[Clinical aspects of high peritoneal permeability].
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Age Factors↗
Biomedical subjects
I Mariak
Publications and source records attributed to I Mariak.
Polyglucose dialysis solution induces changes in blood chemistry.
In peritoneal dialysis patients, polyglucose dialysis solution (PG-DS) influences serum levels of sodium, amylase, and lipase, and of iron parameters. We aimed to examine, in the blood or serum of continuous ambulatory peritoneal dialysis (CAPD) patients treated with PG-DS, changes in the concentrations of Na+, K+, Ca++, total Ca, phosphorus, urea nitrogen, creatinine, uric acid, total protein, albumin, and intact parathyroid hormone (iPTH); in lipid profile [total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, HDL:total cholesterol ratio]; and in acid-base status. We started studies in 14 CAPD patients in whom 7.5% PG-DS was applied for the overnight 2-L exchange (duration: about 10 hours). Determinations of blood chemistry were carried out at 1.6 +/- 0.8 months before the introduction of PG-DS (period I, n = 14); after 1.2 +/- 0.6 months (period II, n = 14), 4.4 +/- 0.8 months (period III, n = 11), and 8.8 +/- 2.4 months (period IV, n = 9) of PG-DS administration; and 2.0 +/- 0.6 months after PG-DS discontinuation (period V, n = 11). The most pronounced (significant) differences in the examined parameters were seen between periods I and III or periods I and IV for Na+ (140 +/- 3 mmol/L vs 136 +/- 4 mmol/L), K+ (4.2 +/- 0.6 mmol/L vs 4.8 +/- 0.6 mmol/L), total Ca (9.4 +/- 1.1 mg/dL vs 10.5 +/- 1.3 mg/dL), urea nitrogen (61.3 +/- 25.9 mg/dL vs 79.4 +/- 20.9 mg/dL), creatinine (10.7 +/- 2.6 mg/dL vs 12.8 +/- 4.3 mg/dL), uric acid (4.8 +/- 2.3 mg/dL vs 7.1 +/- 1.7 mg/dL), and total protein (61.7 +/- 10.8 g/L vs 70.5 +/- 8.0 g/L). Serum lipid levels were stable during PG-DS administration, but they increased after discontinuation of the PG-DS. Other studied parameters usually returned to pre-treatment values after PG-DS discontinuation. All patients were in good clinical status during the study. The changes in blood chemistry did not cause clinical intervention. Our results indicate that PG-DS influences blood chemistry. The observed differences need to be clinically analyzed.
Blood Proteins↗
Zinc as a marker of nutrition in continuous ambulatory peritoneal dialysis patients.
Our aim was to show, in continuous ambulatory peritoneal dialysis (CAPD) patients, the relationships between zinc (serum level and dietary intake) and adequacy and duration of CAPD, age, and measures of nutrition. Serum zinc (12.2 +/- 1.8 mumol/L) was not significantly related to dietary zinc intake (9.9 +/- 2.5 mg daily), but depended on daily instilled (r = -0.331, p < 0.05) and effluent (r = -0.311, p < 0.05) dialysate volumes and on patient age (r = -0.304, p < 0.05). Positive correlations were seen between serum zinc level and laboratory (but not anthropometric) markers of nutrition: prealbumin (r = 0.349, p < 0.05), iron (r = 0.447, p < 0.05), transferrin saturation [(TSAT) r = 0.374, p < 0.05]. Additionally, zinc intake was positively related to serum ferritin level (r = 0.370, p < 0.05). Serum zinc level positively influenced blood morphology [correlation with hemoglobin (r = 0.287, p < 0.05) and mean corpuscular hemoglobin concentration (r = 0.361, p < 0.05)]. Zinc intake showed negative correlations with serum levels of total cholesterol (r = -0.373, p < 0.05) and vitamin E (r = -0.504, p < 0.05), and a positive correlation with HDL: total cholesterol ratio (r = 0.338, p < 0.05). Mean values of three latter parameters were out of the normal limits (total cholesterol: 219.2 +/- 47.0 mg/dL; vitamin E: 1.91 +/- 0.82 mg/dL; HDL: total cholesterol ratio: 16.7 +/- 5.1). We conclude that, in CAPD patients, zinc is a marker of nutrition showing beneficial effect on serum iron parameters, blood morphology, lipid profile, and elevated vitamin E concentration. Zinc supplementation is needed for approximately 16% of CAPD patients, especially older patients and those requiring higher dialysate volumes.
C-Reactive Protein↗
Parathyroid hormone contributes to variations in blood morphology in diabetic and non diabetic patients treated with continuous ambulatory peritoneal dialysis.
The present study looked for variations in blood morphology between diabetic patients (group I, n = 7) and non diabetic patients (group II, n = 16) treated with continuous ambulatory peritoneal dialysis (CAPD). A subsequent trial sought to find a reason for discrepancies in the results between the two groups. The patients in both groups and similar ages, CAPD durations, and erythropoietin dosages. Nutrition, CAPD adequacy, serum iron and ferritin levels, total iron binding capacity (TIBC), transferrin saturation (TSAT), red blood cells (RBCs), mean corpuscular hemoglobin (MCH), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), hemoglobin (Hb), hematocrit (Hct), white blood cells (WBCs), total lymphocyte count (TLC), platelets (PLTs), and serum intact parathyroid hormone (PTH) were evaluated every three months. The mean result of each parameter was obtained in every patient as representative for the entire CAPD course. Means and standard deviations for all respective parameters were then calculated for the two groups and compared. In patients with diabetes as compared with patients without diabetes, significantly higher numbers of RBCs, WBCs, and PLTs were seen, as were higher values for Hb and Hct and a lower serum PTH concentration. Values for WBCs, PLTs, and MCH obtained in all patients (n = 23) were correlated with serum intact PTH (r = -0.520, p = 0.011; r = -0.422, p = 0.045; and r = -0.436, p = 0.037 respectively). When data obtained in the patients receiving erythropoietin were excluded and the correlation analysis was repeated for the 10 remaining patients, a correlation between serum PTH and RBCs was found (r = -0.685, p = 0.029). With comparable age, renal function, nutrition, erythropoietin dosage, iron indices, and CAPD adequacy, duration, and outcome, higher parameters of blood morphology in diabetic patients may be related to lower levels of serum intact PTH, indicating no or only mild secondary hyperparathyroidism. Patients with diabetes usually show smaller disturbances in PTH level than do non diabetic uremic patients on CAPD. Better peripheral morphology indices in the group with diabetes can be expected when other factors affecting hematologic status are similar.
Adult↗
[A role of serum ferritin estimations in continuous ambulatory peritoneal dialysis patients].
The aim of our studies was to establish an aspect of pathophysiology that is specially indicated by serum ferritin level in continuous ambulatory peritoneal dialysis (CAPD) patients. In 50 CAPD patients serum ferritin level was related to other serum indicators of iron status as well as serum level of C-reactive protein (CRP), peripheral blood morphology (including RBC indices), serum lipid profile, anthropometrical and laboratory parameters of nutritional status, parameters of dialysis adequacy and dietary food intake. In examined CAPD patients serum ferritin concentration was elevated (median 448, range 25-5334 ng/ml). Statistically significant correlations between serum ferritin level and other examined parameters included positive correlation with CRP (r = +0.389) and negative correlation with transferrin (r = -0.462), RBC (r = -0.441), haemoglobin (r = -0.412), haematocrit (r = -0.483), total cholesterol (r = -0.580) and LDL-cholesterol concentration (r = -0.442). There were also positive correlations with daily effluent volume and dietary food intake. Our studies show that in CAPD patients an elevated serum ferritin level is an indicator of inflammatory status, protein malnutrition, and inadequate erythropoiesis, despite normal or nearly normal mean levels of other serum iron parameters. On the other hand, serum ferritin level increases with greater food intake.
Adult↗
Amino-acid-based dialysis solution changes leptinemia and leptin peritoneal clearance.
In continuous ambulatory peritoneal dialysis (CAPD) patients, nutritional parameters, appetite, and transperitoneal solute movement can be modified by treatment with amino-acid-based dialysis solution (AADS). Because leptin is involved in energy expenditure and appetite regulation, we decided to examine the influence of AADS on serum and dialysate leptin concentrations. We prospectively evaluated AADS influence on leptinemia and peritoneal transport indices in CAPD patients. Nine clinically stable patients (7 males, 2 females), mean age 55.4 +/- 10.5 years, who had been treated with CAPD for 6.1 +/- 5.8 months, were studied. Examinations were conducted before treatment with 1.1% AADS (period I), after 3 months of AADS administration (period II), after 6 months of AADS administration (period III), and at 3 months after AADS discontinuation (period IV). The primary outcome measure was concentration of leptin in serum and dialysate. Secondary measures included anorexia incidence, nutrient intake, and nutritional parameters. Dialysate-to-plasma ratio (D/P), peritoneal excretion, and clearance (PCl) of leptin were calculated. After 3 months of AADS administration (period II), leptinemia was transiently lower (9.8 +/- 6.2 ng/mL vs 17.1 +/- 14.2 ng/mL, p = 0.017), while D/P (0.51 +/- 0.44 vs 0.23 +/- 0.19, p = 0.012), peritoneal excretion (72.9 +/- 85.4 micrograms/day vs 37.2 +/- 32.3 micrograms/day, p = 0.015), and PCl (4.02 +/- 3.40 mL/min vs 1.75 +/- 1.32 mL/min, p = 0.008) of leptin were higher than measurements obtained at entry. Anorexia incidence and daily protein and energy intakes showed no significant changes during the study. Total body mass, body mass index, and plasma concentrations of total protein and of albumin increased significantly during AADS treatment. A significant positive relation of leptinemia to total fat mass was observed when AADS was not used (periods I and IV). We conclude that administration of AADS in CAPD patients causes a transient decrease in leptinemia and increases in peritoneal excretion and in PCl of leptin, as well as dissociation of the physiological relationship between serum leptin level and total fat mass.
Adult↗
Polyglucose dialysis solution influences serum iron parameters.
Owing to the lack of data dealing with the influence of polyglucose dialysis solution (PG-DS) on serum indicators of iron status, our study aimed at examining this problem in patients receiving PG-DS for the overnight exchange during treatment with continuous ambulatory peritoneal dialysis. We evaluated serum concentrations of iron, ferritin, and transferrin, total iron binding capacity (TIBC), and transferrin saturation (TSAT) at 1.6 +/- 0.8 months before introducing 7.5% PG-DS for an overnight 2 L exchange lasting about 10 hours (period I, n = 14), after 1.2 +/- 0.6 months of PG-DS administration (period II, n = 14), after 4.4 +/- 0.8 months of PG-DS administration (period III, n = 11), after 8.8 +/- 2.2 months of PG-DS administration (period IV, n = 9), and at 2.0 +/- 0.6 months after PG-DS discontinuation (period V, n = 11). Interference owing to PG-DS in laboratory determinations of serum iron parameters was excluded. Indices of nutritional status were also evaluated in all study periods. Significant differences in iron parameters were seen between periods I and III, or I and IV for transferrin (212 +/- 41 mg/dL vs 253 +/- 36 mg/dL), TIBC (304 +/- 40 micrograms/dL vs 338 +/- 31 micrograms/dL) and TSAT (34% +/- 15% vs 24% +/- 4%). After PG-DS withdrawal, these parameters all returned to pre-treatment values. Improvement in nutritional status was indicated by increases in total body mass (73.9 +/- 15.6 kg vs 77.4 +/- 13.8 kg), lean body mass (54.5 +/- 9.7 kg vs 56.9 +/- 8.5 kg), and serum total protein concentration (61.7 +/- 10.8 g/L vs 70.5 +/- 8.0 g/L). We conclude that serum transferrin concentration increases during PG-DS administration without enhanced iron binding to transferrin. An increase in transferrin level can be related to improved nutritional status.
Dialysis Solutions↗
Polyglucose dialysis solution influences serum activity of amylase and of lipase differently.
Polyglucose dialysis solution (PG-DS) decreases serum amylase activity owing to interference in the analytical method. The interference can make it difficult to diagnose pancreatitis. Our aim was to check whether, during PG-DS administration, serum lipase activity changes simultaneously with serum amylase activity, and, if so, what the reason is for the detected change. Studies were started in 14 continuous ambulatory peritoneal dialysis (CAPD) patients in whom 7.5% PG-DS was applied for the overnight exchange. In addition to standard clinical and laboratory data, serum activity of lipase and of total amylase were evaluated at 1.6 +/- 0.8 months before PG-DS introduction (period I, n = 14), after 1.2 +/- 0.6 months of PG-DS administration (period II, n = 14), after 4.4 +/- 0.8 months of PG-DS administration (period III, n = 11), after 8.8 +/- 2.2 months of PG-DS administration (period IV, n = 9), and at 2.0 +/- 0.6 months after PG-DS discontinuation (period V, n = 11). The PG-DS was also added to serum from CAPD patients with known activity of amylase and of lipase. Immediately and 3 hours after PG-DS addition, a significant decrease in total amylase activity was seen; lipase activity was unchanged. In consecutive study periods, the results (median and range) were: for lipase activity--50 U/L (12-131 U/L), 59 U/L (25-160 U/L; p < 0.05 vs period I), 73 U/L (26-158 U/L; p < 0.05 vs period I), 66 U/L (30-203 U/L; p < 0.05 vs period I), and 44 U/L (15-112 U/L); for amylase activity--81 U/L (43-249 U/L), 14 U/L (5-82 U/L; p < 0.05 vs period I and period V), 15 U/L (5-192 U/L; p < 0.05 vs period I), 15 U/L (10-93 U/L; p < 0.05 vs period I and period V), and 118 U/L (4-221 U/L). An increase in serum lipase activity over the normal range (27-65 U/L) was not accompanied by clinical symptoms of pancreatic dysfunction, but rises were simultaneously shown in blood urea nitrogen, in serum level of creatinine and of total calcium, and in calcium phosphorus product. Our results confirm PG-DS influence on amylase determinations, exclude PG-DS interference in lipase measurements, and indicate that long-term PG-DS administration influences pancreatic exocrine function at a subclinical level.
Amylases↗
Continuous ambulatory peritoneal dialysis (CAPD) adequacy influences serum free carnitine level.
OBJECTIVE: An evaluation of serum free carnitine level in CAPD patients in relation to dietary intake, nutritional status and CAPD adequacy and duration. STUDY DESIGN: Food diaries, nutritional (total body mass, lean body mass, serum level of proteins, carnitine, cholesterol) and adequacy (Kt/V, PCR, tCcr, EN) parameters were obtained in 23 CAPD patients. RESULTS: Normal carnitine level (41.8+/-6.7 micromol/l) was found in 17 patients being on CAPD through 11.1+/-9.6 months, whereas in 6 persons treated with CAPD through 9.7+/-4.1 months carnitine level was 25.4+/-5.7 micromol/l. Significant differences between low and normal carnitine groups were in tCcr (82.7+/-16.7 v. 65.9+/-13.2 l/wk/1.73 m2 BSA), effluent volume (10.9+/-0.8 v. 9.9+/-1.5 l/day), effluent glucose concentration (729+/-167 v. 530+/-220 mg/dl) and serum globulin level (22.6+/-6.4 v. 29.3+/-4.4 g/l). Significant correlation coefficients (for n = 23) were found between serum carnitine level and effluent volume (r=-0.509) or plasma globulin level (r=+0.522). CONCLUSION: Patients with higher CAPD adequacy show lower serum free carnitine levels and this is related to higher effluent volumes.
Adult↗
[Parameters of blood acid: base balance and adequacy of continuous ambulatory peritoneal dialysis as well as dietary intake and nutritional status].
The purpose of studies was: 1) an evaluation of acid-base balance parameters of capillary blood in the course of CAPD treatment with the correlation analysis between these parameters and indices of CAPD adequacy, dietary intake, nutritional status and selected clinical and laboratory findings, 2) an influence of dialysis solution containing amino acids on capillary acid-base balance. The purpose first was realized in 55 patients treated CAPD up to 24 months, the second one-in 8 CAPD patients. Kt/V, PCR, total creatinine clearance, efficacy number and clinical laboratory scores (Missouri system) were used as CAPD adequacy indices. Dietary intake was evaluated from diet histories. Indices of nutritional status included total body mass, blood concentration of total protein, albumin, Fe, ferritin and cholesterol as well as TIBC. It was shown that compensated metabolic acidosis is the most common finding in patients on CAPD. Acid-base parameters do not depend significantly on Kt/V and total creatinine clearance but there is a negative correlation between HCO3- and PCR as well as between H+ concentration and efficacy number. There is no relationship between dietary intake and acid-base parameters of CAPD patients. The worse acid-base status the greater azotemia and the higher removal of nitrogenous compounds in dialysate. It was confirmed that amino acid dialysis solution deteriorates metabolic acidosis but it can be avoided by the use of oral alkalizating drugs.
Acidosis, Renal Tubular↗
Differences in assessment of patients with satisfactory or complicated continuous ambulatory peritoneal dialysis courses.
The aim of our study was a comparison of comorbid scores, peritonitis rates, dialysis adequacy, and nutritional parameters in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients were separated into two groups: those who, in the course of CAPD, were ingood clinical condition and underwent renal transplantation (group I, n = 11), and those who had to discontinue CAPD treatment (group II, n = 16) owing to death caused by comorbid disease or owing to transfer to hemodialysis for technique failure related mainly to recurrent peritonitis. Clinical scores were lower in group II, showing significantly more insomnia, weakness, and anorexia. The PET D/P creatinine, mean adequacy parameter, and urine output were similar in groups I and II. Daily protein intake (DPI) and daily energy intake (DEI) showed higher values in group I than in group II when expressed in g/kg and kcal/kg total body mass (TBM) respectively (DPI 1.09 +/- 0.15 g/kg TBM vs 0.92 +/- 0.31 g/kg TBM, p = 0.036; DEI 36.3 +/- 4.3 kcal/kg TBM vs 31.0 +/- 9.0 kcal/kg TBM, p = 0.048), but the intakes were not significantly different when calculated per kilogram ideal body mass (IBM). Lean body mass as a percent of total mass was 77.7% +/- 7.8% versus 73.9% +/- 6.8% (p = 0.048) in groups I and II respectively. Group I showed lower serum cholesterol than group II (179 +/- 33 mg/dL vs 231 +/- 41 mg/dL, p = 0.001) despite higher dietary intake of cholesterol (367 +/- 137 mg/day vs 251 +/- 97 mg/day, p = 0.016), correlating with DPI (r = +0.673, p = 0.023). Our results indicate that under conditions of similar CAPD adequacy, patients with a satisfactory course of CAPD therapy have higher dietary intake and are better nourished than those with a poor outcome. The changes in nutrition seem to be related to comorbid diseases and complications of CAPD therapy. Increased cholesterol level, associated with a diminished DPI, is prognostic of a poor outcome for CAPD patients.
Adult↗
[Evaluation of nitrogen balance in patients treated with continuous ambulatory peritoneal dialysis].
The aim of the study was an estimation of nitrogen balance (NB) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and an evaluation of relationship between NB and CAPD adequacy parameters, dietary intake and nutritional status of CAPD patients. Examinations, preformed every 3 months through 2 years, included the group of 44 patients in the age of 45 +/- 12 years, treated with CAPD through 17 +/- 10 months. NB was calculated as a difference between nitrogen intake (value obtained using dietary protein intake taken from computer analysis of diet histories--Method I or using protein catabolic rate calculated according to Randerson et al.--Method II) and amount of nitrogen excreted with dialysate and urine, estimated with modified Kjeldahl method. Results of NB I and NB II were normalized using actual total, standard, ideal or lean body mass (TBM, SBM, IBM and LBM, respectively). LBM was estimated with 3 methods: from creatinine kinetics (LBMcr), anthropometric measurements (LBManthr) and as 1/0.73 of total body water (LBMTBW/0.73). Mean values of NB were positive during the entire period of CAPD treatment. Results of NB I exceeded that of NB II (6.31 +/- 3.26 v. 4.80 +/- 2.94 g/day with daily protein and energy intake of 1.0 g/kg IBM and 37 kcal/kg IBM, respectively). Mean values of NB I or NB II, normalized using total body mass, were the highest when IBM was used, and the lowest--when TBM was applied. When normalization of NB was done with LBM, the highest values were expressed in g/kg LBMcr, the lowest--in g/kg LBManthr. Significant positive correlation was shown between NB I and plasma concentration of total protein and albumin, clinical-laboratory scores (Missouri system), dietary intake of fat, fatty acids, carbohydrates, sodium, potassium, calcium, ferrum, leucin, alanin, glycin and energy (without and with energy of glucose absorbed from the peritoneal cavity). Negative correlation was shown between NB I and dialysis duration. The highest correlation coefficients occurred when NB I was expressed in g/day, the lowest--when NB I was normalized with LBMcr. Values of NB II showed positive correlation with plasma albumin concentration, negative one--with CAPD efficacy number and creatinine D/P ratio in the peritoneal equilibration test. The highest correlation coefficients were obtained for NB II in g/kg LBManthr/day, the lowest--when NB II was expressed in g/day. Values of NB and their relationships with other parameters dependent on methods of NB estimation: when in calculations diet histories were applied, an influence of NB on plasma protein concentration and clinical-laboratory scores as well as relationship between NB and dietary intake and dialysis duration were shown; the use of protein catabolic rate for NB calculation revealed correlation between NB and plasma albumin concentration, peritoneal membrane permeability and CAPD adequacy. Patients, in whom nightly exchange of standard dialysis solution was replaced with amino acid containing dialysis solution, showed significantly higher NB II as compared to that of patients treated exclusively with standard solutions.
Adult↗
[Measuring ionized calcium (Ca2+) transport during intermittent peritoneal dialysis (IPD)].
The aim of studies was an evaluation of dialysate/plasma ratio and peritoneal balance of Ca2+ during IPD performed using 1.5 g% glucose and 1.75 mmol/l Ca2+ dialysis solution. Net ultrafiltration rate and EPBF were simultaneously examined. Studies were carried out using dialysis solution without any drugs except heparin (n = 10) and with intraperitoneal administration of sodium nitroprusside (n = 11), chlorpromazine (n = 10) and isoprenaline hydrochloride (n = 10) in the doses of 5, 2.5 and 0.5 mg/l of dialysis solution, respectively. During IPD conducted with 1.75 mmol/l Ca2+ dialysis solution, in 2-7% of patients hypercalcaemia (Ca2+ > 1.5 mmol/l) was present. It was promoted by Ca2+ absorption from dialysis solution to blood, observed in all patients. Chlorpromazine but not sodium nitroprusside or isoprenaline hydrochloride influenced significantly peritoneal transfer of Ca2+, decreasing its absorption from the peritoneal cavity. Chlorpromazine-induced changes in peritoneal transfer of Ca2+ were not a result of the drug influence on EPBF, which was not significantly different in patients dialysed without and with drugs. Ultrafiltration rate induced by 1.5 g% glucose dialysis solution did not exert significant influence on Ca2+ transport.
Absorption↗
[Problems with food intake and nutritional status in patients treated with continuous ambulatory peritoneal dialysis (CAPD)].
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Body Mass Index↗
Correlation between effective peritoneal blood flow, blood pressure, and peritoneal transfer rates.
The aim of the studies was an evaluation of the correlation between effective peritoneal blood flow (EPBF), blood pressure, and peritoneal transfer during intermittent peritoneal dialysis (IPD). In 20 IPD patients it was shown that EPBF does not depend on either systolic or diastolic blood pressure. Differences in EPBF did not influence peritoneal transfer of small solutes and total protein during the first 25 minutes of dwell, but EPBF dependence of transfer was shown in the later periods of the dwell. Peritoneal transfer rates were greater with higher systolic blood pressure; the significant changes were shown at the beginning (for bicarbonate and total carbon dioxide), in the middle (for urea), and at the end (for uric acid) of the dwell time. Differences in diastolic pressure influenced peritoneal transfer predominantly during the first 25 minutes of dwell, although significant changes during the entire dwell were also observed. Our results indicate that the influence of both EPBF and blood pressure on transport kinetics depends on dwell time: in the first minutes of dwell diastolic blood pressure can predominantly contribute to transfer rates, in later periods the greater role of EPBF in the determination of transfer rates cannot be excluded.
Adult↗
Total lymphocyte count as a prognostic index in CAPD patients.
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Humans↗
Effects of amino acid dialysis solution on the nutrition of continuous ambulatory peritoneal dialysis patients.
OBJECTIVE: To evaluate the influence of 1.1% amino acid dialysis solution (AADS) on parameters of nutrition in continuous ambulatory peritoneal dialysis (CAPD) patients. STUDY DESIGN: Studies were performed in 8 men, using AADS for the overnight exchange. Before starting AADS, food intake, nutritional status, and laboratory indices were evaluated and compared to the respective parameters obtained after 3 and 6 months of treatment with AADS, as well as after 3 months of AADS withdrawal. With the start of AADS, doses of antacids were increased and modified during AADS administration; the modified doses were continued through 3 months after cessation of AADS. Another group of CAPD patients using standard dialysis solutions served as controls. In these patients the same parameters were evaluated four times at 3-month intervals. RESULTS: Administration of AADS resulted in: (1) 91% absorption of amino acids and improvement of serum amino acid pattern; (2) no change in nutritional intake during the treatment, but after the 3 months of AADS therapy, levels of nutrient intake were lower than those 3 months after withdrawal of AADS with correction of metabolic acidosis; (3) no change in indices of nutritional status, but 3 months after AADS discontinuation, total body weight, lean body mass, and body mass index were significantly higher than those shown after 3 months of treatment; (4) an increase in hemoglobin concentration, hematocrit, BUN, and blood H+. The examined parameters were not significantly changed in patients treated for 9 months with standard dialysis solutions exclusively. The values of nitrogen balance obtained during AADS administration and after 3 months of AADS withdrawal were significantly higher than those obtained in the respective periods in the control group. The blood pH, pCO2, and HCO3- in the last period of the study were higher in the AADS group than in the control group. CONCLUSION: In relatively well-nourished CAPD patients, overnight AADS administration results in increased serum concentration of amino acids without changes in other nutritional parameters. The use of AADS should be associated with increased doses of antacid medication, which abolishes the metabolic effects of acidosis that develop during AADS administration and facilitates positive nitrogen balance.
Adult↗
Arterial blood pressure and effective peritoneal blood flow during intermittent peritoneal dialysis.
Our earlier studies indicate that effective peritoneal blood flow (EPBF) during intermittent peritoneal dialysis (IPD) does not depend on gender, age, body mass, renal disease leading to uremia and duration of IPD. Thus, a cause of differences in EPBF observed in uremic patients during IPD is still not clear. The aim of present studies is an evaluation of relationship between arterial blood pressure and EPBF calculated as diffusive mass transfer coefficient of CO2. Studies were performed in 20 patients in the age of 47 +/- 14 (x +/- SD) years, treated with IPD during 4.3 +/- 3.6 months. EPBF and arterial blood pressure were evaluated in the middle of dialysis. Mean arterial pressure was calculated from systolic and diastolic pressure. In patients (n = 10) with greater EPBF (291 +/- 99 ml/min) systolic, diastolic and mean pressures were respectively 166 +/- 24, 100 +/- 20 and 122 +/- 20 mmHg. In patients (n = 10) with smaller EPBF (154 +/- 27 ml/min) respective pressure were 160 +/- 12, 91 +/- 9 and 114 +/- 8 mmHg. The highest but insignificant correlation was found between EPBF and diastolic blood pressure (r = 0.310, n = 20). Patients with significantly higher diastolic (108 +/- 16 mmHg, n = 9, v. 85 +/- 6 mmHg, n = 11) and mean blood pressure (129 +/- 17 v. 108 +/- 2 mmHg) showed insignificantly greater EPBF (260 +/- 121 v. 192 +/- 63 ml/min). Our studies indicate that EPBF during IPD cannot significantly depend on blood pressure.
Adult↗