7 men and 3 women (mean age 62 +/- 11 years) with end-stage renal disease, who were on continuous ambulatory peritoneal dialysis, underwent a peritoneal equilibration test to determine the rate of peritoneal ultrafiltration and creatinine transfer. The test is based on glucose absorption into the plasma from the peritoneal solution and the diffusion of creatinine into the peritoneal fluid after 2-4 hours. Patients with rapid absorption of glucose have low drain water ultrafiltration volumes but higher creatinine clearances, and therefore need adjustment of the therapy plan or else should be on hemodialysis. No correlation was found between the time the patients were on treatment and glucose absorption or creatinine diffusion.

Peritoneal equilibration test

Diabetes mellitus (DM) is the main cause of end-stage renal disease (ESRD). Conversely, chronic renal failure (CRF) is also associated with diverse alterations in carbohydrate and insulin metabolism. CRF-induced metabolic disorders should be borne in mind when treating diabetic patients, to ensure the introduction of adequate therapy adjustments that are in line with the onset of renal function decline. Moreover, several specific therapies employed in CRF may also influence pharmacological therapy of DM in uraemic patients. Adequate glycaemic control has also been associated with a reduction in the onset and progression of diabetic nephropathy as well as in the morbidity and mortality in uraemic diabetic patients during dialysis. Intensive insulin therapy can notably improve glycemic control and it should be considered part of the management of insulin-treated CRF diabetic patients. Insulin analogues have been recently evaluated in CRF diabetic patients, with encouraging results. In this study, we review the more relevant aspects related to insulin therapy in diabetic patients with different degrees of renal failure and in patients with ESRD, both in conservative therapy and dialysis.

Insulin therapy in renal disease

Progress in Hemodialysis - From Emergent Biotechnology to Clinical Practice

Treatment of Atherogenic Liver Based on the Pathogenesis of Nonalcoholic Fatty Liver Disease: A Novel Approach to Reduce Cardiovascular Risk?

The steady decrease in the incidence of bacterial peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD) has allowed us to focus on noninfectious complications of peritoneal dialysis. Many of the complications result from the increased intra-abdominal pressure caused by the instillation of litres of fluid into a cavity which usually holds much less. Other complications arise because of the long-term effect of peritoneal dialysate directly on the mesothelial cells with which it has almost continuous contact, and more indirectly from the long-term metabolic consequences of this solution on the body’s physiochemistry. This chapter will address these and other complications of peritoneal dialysis.

Noninfectious complications of peritoneal dialysis

ObjectivesThe aim of this study was to evaluate hepatic subcapsular steatosis (HSS) and its association with clinical parameters in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) pati...

Hepatic Subcapsular Steatosis as a Complication Associated with Intraperitoneal Insulin Treatment in Diabetic Peritoneal Dialysis Patients

SUMMARY:

Aim: The aim of this prospective study was to assess the determinants of the progression of carotid artery intima-media thickness (CA-IMT) for 1 year in haemodialysis (HD) patients without significant comorbidities.



Methods:  Fifty-four HD patients younger than 55 years, without diabetes, obesity and any clinical evidence of cardiovascular disease (29 men, 25 women; mean age 33.3 ± 10 years; mean time on HD 49.4 ± 43 months) were included in the 1-year study. CA-IMT was assessed at baseline and after 12 months. The difference in IMT between these two points of time was calculated (ΔCA-IMT). C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), haematocrit-corrected ESR, beta-2 microglobulin, cardiac troponin I, lipid profile, fibrinogen, homocysteine, CaXP product, intact parathyroid hormone, haematocrit, albumin, uric acid levels, anthropometric parameters (age, body mass index), smoking, hypertension and left ventricular hypertrophy were recorded at baseline.



Results:  The mean value for CA-IMT at baseline (0.59 ± 0.05 mm) was significantly lower than that at 12 months (0.64 ± 0.07 mm) (P < 0.001). CA-IMT had increased in 41 patients (75.9%). Age (P = 0.02), CRP (P = 0.03), beta-2 microglobulin (P = 0.001) and left ventricular hypertrophy (P = 0.01) were independently related with CA-IMT at baseline. Age (P = 0.003) and CRP (P = 0.04) were the independent variables related with CA-IMT, measured at 12 months. ΔCA-IMT correlated positively with age (r = 0.31, P < 0.05). Age and sex were independent predictors of ΔCA-IMT (R2 for the model 0.56).



Conclusion:  In addition to age and male sex, non-specific inflammation may have a possible role in the progression of atherosclerosis in HD patients without significant comorbidities.

Atherosclerosis in haemodialysis patients without significant comorbidities: determinants of progression.

not be performed. We chose to use the ISPD intermittent dosing recommendations for CAPD of 1 g IP twice daily. We did have the same concern expressed previously that there are potentially long periods of time where the imipenem may not be present in adequate MIC levels to treat the infection due to the rapid exchange in APD. Fortunately, our patient was able to be successfully treated with this dosing regimen. Alcaligenes xylosoxidans is a rare cause of peritonitis and is associated with high mortality despite catheter removal and antibiotic treatment. Peritoneal dialysis patients may be predisposed to infection with this organism due to their compromised immunity and the fact that the PDF provides an aqueous environment that favors the growth of this organism. Alcaligenes xylosoxidans is especially virulent due to its resistance to most antibiotic therapies, and the majority of case reports required catheter removal. We present the first case of APD-associated Alcaligenes xylosoxidans peritonitis that was successfully treated with imipenem and ciprofloxacin.

Icodextrin-Associated Sterile Peritonitis: A Recent Outbreak in Turkey:

Aim. To investigate the influence of anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis (HD) patients. Methods. Stable HD patients who had persistently negative or positive HCV antibodies (at least three) and without elevated aminotransferase levels in routine periodical tests with a duration of more than 12 months were included. Patients with conditions known to be associated with acute-phase responses or clinically active (HCV RNA positive) or advanced liver failure were excluded. Thirty-six anti-HCV-positive patients (22 male, 14 female, mean age 47.3 ± 14.5 years, mean time on HD 72.0 ± 39.0 months), were compared with 36 anti-HCV negative patients with similar age and HD duration (25 male, 11 female, mean age 49.2 ± 13.8 years, mean time on HD 59.7 ± 27.1 months). Malnutrition-Inflammation Score (MIS), a fully quantitative score adopted from subjective global assessment, was recorded for each patient (ranges from 0 to 30). High sensitivity serum C-reactive protein (hs-CRP...

Effect of anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis patients.

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Papers

Hepatic Subcapsular Steatosis as a Complication Associated with Intraperitoneal Insulin Treatment in Diabetic Peritoneal Dialysis Patients

Atherosclerosis in haemodialysis patients without significant comorbidities: determinants of progression.

Icodextrin-Associated Sterile Peritonitis: A Recent Outbreak in Turkey:

Effect of anti-HCV positivity on markers of malnutrition and inflammation in hemodialysis patients.