Peritoneal Dialysis: A Clinical Update: 15th International Course on Peritoneal Dialysis, Vicenza, May-June 2006 (Contributions to Nephrology, Vol. 150)

Even though peritoneal dialysis (PD) is by now well established and its advantages in terms of clinical efficacy, social impact and individual tolerance are acknowledged, it is still underutilized on a global scale. In view of this fact, the publication at hand has two objectives, namely to provide help to identify possible obstacles to a wider application of PD and to advance a project called USS PD: Understanding, Starting and Sustaining Peritoneal Dialysis (initiated by the Department of Nephrology, Dialysis and Transplantation of the St. Bortolo Hospital in Vicenza, Italy). The initial part of this book is thus dedicated to basic principles of PD, as understanding how this technique works is one of the prerequisites to improve the quality of its application and, ultimately, its outcomes. In the second part, in-depth reviews help the physician to identify the benefits and problems involved in a PD program, facilitating the initiation of a new program or the start of new patients on PD. The third part, finally, is dedicated to potential complications and technical solutions designed to solve the problems of the different techniques. This helps physicians to sustain the use of PD after having acquired the know how and the capacity of starting the program. Everyone interested in understanding and implementing PD will highly profit from the papers presented in this publication. Cover......Page 1 Contents......Page 6 Preface......Page 12 Hemodialysis......Page 14 Diffusion and Convection......Page 15 Membranes, Diffusivity and Sieving......Page 16 The Membrane and the Blood Compartment......Page 17 The Dialysate Compartment......Page 18 Factors Affecting Solute Transport......Page 19 References......Page 24 Anatomy of the Peritoneum......Page 26 Resistance to Solute and Water Transport......Page 27 Solute Transfer by Diffusion......Page 28 Lymphatic Absorption......Page 29 Peritoneal Function After Long-Term Exposure to Peritoneal Dialysis Solutions......Page 30 References......Page 31 Abstract......Page 33 Small Solute Kinetics and Clearance in Native Kidneys, PD and HD......Page 34 Understanding Urea Kinetics in Continuous (PD) and Intermittent (HD) Dialysis – A Simplified Approach......Page 36 Peritoneal Dialysis......Page 37 Hemodialysis......Page 38 References......Page 39 Abstract......Page 41 Net Ultrafiltration: Osmosis and Fluid Loss......Page 42 Basic Physiology and Anatomy of the Peritoneal Barrier......Page 44 Remaining Questions Concerning the Mechanism of Net UF......Page 47 References......Page 48 Abstract......Page 50 Conclusion......Page 53 References......Page 54 Abstract......Page 55 References......Page 59 The Peritoneal Membrane During Long-Term PD......Page 61 Glucose Degradation Products and the Peritoneal Membrane......Page 63 References......Page 64 Abstract......Page 67 The Experimental Model......Page 68 Effects of Dialysis Solutions Upon the Undressed Areas: Repopulation or Repair?......Page 70 Discussion......Page 72 References......Page 73 Abstract......Page 75 Pathology......Page 76 Animal Models......Page 78 Etiology and Pathogenesis......Page 79 Conclusions......Page 80 References......Page 81 Animal Model Research: The ANIMOD Collaboration......Page 83 Relevance of the Animal Models for Clinical Practice......Page 84 Chronic Animal Models......Page 85 References......Page 87 Abstract......Page 90 GDP-Related Effects to Mesothelial Cells......Page 91 Formation of AGEs and their Interaction with RAGE......Page 92 AGE/RAGE Interaction: Peritoneal Neoangiogenesis......Page 93 Concluding Remarks......Page 94 References......Page 95 Abstract......Page 97 Acute Effects of Perfusion with Peritoneal Dialysis Fluid......Page 99 Chronic Exposure Rat Models......Page 100 References......Page 101 Abstract......Page 103 The Neutral pH, Low GDP PDF (Balance®, Fresenius Medical Care)......Page 104 The Low GDP, Bicarbonate/Lactate Based, Physiological pH PDF (Physioneal®, Baxter Healthcare)......Page 105 Amino Acid Containing PDF (Nutrineal®, Baxter Healthcare)......Page 106 Combination Regime......Page 107 References......Page 108 Abstract......Page 110 The Peritoneal Transport Process......Page 111 Peritoneal Transport with Icodextrin Solution......Page 113 Use of Icodextrin Solutions in High Transporters......Page 114 References......Page 115 Abstract......Page 117 Dry Body Weight......Page 118 Water and Sodium Removal Targets......Page 119 Conclusions......Page 121 References......Page 122 The Problem of Overhydration in Peritoneal Dialysis......Page 124 Diagnosis of Overhydration......Page 125 Treatment of Overhydration......Page 126 Effect of Treatment of Overhydration by Increasing Peritoneal Ultrafiltration on Residual Renal Function and Diuresis......Page 127 Can a Decline in Renal Function with Strict Volume Control be Prevented?......Page 128 References......Page 129 Abstract......Page 132 Measurement Methods......Page 133 Fluid Volume Estimation......Page 135 50 kHz bioimpedance Vector Analysis......Page 136 Application of BIA to PD Patients......Page 137 Summary of BIA Study in PD......Page 139 References......Page 140 Abstract......Page 142 References......Page 146 Abstract......Page 148 Malnutrition......Page 149 Residual Renal Function......Page 150 Treatment of Acidosis......Page 151 Volume Control......Page 152 Measures to Reduce AGE......Page 153 Role of Antibiotics......Page 154 References......Page 155 Chronic Kidney Disease Prognosis; Lasciate Ogni Speranza Voi Ch’entrate......Page 157 Inflammation in Peritoneal Dialysis – Still Some Things We Need to Understand......Page 158 Potential Strategies to Modulate the Inflammatory Response in Peritoneal Dialysis......Page 160 References......Page 162 Abstract......Page 165 References......Page 167 Abstract......Page 169 Clinical Evidence......Page 170 Cellular Immune Response System of the Peritoneal Barrier......Page 171 Dialysis Solutions and Alteration of Mesothelial Cells to a Fibroblast-like Phenotype......Page 172 Mechanisms of Inflammation......Page 173 Low GDP Solutions and Biocompatibility......Page 175 References......Page 176 Abstract......Page 179 Adipokines – Mysterious Acquaintances......Page 180 Adipose Tissue as a Contributor to Increased Systemic Inflammation......Page 182 Is it Good to be Fat if You are on PD?......Page 183 References......Page 184 Abstract......Page 187 Interstitium and Peritoneal Transport......Page 188 Alteration in the Sub-Peritoneal Compact Zone......Page 189 Possible Mechanism for the Clinical Observations due to Fibrosis of the Peritoneum......Page 191 References......Page 192 Abstract......Page 194 Causes of Peritonitis......Page 195 Fungal Peritonitis......Page 196 Catheter Removal for Infection......Page 197 References......Page 198 Abstract......Page 200 Polymorphonuclear Leukocytes......Page 202 Monocytes......Page 203 Non-Cellular Causes of Cloudy Dialysate......Page 204 Conclusion......Page 205 References......Page 206 Early History of Catheter Development (1923–1968)......Page 208 Modifications to Mitigate Complications of the Tenckhoff Catheter......Page 210 Most Commonly Used Chronic Peritoneal Catheters......Page 211 Concluding Remarks......Page 212 References......Page 213 Abstract......Page 215 Target Haemoglobin Concentration......Page 216 Exclude Other Causes of Anaemia......Page 218 Iron Management......Page 219 Choice of Agent......Page 220 Expected Response to ESA Therapy......Page 221 Poor Response to ESA Therapy......Page 222 How to Manage Anaemia During Peritonitis and Other Infective Complications of PD......Page 223 Conclusions......Page 224 References......Page 225 Abstract......Page 227 Pathogenesis of Vascular Calcification......Page 228 The Impact of Vascular Calcification in Dialysis Patients......Page 230 Renal Osteodystrophy in PD Patients......Page 231 Calcium Balance in PD Patients......Page 232 Phosphorus Balance in PD Patients......Page 233 Control of Calcium and Phosphate in PD Patients......Page 234 Conclusions......Page 235 References......Page 236 Abstract......Page 239 Organizational Aspects......Page 240 Clinical Parameters of Adequacy......Page 241 Technical Issues......Page 242 Peritoneal Dialysis is a Full Treatment for ESRD......Page 243 References......Page 247 Abstract......Page 248 References......Page 252 Abstract......Page 253 Compliance......Page 254 Dialysis Adequacy and Nutrition......Page 255 Patient Survival......Page 256 Conclusion......Page 257 References......Page 258 Abstract......Page 260 Recommended Therapeutic Strategies......Page 261 The Hope of PD......Page 262 Why Can PD Be so Effective in Refractory CHF?......Page 264 References......Page 265 Immediate Post-Transplant Graft Function......Page 267 Long-Term Graft and Patient Survival......Page 269 References......Page 270 Abstract......Page 272 PD Penetration and PD Technique Survival......Page 273 Cold Ischemia Time......Page 274 Short-Term Outcome......Page 275 Graft Vascular Thrombosis......Page 277 Long-Term Outcome......Page 279 References......Page 281 Peritoneal Dialysis Following Transplant Failure: What are the Issues?......Page 284 Haemodialysis or Peritoneal Dialysis?......Page 285 Technique Failure Following a Failed Transplant......Page 286 Balancing the Risk of Preservation of Renal Function and Immune-Suppression......Page 287 Conclusion......Page 288 References......Page 289 Abstract......Page 291 Indications......Page 292 Reaching Adequacy Targets......Page 294 Ultrafiltration......Page 295 References......Page 296 APD and Adequacy Targets......Page 298 APD Schedules for Anuric Patients......Page 299 APD Schedules with Various Dwell Volumes......Page 300 Clinical Results......Page 301 References......Page 303 Abstract......Page 304 History and Development of APD......Page 305 The New Generation of Cyclers......Page 307 The Home Choice and the Home Choice Pro......Page 308 The PD Night and the Sleep Safe......Page 309 The PD 100T, PD101 and the PD 200......Page 311 Prescription and Delivery of APD......Page 313 Treatment Monitoring......Page 314 New Solutions......Page 317 On-Line Preparation of Solutions for APD......Page 318 References......Page 319 Abstract......Page 323 Conclusion......Page 329 References......Page 330 Abstract......Page 334 Benefits of CFPD......Page 335 The Faulty Rationale for CFPD......Page 336 References......Page 337 Abstract......Page 339 Patient and Methods......Page 342 Results......Page 343 Discussion......Page 345 References......Page 347 Abstract......Page 349 Novel Sorbents......Page 350 Peritoneal Dialysis......Page 353 References......Page 354 T......Page 357 Z......Page 358 A......Page 359 C......Page 360 F......Page 361 K......Page 362 P......Page 363 U......Page 365 W......Page 366 Aims to help to identify possible obstacles to an application of peritoneal dialysis (PD) and to advance a project called USS PD: Understanding, Starting and Sustaining Peritoneal Dialysis. This book is dedicated to basic principles of PD, and includes reviews that help the physician to identify the benefits and problems involved in a PD program.