Leptin in peritoneal dialysate from continuous ambulatory peritoneal dialysis patients.

The adipocyte-derived hormone leptin is the 16-kd product of the ob gene that regulates food intake and body weight. Plasma leptin level is elevated in patients with chronic renal failure, partly because of impaired clearance through the kidney. In this study, we examined whether leptin is cleared into peritoneal dialysate in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). The subjects were 46 CAPD patients and 67 age- and gender-matched healthy subjects. Leptin concentration in peritoneal dialysate from CAPD patients was measurable by a sensitive enzyme-linked immunosorbent assay (ELISA), and the daily loss of leptin by the peritoneal route was estimated to correspond to the amount contained in approximately 2 L plasma. Dialysate leptin concentration correlated positively with plasma leptin level and with percent body fat measured by dual-energy X-ray absorptiometry. The dialysate-to-plasma (D/P) ratio of leptin concentration was twice higher than expected from its molecular weight. D/P ratios of beta2-microglobulin, albumin, and transferrin showed strong correlations with each other (r = 0.768 to 0.801), whereas the correlation between D/P ratios of leptin and beta2-microglobulin was less impressive (r = 0.378). This was also the case with the relationship between apparent peritoneal clearances of these macromolecules, suggesting that dialysate leptin had some origins other than passive transport of plasma leptin. To test the hypothesis that abdominal visceral fat may contribute to the unexpectedly raised peritoneal dialysate leptin concentration, multiple regression analysis was performed. Leptin concentration in peritoneal dialysate showed significant association with plasma leptin level and D/P ratio of beta2-microglobulin, and it also showed an independent association with abdominal visceral fat but not with subcutaneous fat assessed by ultrasonography. These results showed that peritoneal dialysate from CAPD patients contained a significant amount of leptin, which derived presumably from both plasma and local visceral fat tissue.     

Serum and peritoneal dialysate thyroid hormone levels in patients on continuous ambulatory peritoneal dialysis

Thyroid function tests were performed on 16 clinically euthyroid patients with end-stage renal failure undergoing regular haemodialysis or continuous ambulatory peritoneal dialysis and compared with 8 healthy subjects. The patient groups were carefully matched, especially regarding relative duration of dialysis (mean of 24 months). Total serum thyroxine, total triiodothyronine, free thyroxine, free triiodothyronine and reverse triiodothyronine were significantly lower in both patient groups than control. The thyrothrophin response to the standard thyrotrophin-releasing hormone test was delayed and blunted. Using a novel concentration technique we measured loss of T4 in peritoneal dialysate effluent and found it to be approximately 10% of daily thyroidal T4 release.     

Influence of exchange volume and dialysate flow rate on solute clearance in peritoneal dialysis.

To find the ideal dialysate flow rate and exchange volume for use in long-term peritoneal dialysis, 10 patients were studied over a period of 1.5 yr. Exchange volumes of 1 or 2 liters and dialysate flow rates of 1, 2, 3, 4, and 6 liters/hr were tested. Dextrose concentration remained constant at 1.5 g/100 ml. Peritoneal clearances for BUN, creatinine, and uric acid were calculated at 2, 5, 10, 15, and 20 hr during dialysis making a total of 120 clearances for each patient. All patients used a reverse osmosis automatic machine. The clearance of all three solutes tended to be higher with exchange volumes of 2 liters than they did with 1 liter; this trend was significant for BUN (P less than 0.025) and uric acid (P less than 0.025) but not for creatinine. There was a significant rise in clearance with increasing flow rates per hour for all solutes as shown in the following table. (Formula: see text), Since patients could not tolerate a flow rate of 6 liters/hr, we conclude that flow rate of 4 liters/hr with a 2-liter exchange will give maximum efficiency.     

Impact of low calcium dialysate on survival in continuous ambulatory peritoneal dialysis patients

Objective To investigate the impact of low calcium dialysate on survival in continuous ambulatory peritoneal dialysis（CAPD）patients. Methods CAPD patients at our PD center between January 1,2006 and December 31,2010 were retrospectively studied. The patients were divided into standard - calcium dialysate (SCD) group and low - calcium dialysate (LCD) group. Cox regression analysis was used to compare patient survival and determine the related risk factors Results A total of 982 eligible PD patients were included in this study, of whom 634 patients treated with standard-calcium dialysate, and 348 with low-calcium dialysate. During a median follow-up of 24.2 - month, 162(16.5% ) died, 71(43.8% ) of them due to cardiovascular and cerebrovascular diseases. The overall 1-, 3-, and 5-year patient survival rates were 90.9%, 74.2% and 58.9% in SCD group and 98.6%, 94.0% and 76.4% in LCD group. Cox regression analysis demonstrated that low calcium dialysate treatment reduced 59% risk of all-cause death, as compared with standard calcium dialysate exposure. Old age, diabetes status and lower hematoglobin were independent risk factors of all - cause death in CAPD patients. Conclusion The survival rate of CAPD patients using LCD is obviously higer than that using SCD. Old age, diabetes status and lower haematoglobin are independent risk factors of all-cause death in CAPD patients.     

Magnetic resonance imaging of the peritoneal cavity among peritoneal dialysis patients, using the dialysate as "contrast medium".

The objectives of this study were to evaluate whether adequate observation of abdominal pathologic features related to peritoneal dialysis (PD) was possible with magnetic resonance imaging (MRI) under routine conditions, i.e., against the background of the dialysate and without contrast medium. For 16 male and seven female patients (mean age, 51.8 +/- 15.0 yr; mean duration of PD, 324 +/- 542 d), 25 peritoneal MRI studies were performed with the intraperitoneal dialysate as usual. Indications were symptoms or combinations of symptoms, such as leakage or abdominal wall edema (n = 3), bloody dialysate (n = 4), suspected herniation (n = 1), suspected ultrafiltration failure (n = 2), and abdominal pain (n = 5), or routine assessment after initiation of PD (n = 12). The MRI protocol, which was performed with a 1.0-T scanner, consisted of breath-hold, coronal and transverse, T2-weighted, half-Fourier single-shot turbo spin-echo sequences, using a standard body-array coil. MRI studies were well tolerated and successfully completed for all except two patients. Results indicated a leak along the catheter (n = 1), a leak in an umbilical hernia (n = 1), suspected leakage (n = 1), hernias (n = 5, in three patients), intraperitoneal adhesions (n = 5, in four patients), a ruptured ovarian cyst (n = 1), and pleural effusions (n = 4). Pathologic findings unrelated to PD or located extra-abdominally were observed in 19 of the 25 studies. The catheter tip position was easily identified for all patients. In conclusion, this first report on peritoneal MRI using only dialysate as the "contrast medium" indicates that MRI permits detailed observation of all relevant, PD-related, abdominal pathologic features against the dialysate background, thus avoiding system contamination (and thus the risk of peritonitis).     

调整腹透液钙浓度对尿毒症患者颈动脉粥样硬化的影响

目的观察调整腹透液钙浓度对持续性不卧床腹膜透析（㈣）患者颈动脉粥样硬化的影响。方法在规律性腹膜透析随访的患者中选择30例伴有颈动脉粥样硬化的患者，先予患者继续使用标准钙腹透液6个月后改用低钙腹透液（Baxter PD4：Ca^2＋1．25mmol／L，其余成分不变），同时增加碳酸钙用量，继续观察12个月，回顾分析患者的血清钙、磷、钙磷乘积及甲状旁腺素（iPTH）水平，颈动脉内-中膜厚度（IMT）、颈动脉血流阻力指数（R1）、颈动脉粥样斑块数量和超声分型的变化。同时观察使用低钙腹透液的不适症状。结果在继续使用标准钙腹透液的6个月中，患者血钙水平逐渐增加，颈动脉IMT增厚，RI增加，差异均有统计学意义。换用低钙腹透液治疗3个月后，颈动脉IMT变薄，RI较前明显下降（P〈0．05），血钙、磷及钙磷乘积明显下降（P〈0．01），iPTH明显增加（P〈0．01）。患者碳酸钙的每日口服剂量也由（2．27±0．41）g增加至（3．35±0．22）g（P（0．05）。在随后的9个月中，血钙、钙磷乘积均稳定在正常范围，血磷降至正常，iPTH 150ng／L左右；颈动脉IMT变薄（P〈0．01）、RI下降（P〈0．01），颈动脉粥样硬化斑块的超声分型及数量变化有统计学意义。治疗过程中，1例死亡，2例自行退出，其余患者均未有明显低钙抽搐、低血压等发生。结论低钙透析能显著减轻腹膜透析患者钙磷代谢紊乱对血管的毒性作用，有助于尿毒症患者颈动脉粥样硬化的转归。     

Effect of hypertonic dialysate and vasodilators on peritoneal dialysis clearances in the rat

A model for performing peritoneal dialysis in the rat was established which permitted the consistent measurement of dialysis clearances. The effects on urea and inulin clearances of interperitoneal vasodilators and 4.25% dextrose were compared. Isoproterenol, nitroprusside, histamine, and bradykinin, when added to 1.5% dextrose dialysate for three consecutive exchanges, all produced approximately a 20% increase in urea and inulin dialysis clearances. These increases in clearances persisted in the three subsequent exchanges when no drugs were added to the dialysate. The addition of isoproterenol, nitroprusside, or histamine to six consecutive exchanges did not produce a further increment in clearances. The use of 4.25% dextrose dialysate for three exchanges produced approximately a 50% increase in urea and inulin clearances. Clearances remained about 35% greater than control values in the subsequent three 1.5% dextrose exchanges.     

腹膜透析患者透出液糖类抗原125浓度变化的观察

目的分析腹膜透析透出液糖类抗原125(carbohydrate antigen 125,CA125)浓度在长期腹膜透析过程中的变化,探讨CA125在腹膜透析中的临床意义。方法以2013年1月至2014年12月在陕西省人民医院腹膜透析中心随访的终末期肾脏疾病患者32例为研究对象,其中男15例,女17例;年龄29~64岁,平均年龄为(50.1±16.4)岁。随访期内有7例患者发生过1次腹膜透析相关性腹膜炎。观察持续不卧床腹膜透析患者2年中透出液CA125浓度及腹膜功能的变化;观察仅发生1次腹膜透析相关性腹膜炎患者(7例)透出液中CA125在腹膜炎前、腹膜炎时、腹膜炎治愈后(1个月)的浓度变化;采用微量酶免疫法测定CA125浓度,行腹膜平衡试验评估腹膜转运功能。结果腹膜透析透出液中CA125的浓度呈逐渐递减趋势;0个月时为(17.1±3.1)U/rnl,6个月时为(18.4±3.5)U/ml,12个月时为(16.5±2.4)U/ml,18个月时为(15.6±1.9)U/ml,24个月时为(10.3±2.9)U/ml;而代表腹膜功能的平衡试验中4 h腹透液与血清肌酐的比值(4-hour dialysate-to-plasma creatinine,4h D/Pcr)呈逐渐升高趋势:0个月时为0.57±0.02,6个月时为0.60±0.15,12个月时为0.61±0.16,18个月时为0.62±0.13,24个月时为0.65±0.11。在随访过程中,共发生腹膜炎7例;腹膜炎时CA125浓度明显升高[(34.9±5.8)U/ml],与腹膜炎前CA125浓度[(16.5±2.7)U/ml]及腹膜炎治愈后CA125浓度[(17.4±2.1)U/ml]相比,差异均有统计学意义(P均0.05)。结论随着腹膜透析时间的延长,透出液CA125的浓度有所减少,腹膜转运功能逐渐增加;腹膜炎时,透出液CA125呈短期骤升表现,CA125浓度变化与腹膜炎有相关性。     

Impact of dialysate interleukin-6 level on the alteration of peritoneal solute transport rate in peritoneal dialysis patients

Objective To evaluate the effect of dialysate interleukin-6 (IL-6), a marker of ongoing peritoneal inflammation, on the alteration of peritoneal solute transport rates (PSTRs) in stable continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Atotal of 128 case of stable CAPD patients were enrolled in present study.IL-6 levels in the overnight effluent were determined by ELISA and IL-6 appearance rates (AR) were calculated. Mass transfer area coefficients of creatinine (MTACcr) were prospectively followed up. Logistic regression was used to examine the association between IL-6 AR and increased PSTRs. Results The MTACcr was significantly increased after 12 months follow-up[M(1/4,3/4), 6.40(4.70, 8.75) ml/min vs 7.14(5.59, 8.73) ml/min, P＜0.05]. Compared to the patients with stable PSTRs, the dialysate IL-6 AR in patients with increased PSTRs showed significantly higher [277.08(247.45, 349.53) pg/min vs 263.18 (69.94, 286.72) pg/min, P＜0.05]. Patients with increased PSTRs also had lower residual renal function [0.79(0, 2.12) ml/min vs 1.70 (0.39, 3.38) ml/min, P＜0.05], less urine volume [225(0, 600) ml/24 h vs 500(125, 900) ml/24 h, P＜0.05] and lower baseline MTACcr [5.48 (4.17, 7.42) ml/min vs 7.00(5.46, 9.76) ml/min, P＜0.05] when compared to their counterparts with stable PSTRs. Logistic analysis showed that high dialysate IL-6 AR and low baseline MTACcr were independent risk factors for increasing peritoneal solute transport rate (P＜0.05). Conclusion Intra-peritoneal inflammation significantly affects the alteration of PSTRs, and the dialysate IL-6 may be a predictor for increased PSTRs in PD patients.     

Effects of an amino acid dialysate on leucine metabolism in continuous ambulatory peritoneal dialysis patients

BACKGROUND: Protein-energy malnutrition is frequent in continuous ambulatory peritoneal dialysis (CAPD) patients. The use of amino acids in the dialysate could improve the protein balance, especially if associated to a concomitant energy intake. METHODS: A 1.1% amino acid solution for peritoneal dialysis was administered to CAPD patients over 30 minutes during concomitant absorption of 600 ml water (control study) or of a 600 kcal meal/600 ml. Leucine metabolism was studied using the combination of intravenous [2H3] and intraperitoneal [13C] leucine. RESULTS: The rate of leucine appearance was stimulated by 56 and 53% (control and meal) at 45 minutes. The rates of leucine appearance and disappearance were lower from 180 to 300 minutes during the meal versus control study (P < 0.05). Proteolysis was unaffected during the control study and was inhibited by 25% during the meal study (P < 0.05). During the five-hour cycle dialysis with or without a meal, 80% of the leucine administered into the peritoneum was absorbed. Forty-one percent was retained in the splanchnic bed. Forty-three percent was used for protein synthesis, and 16% was oxidized. CONCLUSIONS: This amino acids solution is efficaciously utilized for protein synthesis in CAPD patients with no effect on protein breakdown. The concomitant ingestion of a carbohydrate-lipid meal inhibits protein breakdown and reinforces a positive effect of the amino acids solution on protein balance.     

低钙透析液对腹膜透析患者钙磷代谢的影响

目的横断面研究腹膜透析患者使用低钙透析液的安全性及其影响因素。方法选择西安交通大学医学院第一附属医院肾脏内科腹膜透析超过6个月的患者共39例，其中男24例，女15例，年龄56．49±19．31岁，其中使用常规（ca 1．75mmol／L）透析液8例，低钙（ca 1．25mmol／L）透析液31例，比较两组血清钙、磷、甲状旁腺激素、血压以及使用碳酸钙的情况。结果两组血钙无明显差异；常规透析液组血磷和钙磷乘积高于低钙组，两组iPTH无明显差异。低钙组服用碳酸钙剂量明显高于常规透析液组。低钙组服用碳酸钙与未服用碳酸钙血钙无明显差异，服用碳酸钙组血磷控制较为理想、钙磷乘积更接近正常，未服用碳酸钙组血PTH明显升高。结论腹膜透析患者使用低钙透析液有利于控制血磷和血压，有效预防钙磷乘积升高。提高对碳酸钙的依从性是预防使用低钙透析液后引起继发性甲状旁腺功能亢进的关键。     

The influence of low calcium dialysate on left ventricular diastolic function in peritoneal dialysis patients

Left ventricular (LV) diastolic function was found to be a significant predictor of cardiovascular events and general mortality in dialysis. Studies have indicated that dialysate calcium concentrations were significantly associated with cardiac function. However, the relationship between low calcium dialysate and LV diastolic function has not been clear. The aim of this study was to investigate the influence of low calcium dialysate on cardiac function in peritoneal dialysis (PD) patients. A total of 60 PD patients were enrolled in this study, with a calcium content of the PD solution of 1.25?mmol/L in 30 patients (low-calcium group) and 1.75?mmol/L in 30 patients (standard-calcium group). Standard M-mode and two-dimensional ultrasound measurements were applied to detect the cardiac function. After 12-month follow-up, we found no significant difference in blood pressure, calcium, phosphorus, parathyroid hormone (PTH), etc., between the two groups. Residual renal function (RRF), which is associated with LV cardiac function, was significantly decreased in the standard-calcium group compared with the low-calcium group (5.64?±?3.23 vs. 9.38?±?3.17, p?=?.001). Compared with the low-calcium group, E_max (peak early diastolic velocity) and A_max (peak late diastolic velocity) were significantly decreased (p?p?相似文献   

维持透析时间对腹膜透析患者CKD-MBD的影响

目的 对维持腹膜透析患者的骨代谢指标进行横断面调查,并探讨腹膜透析时间对腹膜透析患者慢性肾脏疾病矿物质骨代谢异常(Chronic kidney disease-mineral and bone disorder,CKD-MBD)的影响.方法 以60例腹膜透析患者和30例健康体检者(对照组)作为研究对象,腹膜透析患者分为A组(腹膜透析时间＜24个月)和B组(腹膜透析时间≥24个月),比较各组间骨代谢指标,如血钙,血磷,25-羟维生素D3[25-hydroxyl vitamin D3,25 (OH) D3]、血清全段甲状旁腺素(intact parathyroid hormone,iPTH)和骨碱性磷酸酶(bone alkaline phosphatase,BALP)的变化.结果 与对照组相比,腹膜透析组的血磷升高,血钙降低且差异具有统计学意义(P1.40±0.29mmol/L vs 1.75±0.57mmol/L;Ca 2.33±0.19mmol/L 2.02±0.2mmol/L,P＜0.叭),iPTH,25 (OH) D3,BALP具有显著性差异[iPTH 436.41±368.28pg/mL vs 53.31±23.71pg/mL;25(OH)D3199.28±139.52ng/mL vs 36.04±14.17ng/mL;BALP80.24±39.41ng/mL vs 173.76±52.38ng/mL,P＜0.01].腹膜透析患者一项或多项骨代谢指标异常的发生率为100％.与对照组相比,A组、B组的血钙降低,血磷升高,且具有统计学意义;但A组与B组的血钙、血磷水平差异无统计学意义(P＞0.05).与对照组相比,A组、B组的iPTH显著升高(53.31±23.71pg/mL vs 596.57±449.91 pg/mL & 276.25±148.23pg/mL,P＜0.05);25(OH)D3显著减低[173.76±52.38ng/mL vs 58.99±25.79ng/mL & 101.48±39.67ng/mL,P＜0.05],A组BALP明显减低(36.04±14.18ng/mL vs 264.58±114.24ng/mL);与A组相比,B组的iPTH升高,25(OH)D3降低,BALP降低,且差异均具有统计学意义(BALP:133.97±133.90ng/mL vs 264.58±114.24ng/mL,P＜0.05).结论 腹膜透析患者存在明显的矿物质骨代谢异常.随着腹膜透析时间的增加,骨转化类型可能会发生变化,由于常规行骨活检较困难,需动态的检测患者的骨代谢血清学指标来辅助判断骨转化类型.腹膜透析患者矿物质骨代谢异常的治疗方案需根据骨转化类型进行调整.     

Cellular response to peritonitis among peritoneal dialysis patients

White blood cell counts and differential cell counts were performed on 249 peritoneal dialysis effluents from 48 patients using chronic peritoneal dialysis. The finding of more than 50% polymorphonuclear leukocytes in the dialysate was a more sensitive indicator of peritonitis than was an absolute cell count of 100 cells/microL. This finding was true for patients using intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, and continuous cycling peritoneal dialysis.     

Potassium supplementation via the dialysate in continuous ambulatory peritoneal dialysis

A small percentage of patients treated with continuous ambulatory peritoneal dialysis (CAPD) may become hypokalemic. Since both the intravenous and oral routes for potassium repletion have disadvantages, we studied the feasibility, effectiveness, and safety of acute potassium loading via the dialysate in patients on CAPD. Five patients were studied during an exchange containing 20 mEq/L of potassium. This was well tolerated and led to a gradual increase in the plasma potassium concentration (.44 +/- .11 mEq/L) as about three-fourths of the intraperitoneal load was absorbed, most of it by two hours. The greatest increase in the plasma potassium concentration was .63 mEq/L. A separate patient developed intense abdominal pain during an exchange containing 40 mEq/L of potassium. We conclude that the dialysate is a safe and effective route for acute potassium repletion during CAPD when the dialysate potassium concentration does not exceed 20 mEq/L.     

Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD)

Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the dialysate and urine were 9.1 +/- 4.1 micrograms/l and 52.5 +/- 47.3 micrograms/l, respectively. Bone Al concentration was 21.0 +/- 14.9 ppm and correlated significantly with concentrations of Al in serum (p less than 0.01) and dialysate (p less than 0.01). A mass transfer (MT) from the patients to the dialysate was observed in all patients (-44.0 +/- 28.8 micrograms/24 h). There was a highly significant correlation between peritoneal Al MT and serum Al (p less than 0.001), actual Al consumption (p less than 0.05) and bone Al concentration (p less than 0.005) supporting the existence of an overflow phenomenon. Despite very low Al levels in the dialysate, patients are at risk of elevated Al levels in the serum, dialysate, urine and bone because of consumption of Al-containing phosphate binders.