Biomedical subjects

T Lilaj

Publications and source records attributed to T Lilaj.

4 recordsLinked to original sources

PubMed2001

A preceding exchange with polyglucose versus glucose solution modifies peritoneal equilibration test results.

The peritoneal equilibration test (PET) is an important tool for evaluating peritoneal membrane characteristics. The polyglucose icodextrin induces ultrafiltration caused by colloid osmosis through the small pores of the peritoneal membrane and therefore is especially effective during long dwell times. The main indications for polyglucose solutions are daytime dwells in patients on automated peritoneal dialysis and nighttime exchanges in continuous ambulatory peritoneal dialysis (CAPD) patients. In CAPD patients, PET is started immediately after the icodextrin exchange. Therefore, we performed two PETs in each of 15 CAPD patients. PET post-1.36% glucose was performed immediately after a preceding exchange with 2 L of 1.36% glucose dialysate solution (dwell time, 10 hours). PET postpolyglucose was started immediately after a preceding exchange with 2 L of 7.5% icodextrin solution (dwell time, 10 hours). The dialysate to plasma (D/P) ratio of creatinine, phosphate, and sodium during PET postpolyglucose was significantly greater than during PET post-1.36% glucose at 1, 2, 3, and 4 hours of dwell time. The quotient of dialysate glucose at 1, 2, and 4 hours of dwell time to dialysate glucose at 0 dwell time was significantly lower in PET postpolyglucose compared with PET post-1.36% glucose. In the case of creatinine, phosphate, and glucose, PET postpolyglucose curves tended to be steeper than those of PET post-1.36% glucose during the first hour of dwell time, whereas both curves were parallel between 1 and 4 hours of dwell time. The course of D/P ratio curves of urea nitrogen, protein, and albumin was nearly identical between PET postpolyglucose and PET post-1.36% glucose. In a subgroup of 5 patients, D/P ratios of creatinine and phosphate were also greater in PET postpolyglucose compared with PET performed after a long dwell with 2.27% glucose solution. Before a scheduled PET, CAPD patients using icodextrin solution during the nighttime should perform their nighttime exchange with conventional glucose solution.

Adult↗

PubMed1999

Ultrasonography of the catheter tunnel in peritoneal dialysis patients: what are the indications?

The importance of sonography for the early detection and follow-up of tunnel infections in peritoneal dialysis patients is well documented, whereas other indications are less clear. We investigated indications and outcome of 738 ultrasound examinations of the peritoneal dialysis catheter tunnel. Indications for tunnel sonography included routine screening (27%), exit-site infection without peritonitis (24.1%), follow-up of tunnel infection (29.5%), clarification of questionable results (7.5%), pain in the course of the catheter tunnel (1.8%), peritonitis without (5.3%) and with (2.0%) exit-site infection, search for foci (2.2%), and recurrent peritonitis (0.7%). No positive sonographic results were obtained during routine screening or in patients with fever or elevated C-reactive protein levels showing no clinical signs of exit-site infection. Sonographic examinations were positive in 1 of 13 patients with pain in the course of the catheter tunnel, in 1 of 39 cases of peritonitis not associated with exit-site infection, in 12 of 15 patients with peritonitis and simultaneous exit-site infection, and in 2 of 5 patients with recurrent peritonitis. Questionable results were detected in 15 of 178 patients with exit-site infection, in 15 of 199 routine examinations, in 2 of 16 examinations of patients with elevated C-reactive protein levels or fever, and in 2 of 15 cases of peritonitis and simultaneous exit-site infection. All but two of these questionable results had to be rated as negative during further follow-up. We conclude that tunnel sonography is indicated in patients with exit-site infection (including cases with simultaneous peritonitis), for follow-up of tunnel infections, and for estimating the prognosis of these infections. Furthermore, tunnel sonography should be performed in patients with recurrent peritonitis. Tunnel sonography is not indicated for routine screening, search for foci, in cases of peritonitis without exit-site infection, or in patients with pain in the course of the catheter tunnel showing no other clinical signs of exit-site infection.

C-Reactive Protein↗

PubMed1999

Tidal peritoneal dialysis for home-treated patients: should it be preferred?

Tidal peritoneal dialysis (TPD) was introduced to increase the efficacy of peritoneal dialysis. We measured peritoneal clearances of small solutes and beta2-microglobulin, peritoneal protein loss, and efficacy of ultrafiltration in 30 patients during TPD and intermittent peritoneal dialysis (IPD) with low-dialysate flow (1.7 L/h) and, in addition, in 17 of these patients using a high-dialysate flow (3 L/h). Using a low-dialysate flow, patients with low/low average peritoneal transport rates showed significantly better peritoneal creatinine and urea nitrogen clearances during IPD compared with TPD, whereas there was no difference between these two treatment modalities in high/high average transporters. With high-dialysate flow, peritoneal clearances of creatinine and urea nitrogen were similar between TPD and IPD independent of peritoneal transport type. Clearances of phosphate and beta2-microglobulin were similar between TPD and IPD independent of dialysate flow or peritoneal transport type. Increasing the dialysate flow rate led to a significant increase in small-solute clearances, but not beta2-microglobulin clearances, in both peritoneal transport types. Total peritoneal protein and albumin losses were similar between TPD and IPD only with low-dialysate flow. However, using a high-dialysate flow, total protein losses tended to increase in both transport types during IPD compared with TPD. In conclusion, up to a dialysate flow of 3 L/h, TPD did not provide better small-solute or middle-molecule clearances compared with IPD. Moreover, using a low-dialysate flow, IPD was superior to TPD in low/low average transporters.

Adult↗

PubMed1999

Influence of the preceding exchange on peritoneal equilibration test results: a prospective study.

The standard peritoneal equilibration test (PET) should be performed after a long overnight dwell, which is easily possible in continuous ambulatory peritoneal dialysis patients. However, for such a procedure, patients undergoing automated peritoneal dialysis or daily ambulatory peritoneal dialysis have to change their regimen and, in the case of high peritoneal transport rates, run the risk for fluid absorption. We compared dialysate to plasma ratios (D/P) of creatinine, blood urea nitrogen (BUN), phosphate, sodium, total protein, and albumin measured during PET after an 8- to 11-hour dry period (PET dry), after a preceding exchange with a long dwell time (PET standard), and immediately after tidal peritoneal dialysis (PET tidal). D/P ratios of creatinine, BUN, phosphate, and sodium at 2 and 4 hours were greater during PET dry compared with both PET standard and PET tidal. The quotient of dialysate glucose at 2 hours to dialysate glucose at time point 0 was significantly less in PET dry compared with both PET tidal and PET standard. During the first 2 hours of PET, the increase of D/P curves of creatinine and BUN, as well as phosphate, was significantly steeper in PET dry than PET tidal and PET standard. D/P ratios of albumin and protein were greatest in PET dry and least in PET tidal. There was a significant difference between all three PETs at 0, 2, and 4 hours of dwell time. PET curves were significantly steeper during PET dry compared with PET tidal in case of D/P protein (during the first 2 hours of dwell time) and D/P albumin (during the entire dwell time). Similar differences between the PET curves of protein and albumin were observed between PET dry and PET standard. These data clearly indicate a dry period before PET significantly influences the D/P ratios of small solutes, protein, and albumin measured during the test.

Adult↗