New solutions for peritoneal dialysis in adult and pediatric patients

Baxter International Inc., Дирфилд, Illinois, United States
Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis (Impact Factor: 1.53). 02/1999; 19 Suppl 2:S429-34.
Source: PubMed


Glucose is almost universally used as an osmotic agent in peritoneal dialysis (PD) solutions. The major advantages of glucose are that it produces high ultrafiltration rates at relatively low mass concentrations; it is readily metabolized; it is safe; and it has beneficial nutritional value, especially for patients with poor calorie intake. Glucose-containing solutions are also relatively inexpensive and easy to manufacture. The major drawbacks of glucose as an osmotic agent include inadequate ultrafiltration during long-dwell exchanges, particularly in patients with high peritoneal permeability; worsening of metabolic abnormalities owing to the peritoneal glucose load; and potential local adverse effects in the peritoneum owing to the bioincompatible aspects of standard lactate-buffered PD solutions. Because of the drawbacks, which are indeed applicable in adult patients as well as in pediatric patients, there has been continued research and development of new PD solutions. Efforts have been focused mainly on three areas. The first area is the replacement of glucose with equally small molecular weight substances, such as amino acids, to alter the metabolic profile. The second area is the replacement of glucose with large molecular weight substances such as glucose polymers to enhance ultrafiltration while minimizing absorption of the osmotic agent, thereby reducing metabolic side effects. The final area is providing PD solutions that contain bicarbonate as a buffer and that are thus pH-neutral, with improved biocompatibility profiles. This paper will focus on clinical experience with these three new commercially available solutions.

Download full-text


Available from: Ty R Shockley, Sep 10, 2014
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Standard peritoneal dialysis (PD) solutions may contribute to anorexia in PD patients due to the peritoneal absorption of glucose from the dialysate, abdominal discomfort and other factors. New PD solutions containing alternative osmotic agents, neutral pH and bicarbonate as buffer were recently developed. To test the effect of these solutions on appetite, we investigated how intraoral (IO) intake of sucrose via an IO cannula was influenced by intraperitoneal (IP) infusion of different PD solutions in an appetite model in rats. The IO intake was measured in male Wistar rats after an IP dwell of 30 and 120 minutes with the following PD solutions: 1.36%, 2.27% and 3.86% glucose based and lactate buffered solutions (D); 1.36%, 2.27% and 3.86% glucose based and bicarbonate/lactate buffered solutions (P); 7.5% icodextrin based solution (E); 1.1% amino acid-based solution (N); and, 2.5% glucose-based lactate-buffered solution (GB), using sham injection (injection without infusion) as control. Prior to the tests, rats were provided with an IO cannula, and were trained for two weeks until the rate of IO intake had stabilized. The D and N solutions inhibited IO intake. For the D solutions, the degree of appetite suppression was higher with the higher concentration of glucose. P 3.86%, but not P 1.36% and P 2.27% solutions, inhibited the IO intake. However, a comparison of the degree of appetite inhibition between D and P showed less inhibition with P 1.36%, 2.27% and 3.86% solutions than with corresponding D solutions. The E solution did not seem to suppress appetite. Finally, no significant difference in IO intake was found between rats given GB 2.5% and D 2.27%. In this appetite model in rats, the measurement of IO intake after the IP infusion of different dialysis solutions showed that (1) N and D solutions may reduce appetite, and for the D solutions the degree of appetite inhibition was related to the dialysate concentrations of glucose; (2) the P solutions had less impact on appetite than the D solutions; (3) the E solution had no impact on appetite during the short dwells of 30 and 120 minutes. The demonstrated differences between the different solutions appear to be due to different concentrations, and type, of nutrients used as osmotic agent (glucose, amino acids, icodextrin) or buffer (lactate), although differences in dialysate pH, tonicity and concentration of glucose degradation products also may be important. The present studies suggest a possible positive effect on appetite by using bicarbonate/lactate buffered solutions instead of lactate buffered solutions.
    Preview · Article · Jan 2002 · Kidney International
  • [Show abstract] [Hide abstract]
    ABSTRACT: The metabolic abnormalities associated with chronic renal failure and complications of the dialysis procedure present unique challenges in critical care medicine. Understanding how renal failure impacts the development and management of cardiovascular disease, bleeding tendencies, infection, and malnutrition is necessary to provide optimal care for these patients. The recognition of ESRD as a state of chronic inflammation and increased oxidative stress ultimately should lead to more effective treatment approaches for several of the comorbid conditions common in this patient population.
    No preview · Article · May 2002 · Critical Care Clinics
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As shown in Table 4 the use of icodextrin based peritoneal dialysis fluid for the long dwell in PD patients is associated with metabolic and laboratory effects, which are different than those observed for dextrose-based solutions. Apart from the retention of icodextrin metabolites in plasma, the metabolic effects of icodextrin are in general less conspicuous than those of dextrose solutions. Although icodextrin is a polymer of glucose molecules, its higher molecular weight, slower absorption from the peritoneal cavity and gradual metabolism by serum amylase prevent the hyperglycemia, hyperinsulinemia and other metabolic effects that are associated with hypertonic dextrose solutions. The temporal profile of the peritoneal absorption and metabolism of icodextrin thus explains why the metabolic effects of this glucose polymer are distinct from those of glucose itself.
    Full-text · Article · Nov 2002 · Kidney international. Supplement
Show more