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      Peritoneal Sodium Mass Removal in Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis: Influence on Blood Pressure Control

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          Abstract

          Background/Aim: Sodium and water retention is common in peritoneal dialysis patients and contributes to cardiovascular disease. As peritoneal sodium removal depends partly on dwell time, and automated peritoneal dialysis (APD) often uses short dwell time exchanges, the aim of this study was to compare the 24-hour peritoneal sodium removal in APD and standard continuous ambulatory peritoneal dialysis (CAPD) patients and to analyze its possible influence on blood pressure control. Methods: A total of 53 sodium balance studies (30 in APD and 23 in CAPD) were performed in 36 stable peritoneal dialysis patients. The 24-hour net removal of sodium was calculated as follows: M = ViCi – VdCd, where Vd is the 24-hour drained volume, Cd is the solute sodium concentration in Vd, Vi is the amount of solution used during a 24-hour period, and Ci is the sodium concentration in Vi. Peritoneal sodium removal was compared between APD and CAPD patients. Residual renal function, serum sodium concentration, daily urinary sodium losses, weekly peritoneal Kt/V and creatinine clearance, 4-hour dialysate/plasma creatinine ratio, proportion of hypertonic solutions, net ultrafiltration, systolic and diastolic blood pressures, and need for antihypertensive therapy were also compared between the groups. Results: Peritoneal sodium removal was higher (p < 0.001) in CAPD than in APD patients. There were no significant differences in residual renal function, serum sodium concentration, urinary sodium losses, peritoneal urea or creatinine clearances, 4-hour dialysate/plasma creatinine ratio, or proportion of hypertonic solutions between groups. The net ultrafiltration was higher in CAPD patients and correlated strongly (r = 0.82; p < 0.001) with peritoneal sodium removal. In APD patients, peritoneal sodium removal increased significantly only in those patients with a second daytime exchange. The systolic blood pressure was higher (p < 0.05) in APD patients, and the proportion of patients with antihypertensive therapy was also higher in APD patients, although no significant relationship between blood pressure values and amount of peritoneal sodium removal was found. Conclusions: The 24-hour sodium removal is higher in CAPD than in APD patients, and there is a trend towards better hypertension control in CAPD patients. As hypertension control and volume status are important indices of peritoneal dialysis adequacy, our results have to be considered in the choice of the peritoneal dialysis modality.

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          Biochemical Parameters, Nutritional Status and Efficiency of Dialysis in CAPD and CCPD Patients

          Background/Aims: Several studies indicate that small solute transport is influenced by peritoneal dialysate volume and dwell time. This study focuses on the clinical impact of peritoneal dialysis modality, continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). Methods: We studied 18 patients on CAPD and 11 on CCPD for 18 months and assessed biochemical parameters, nutritional status and efficiency of dialysis at 6-month intervals. Results: Four-hour D/P urea and creatinine ratios were similar in both CAPD and CCPD patients. However, 24-hour D/P urea and creatinine ratios were significantly higher in CAPD than in CCPD patients (0.9 ± 0.1 vs. 0.8 ± 0.2 and 0.8 ± 0.1 vs. 0.6 ± 0.2, p < 0.05 and p < 0.01, respectively). The dialysate urea nitrogen concentration was significantly different between the two groups (65 ± 14 mg/dl in CAPD, 48 ± 13 mg/dl in CCPD; p < 0.05). Total weekly Kt/V and total weekly creatinine clearance were not significantly different between CAPD and CCPD patients at 18 months (1.6 ± 0.4 vs. 1.7 ± 0.3 and 52 ± 21 vs. 50 ± 12 liters, respectively). Two-way ANOVA with a post-hoc Bonferroni-Dunn test showed serum potassium concentration was significantly lower in CCPD patients at 18 months (3.8 ± 0.5 mEq/l, p < 0.05), and significant increases in triglyceride levels in the CAPD groups by 18 months (301 ± 286 mg/dl, p < 0.05). Conclusion: This study demonstrates that the mean serum triglyceride level increases in CAPD patients over time, and the mean serum potassium concentration decreases in CCPD patients at 18 months. Dialysis adequacy and nutritional status are not significantly different between the two peritoneal dialysis modalities, CAPD and CCPD. We suggest the peritoneal dialysis prescription for CAPD or CCPD with respect to volume and frequency of exchanges be individualized to achieve adequate of therapy.
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            Author and article information

            Journal
            AJN
            Am J Nephrol
            10.1159/issn.0250-8095
            American Journal of Nephrology
            S. Karger AG
            0250-8095
            1421-9670
            2001
            June 2001
            25 June 2001
            : 21
            : 3
            : 189-193
            Affiliations
            Department of Nephrology, Hospital Severo Ochoa, Leganés, Madrid, Spain
            Article
            46246 Am J Nephrol 2001;21:189–193
            10.1159/000046246
            11423687
            © 2001 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Tables: 2, References: 28, Pages: 5
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/46246
            Categories
            Clinical Study

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