characteristics, which were evaluated before and after peritoneal resting. RESULTS: Seven CAPD patients were included in the present study. There was a significant improvement in peritoneal ultrafiltration capacity as assessed by ultrafiltration volume per gram of glucose load. Patients' daily glucose exposure and dialysate-to-plasma ratio of creatinine were significantly decreased after peritoneal resting. The peritoneal fluid absorption rate was also significantly decreased after peritoneal resting: 1.011 +/- 0.4484 versus 0.625 +/- 0.3833 mL/minute. CONCLUSION: The present study suggests that peritoneal resting can improve CAPD patients' ultrafiltration capacity and decrease the use of hypertonic dialysis solution. The improved ultrafiltration capacity by peritoneal resting was due to decreased membrane solute transport rate and decreased peritoneal fluid absorption rate.     

不同超滤功能的持续不卧床腹膜透析患者腹膜液体转运功能评估

目的 容量控制对于腹膜透析至关重要.腹膜平衡实验(peritoneal equilibration test,PET)可以评估腹膜小分子溶质转动功能,对优化腹膜透析存腹时间提供依据,但是不能预测腹膜液体转运功能.所以,本研究使用计算机拟合对不同超滤功能腹膜透析患者的腹膜液体转运功能进行评估.方法 纳入研究患者包括每天使用3～4袋2.5％葡萄糖透析液者(为腹膜超滤功能差组)和使用3～4袋1.5％葡萄糖透析液者(为腹膜功能好组),两组患者在上述透析处方下都能达到足够的液体清除.所有入组的患者都要求详细记录自己每天的腹膜透析换液情况,以评估腹膜液体转运功能.结果 本研究包括了17名持续不卧床腹膜透析患者(continuous ambulatory peritoneal dialysis,CAPD),其中9名为超滤功能差组,8名为超滤功能好组.与超滤功能好组相比,超滤功能差组的患者每天更多的处于高葡萄糖(P＜0.01)环境中,透析液/血浆肌酐比值(D/Pcre)更高(P＜0.05),有更高的腹膜液体吸收率(Ke)(P＜0.01). 结论 与超滤功能好的患者相比超滤功能差的患者的腹膜小分子溶质转运率更高,更为重要的是,超滤能力差的患者腹膜液体吸收率更高.     

Peritoneal fluid transport in CAPD patients with different transport rates of small solutes.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) patients with high peritoneal solute transport rate often have inadequate peritoneal fluid transport. It is not known whether this inadequate fluid transport is due solely to a too rapid fall of osmotic pressure, or if the decreased effectiveness of fluid transport is also a contributing factor. OBJECTIVE: To analyze fluid transport parameters and the effectiveness of dialysis fluid osmotic pressure in the induction of fluid flow in CAPD patients with different small solute transport rates. PATIENTS: 44 CAPD patients were placed in low (n = 6), low-average (n = 13), high-average (n = 19), and high (n = 6) transport groups according to a modified peritoneal equilibration test (PET). METHODS: The study involved a 6-hour peritoneal dialysis dwell with 2 L 3.86% glucose dialysis fluid for each patient. Radioisotopically labeled serum albumin was added as a volume marker.The fluid transport parameters (osmotic conductance and fluid absorption rate) were estimated using three mathematical models of fluid transport: (1) Pyle model (model P), which describes ultrafiltration rate as an exponential function of time; (2) model OS, which is based on the linear relationship of ultrafiltration rate and overall osmolality gradient between dialysis fluid and blood; and (3) model G, which is based on the linear relationship between ultrafiltration rate and glucose concentration gradient between dialysis fluid and blood. Diffusive mass transport coefficients (K(BD)) for glucose, urea, creatinine, potassium, and sodium were estimated using the modified Babb-Randerson-Farrell model. RESULTS: The high transport group had significantly lower dialysate volume and glucose and osmolality gradients between dialysate and blood, but significantly higher K(BD) for small solutes compared with the other transport groups. Osmotic conductance, fluid absorption rate, and initial ultrafiltration rate did not differ among the transport groups for model OS and model P. Model G yielded unrealistic values of fluid transport parameters that differed from those estimated by models OS and P. The K(BD) values for small solutes were significantly different among the groups, and did not correlate with fluid transport parameters for model OS. CONCLUSION: The difference in fluid transport between the different transport groups was due only to the differences in the rate of disappearance of the overall osmotic pressure of the dialysate, which was a combined result of the transport rate of glucose and other small solutes. Although the glucose gradient is the major factor influencing ultrafiltration rate, other solutes, such as urea, are also of importance. The counteractive effect of plasma small solutes on transcapillary ultrafiltration was found to be especially notable in low transport patients. Thus, glucose gradient alone should not be considered the only force that shapes the ultrafiltration profile during peritoneal dialysis. We did not find any correlations between diffusive mass transport coefficients for small solutes and fluid transport parameters such as osmotic conductance or fluid and volume marker absorption. We may thus conclude that the pathway(s) for fluid transport appears to be partly independent from the pathway(s) for small solute transport, which supports the hypothesis of different pore types for fluid and solute transport.     

Changes in water transport across the peritoneum during treatment with continuous ambulatory peritoneal dialysis in selected patients with and without peritonitis.

BACKGROUND: The natural course of longitudinal changes in peritoneal permeability and membrane area has been studied mostly by performing single-dwell studies in selected patients during treatment with peritoneal dialysis. PURPOSE: To evaluate the permeability characteristics of the peritoneal membrane by measuring drained ultrafiltration volume relative to initial glucose concentration in dialysis fluid from the start to the end of continuous ambulatory peritoneal dialysis (CAPD) treatment in a selected cohort of patients with and without peritonitis. DESIGN: A retrospective analysis of a group of patients whose peritoneal function was prospectively followed by recording drained ultrafiltration volume and glucose concentration in dialysis fluid for each dwell time, every day, during the time in CAPD treatment. Mean values from a 1-month period starting after the first 3 weeks of CAPD treatment were compared with the mean values from the last month of treatment. Approximately 11 500 exchanges were analyzed. Evaluations were done separately for short (day) and long (night) dwell times. PATIENTS AND STATISTICS: Of 132 patients commencing CAPD treatment in the time period selected for inclusion, 51 had enough data to be included in this study. Of these, 29 patients experienced one or more episodes of successfully treated peritonitis. The selection of patients was not based upon patient characteristics, but upon criteria to satisfy predefined demands, such as number of measurements in each period, time since an episode of peritonitis, and time on CAPD treatment. Data were analyzed in three different groups: patients with episodes of peritonitis, patients without peritonitis, and both groups together. To assess changes between monthly mean at the start and at the end of CAPD, paired t-test was performed. Patients were also stratified into two groups according to low and high glucose in dialysis fluid at the start of CAPD (cutoff = 2 g/dL). Additionally, we used linear regression analyses to predict the level of drained ultrafiltration volume for a given level and change in glucose concentration. Mean treatment time for the entire group was 20 months (median 14.3 months), ranging from 6 to 69 months. RESULTS: No statistical differences in glucose concentrations were found between the periods compared. In the entire group there was an increase in ultrafiltration volume from the start to the end of CAPD treatment, for both day (p = 0.009) and night (p = 0.013) exchanges. Also, for patients without peritonitis, an increase appeared for day (p = 0.046) and night exchanges (p = 0.053). However, for the cohort with peritonitis, only an insignificant increase was indicated. Patient characteristics, diabetic patients, the need for glucose in dialysis fluid when commencing CAPD treatment, the number of episodes of peritonitis, and time on CAPD did not influence the change in ultrafiltration. Regression analyses showed higher ultrafiltration response to a given level and change in glucose concentration at the end of CAPD treatment compared to the start values, also for the cohort with peritonitis. The regression coefficient between these variables was also significantly changed for both day (p < 0.0001) and night (p = 0.027) exchanges. CONCLUSION: A significant change in the regression coefficient between glucose in dialysis fluid and ultrafiltration volume reflects an increase in ultrafiltration response to a given level and change in glucose concentration during time on CAPD treatment. A parallel change after 5- and 9-hour dwells can be explained by a decrease in peritoneal surface area combined with a lesser decrease in peritoneal conductivity. However, changes in Starling forces across the peritoneal membrane are possible even in the absence of changes in peritoneal membrane characteristics.     

Continuous ambulatory peritoneal dialysis in patients with diabetes mellitus

AIM: To analyse the results of continuous ambulatory peritoneal dialysis (CAPD) in diabetes mellitus (DM) patients, to specify complications, to evaluate transport characteristics of peritoneal membrane. MATERIAL AND METHODS: The ability of peritoneal membrane to eliminate low-molecular substances (creatinine, urea), electrolytes and to evaluate treatment efficacy by residual renal function (peritoneal equilibration, total urine and creatinine clearance). RESULTS: DM patients on CAPD developed vascular complications typical for DM:gangrene (n = 2), diabetic foot (n = 4), acute disorder of cerebral circulation (n = 3), acute myocardial infarction (n = 3). Diabetics' residual renal function deteriorated faster than in patients with non-diabetic uremia, though transport characteristics of the peritoneum in diabetics and non-diabetics were the same. Peritonitis in diabetics was observed much less frequently than in non-diabetics. CONCLUSION: CAPD is an adequate replacement therapy in patients with uremia of different origin including diabetes. In the course of the treatment DM patients develop complications typical for basic disease but their frequency is unrelated to CAPD.     

Combination of crystalloid (glucose) and colloid (icodextrin) osmotic agents markedly enhances peritoneal fluid and solute transport during the long PD dwell.

BACKGROUND: Fluid and sodium removal is often inadequate in peritoneal dialysis patients with high peritoneal solute transport rate, especially when residual renal function is declining. METHOD: We studied the effects of using simultaneous crystalloid (glucose) and colloid (icodextrin) osmotic agents on the peritoneal transport of fluid, sodium, and other solutes during 15-hour single-dwell exchanges using 3.86% glucose, 7.5% icodextrin, and a combination fluid with 2.61% glucose and 6.8% icodextrin in 7 prevalent peritoneal dialysis patients with fast peritoneal solute transport rate. RESULTS: The combination fluid enhanced net ultrafiltration (mean 990 mL) and sodium removal (mean 158 mmol) compared with 7.5% icodextrin (mean net ultrafiltration 462 mL, mean net sodium removal 49 mmol). In contrast, the 3.86% glucose-based solution yielded negligible ultrafiltration (mean -85 mL) and sodium removal (mean 16 mmol). The combination solution resulted in significantly improved urea (+41%) and creatinine (+26%) clearances compared with 7.5% icodextrin. CONCLUSION: A solution containing both crystalloid (glucose 2.61%) and colloid (icodextrin 6.8%) osmotic agents enhanced fluid removal by twofold and sodium removal by threefold compared with 7.5% icodextrin solution during a dwell of 15 hours, indicating that such a combination solution could represent a new treatment option for anuric peritoneal dialysis patients with high peritoneal solute transport rate.     

Ultrafiltration and dialysis adequacy with various daily schedules of dialysis fluids

Dialysis regimens for continuous ambulatory peritoneal dialysis (CAPD) patients vary with the need for fluid removal, but also because of concerns about the local and systemic consequences of high glucose exposure. The implications of various regimens for dialysis adequacy-that is, fluid and small-solute removal-are not always clear. We therefore analyzed ultrafiltration (UF) and adequacy indices for 4 different combinations of dialysis fluid. Collections of 24-hour dialysate and urine were carried out in 99 patients on CAPD. On 4 separate occasions, each patient performed 4 exchanges in 24 hours, including 3 daily exchanges with 1.36% glucose and 1 night exchange with either 1.36% glucose (G1 schedule), 2.27% glucose (G2 schedule), 3.86% glucose (G3 schedule), or icodextrin (Ico schedule). Weekly, total, and dialysis Kt/V and KT were calculated for both urea and creatinine. The mean values of urea Kt/V and KT were significantly lower for the G1 schedule than for the G3 and Ico schedules. The adequacy indices for overnight application of 3.86% glucose and icodextrin were similar. Using dialysis fluids with 1.36% and 2.27% glucose overnight reduces glucose exposure, but those schedules may provide inadequate UF and small-solute removal in some patients (UF < 1 L daily, Kt/V < 1.7).