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11 Peritoneal Dialysis
- 2. Ramesh Khanna & Karl D. Nolph Modalities of renal replacement therapy Interchangeable, depends on residual renal function
- 5. Principles of peritoneal dialysis
- 6. Scheme of peritoneal solute transport by diffusion through the pores of capillary wall
- 7. Ramesh Khanna & Karl D. Nolph Model of transport - 3 sorts of pores
- 8. Ramesh Khanna & Karl D. Nolph Na 132 mmol/l Ca 1,25mmol/l Mg 0,5 mmol/l Cl 100 mmol/l lactate 35 mmol/l ev. lactate/bicarbonate glukose 1,36-4,25 g/dl osmolarity 347-486 pH 5,2 GDP (degradation products of glucose) Composition of standard peritoneal dialysis solution
- 9. Urea concentration in dialysate , rate of equalization of solute concentration depends on molecular size of solute
- 10. Concentration of Creatinin in dialysate equilibrium of concentrations between dialysate and blood is slower than for urea
- 12. Types of peritoneal catheters
- 13. Why to start with PD ? 1. better maintenance of residual renal function
- 15. Ramesh Khanna & Karl D. Nolph 80% of patients have no contra-indication to any of the dialysis methods and may choose according to their life style between HD a PD Absolute contra-indications of PD: 1.peritoneal fibrosis and adhesions following intraabdominal operations 2.inflammatory gut diseases Indication / Contraindications of PD
- 18. NIPD – night intermitent peritoneal dialysis (cycler)
- 19. CCPD – continual cyclic PD
- 21. PET (peritoneal equilibration test) 2 CAPD, 5 exchanges daily + 1 exchange at night Good Slow Slow CAPD or APD OK OK Average Frequent exchanges, short dwells – APD Poor Fast High Best type of PD Water removal Waste removal Transporter
- 22. Interpretation of peritonal equilibration test ??
- 23. Ramesh Khanna & Karl D. Nolph Results of baseline PET
- 24. Choice of PD scheme depends of BSA and type of transport
- 26. Ratio D/P for Na , upper curve – 1,27% glucose, lower curve - 3,86% G (initial drop due to transcellular UF of water through aquaporins)
- 28. Ultrafiltration in different types of PD solutions
- 29. Criteria of PD adequacy
- 33. Morphologic changes of peritoneum due to PD (1) Obr.1-before starting PD, norm. peritoneum (omentum)
- 34. Morphologic changes of peritoneum due to PD (2) Obr.2-after 3 years of PD, submesotelial fibrosis and neo-angiogenesis (enlargement of vascular surface of peritoneum)
- 38. Physioneal Infusion pain Peritonitis Glycemic control Appetite Patient acceptance No UF Clinical advantages of new dialysis solutions Extraneal Glucose load Glycemic control UF, control of fluid status Dyslipidemia Quality of life Time on PD Pecoits-Filho, et al. Kidney Int . 2003;64(suppl 88):S100-S104. Vardhan, et al. Kidney Int. 2003;64(suppl 88):S114-S123. Nutrineal Glucose load Glycemic control Protein intake, nutritional status
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- Category: Peritoneal Membrane Preservation This slide shows the beneficial effects of the newer PD solutions containing alternate buffers and osmotic agents. All three solutions reduce levels of GDPs and AGEs. With Physioneal, it is because glucose is sterilized at a very low pH. With Extraneal and Nutrineal, it is because there is no glucose in either solution. Additional benefits of Physioneal : Physiologic pH and pCO 2 , reduced lactate levels. Additional benefit of Extraneal: Same osmolarity as plasma. As a result of its unique properties, each solution has been shown to improve membrane and peritoneal immune cell function. Skoufos L, Topley N, Cooker L, et al. The in vitro biocompatibility performance of a 25 mmol/L bicarbonate/10 mmol/L lactate-buffered peritoneal dialysis fluid. Kidney Int . 2003;64(suppl 88):S94-S99. Vardhan A, Zweers MM, Gokal R, Krediet RT. A solutions portfolio approach in peritoneal dialysis. Kidney Int . 2003;64(suppl 88):S114-S123.
- Category: Peritoneal Membrane Preservation This slide shows the beneficial effects of the newer PD solutions containing alternate buffers and osmotic agents. All three solutions reduce levels of GDPs and AGEs. With Physioneal, it is because glucose is sterilized at a very low pH. With Extraneal and Nutrineal, it is because there is no glucose in either solution. Additional benefits of Physioneal : Physiologic pH and pCO 2 , reduced lactate levels. Additional benefit of Extraneal: Same osmolarity as plasma. As a result of its unique properties, each solution has been shown to improve membrane and peritoneal immune cell function. Skoufos L, Topley N, Cooker L, et al. The in vitro biocompatibility performance of a 25 mmol/L bicarbonate/10 mmol/L lactate-buffered peritoneal dialysis fluid. Kidney Int . 2003;64(suppl 88):S94-S99. Vardhan A, Zweers MM, Gokal R, Krediet RT. A solutions portfolio approach in peritoneal dialysis. Kidney Int . 2003;64(suppl 88):S114-S123.
- This slide summarizes the clinical benefits of Physioneal, Extraneal, and Nutrineal as described in the articles by Pecoits-Filho, et al (S100) and Vardhan, et al (S114). Pecoits-Filho R, Tranaeus A, Lindholm B. Clinical trial experiences with Physioneal™. Kidney Int . 2003;64(suppl 88):S100-S104. Vardhan A, Zweers MM, Gokal R, Krediet RT. A solutions portfolio approach in peritoneal dialysis. Kidney Int . 2003;64(suppl 88):S114-S123.