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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
– There is a risk of overestimation of blood glucose results when these meters are used for samples from patients on treatments that contain (or are metabolised to) maltose, xylose or galactose. The MHRA advises that the affected meters should not be used to measure blood glucose in patients receiving such treatments. Treatments that are known to contain (or that are metabolised to) maltose, xylose or galactose include (Extraneal®) icodextrin (used in peritoneal dialysis, PD), and certain immunoglobulin preparations (including Octagam®).
The peritoneum, omentum, mesentery and retroperitoneal space
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The effect of a number of drugs including antiinflammatory drugs such as aspirin and steroids, some hormones, anticlotting agents, antibiotics, vitamin E and even methylene blue have been investigated in adhesion prevention but have not achieved widespread use, because of either side effects or lack of consistent evidence of effectiveness. Many barrier methods of reducing adhesions have also been trialled. Adept® (4% icodextrin solution) is a solution applied inside the abdomen at the time of surgery; it has been shown to reduce the extent and severity of adhesion formation in animal models. It has also been used widely as a peritoneal dialysis solution for many years. Interceed TC7® is a meshlike product (oxidised regenerated cellulose) which quickly forms a soft gelatinous mass around healing tissues and is absorbed within 2 weeks. It has been shown to significantly reduce the number of adhesions at the site where it is used. However, it is worth noting that a reduction in the number of adhesions in such studies does not necessarily equate to a reduction in adhesion-related problems in the future. In a review of seven randomised trials looking at a similar barrier-type product (hyaluronic acid/carboxymethyl membrane), there was a significant reduction in the incidence, extent and severity of adhesions but no reduction in the incidence of intestinal obstruction or surgical intervention. Such barriers, when placed around bowel anastomosis, also led to a significant increase in the anastomotic leaks. For these reasons barrier approaches have not gained popularity.
Peritoneal drug transport
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
The area of the peritoneum in contact with the therapeutic solution is typically a fraction of the anatomic area. Research in animals [37,79] and humans [80,81] has clearly demonstrated that during peritoneal dialysis, only about 30% of the total surface area is covered at any one time with the typical volume of 2–3 L. Although, over 24 hours, the entire peritoneum will make contact with an IP solution [82], the duration of contact with specific parts of the peritoneum is unknown. Typical dialysis solutions containing glucose are gradually absorbed from the cavity, and therefore, there is a receding volume and contact surface area after the effective osmolar gradient is lost. An alternative to standard dialysis solutions is one containing 4% of icodextrin (a 20–30 kDa starch), which has been shown to maintain the peritoneal volume at a constant for up to 48 hours [83–85], with a loss of 50% over the next 48 hours. A 7.5% icodextrin solution has been shown to be effective as a drug carrier for 5-fluorouracil (5-FU) [86] for up to 96 hours; this type of solution maintains the volume and the area of contact relatively constant. However, even the icodextrin solutions do not guarantee contact with the target areas for any given length of time. The volume of the solution, the size of the patient, and the patient’s position all affect the peritoneal contact area. For example, if the patient is ambulatory, even a large volume (3 L) may pool in the bottom of the peritoneal cavity. Large portions of the peritoneum may not be covered [82], and therefore the residence time of the medication may be a problem for certain regions of the cavity.
Association of serum thymosin β4 with malnutrition-inflammation-atherosclerosis syndrome in peritoneal dialysis patients: a cross-sectional study
Published in Renal Failure, 2023
Jiakun Tian, Rong Zhang, Nan Zhu, Lijie Gu, Yunshan Guo, Weijie Yuan
This cross-sectional, single-center study was supported by the National Natural Science Foundation of China (Grant No: 82170729). The study involved 76 PD patients who had been treated with continuous ambulatory peritoneal dialysis (CAPD) for ≥3 months and regularly followed up at the Lianyungang Clinical College of Nanjing Medical University/The First People’s Hospital of Lianyungang. All patients received routine examinations of standardized peritoneal equilibration test (PET), total weekly Kt/V (Kt/V t), peritoneal weekly Kt/V (Kt/V p), residual kidney weekly Kt/V (Kt/V r), total weekly creatinine clearance rate (Ccr t; normalized to 1.73 m2 of the body surface area), peritoneal Ccr (Ccr p) and kidney Ccr (Ccr r). All patients were in stable condition, and they were free of peritonitis and clinical and/or laboratory signs of other infections during the one month prior to enrollment. Those with a history of malignant diseases, malignant tumors, illness or hospitalization in the previous month were excluded. All included patients received a commercially available, glucose-based PD solution (Baxter Inc.) at various concentrations (1.5% and 2.5%). No patients received icodextrin-based PD solution because it was unavailable during the study period.
Peritoneal dialysis outcomes in patients with nephrotic syndrome: a propensity score-matched cohort study
Published in Renal Failure, 2020
Si-Jia Zhou, Ya-Kun Cong, Qing-Feng Han, Wen Tang, Tao Wang
Previous studies that investigated the effect of PD treatment for NS are generally scarce. Most studies are case reports and mainly focused on short-term PD treatment for refractory edema and fluid overload in patients with severe steroid-resistant NS. In those cases, short-term PD treatment that could provide ultrafiltration (UF) via the peritoneum was used as an effective alternative therapy for extracorporeal UF in both children [6] and adults [10,11, 14]. Barman et al. reported a successful treatment of edema using short-term PD in a child with diuretic-resistant NS and acute kidney injury (AKI). Significant improvement of blood pressure control, response to diuretic, and recovery from the AKI were achieved, and the procedure was tolerated well. The novel short-term use of PD was also mentioned by Harshman et al. [15] in an infant with congenital NS. Although fluid management was improved in that case, the infant died after 2 months of therapy because of multiple complications. In adult patients with NS, Takada et al. [14] introduced icodextrin-single PD therapy to a patient with idiopathic membranous nephropathy patient and overhydration. Refractory subcutaneous edema was alleviated, and remission of NS occurred after 2 weeks of PD treatment. The long-term outcomes of patients with NS were only mentioned in a 5-year retrospective case note review conducted by Dufek et al., who focused on infants with congenital nephrotic syndrome (CNS) [9]. In that study, chronic dialysis was commenced in 44 infants with CNS, while PD was the modality of choice in 93%. The complication, growth, and transplantation rates in infants with CNS on dialysis are comparable to those reported in infants with other primary renal diseases.
The effect of rural and urban life on peritonitis rates in chronic peritoneal patients
Published in Renal Failure, 2023
Erdem Çankaya, Murat Altunok, Aycan Mutlu Yağanoğlu
At PD initiation, participants were assigned to one of the PD modalities; CAPD with a twin-bagged system or instrumented peritoneal dialysis (IPD) (6–8 h with 6–10 l). The prescription of CAPD was 4 × 1.5–2 L (body surface area, RRF determined) exchanges as long as no sign of inadequate dialysis was observed. Dialysate fluids containing (i) 1.36%, 2.27%, or 3.86% glucose; (ii) amino acids; or (iii) icodextrin were used according to the clinical needs of patients.