Background Biocompatible fluids were introduced to improve dialysis and patient outcome in end-stage renal disease. However, being buffered with lactate, they may insufficiently correct metabolic acidosis, and lead to changes in peritoneum structure. Bicarbonate buffered fluids might mitigate these complications. The aim of the study was to evaluate the influence of a bicarbonate dialysis fluid on clinical and laboratory indices of dialysis adequacy. Material and methods 20 prevalent peritoneal dialysis (PD) patients created two groups. One group continued on lactate fluid, the other changed to bicarbonate solution. Clinical and laboratory indices of dialysis adequacy were evaluated at baseline, and at six weeks intervals for 24 weeks. Results In bicarbonate group, pH was 7.36±0.03, HCO3 22.1±1.8 mmol/l at baseline and 7.36±0.04 and 21.2± 2.3 mmol/l at 24 weeks, while in controls pH equaled 7.35±0.12, HCO3 22.2±1.4 mmol/l, at baseline, and 7.40±0.03, and 22.3±1.8 mmol/l, at 24 weeks, with no significant differences. Dialysis adequacy (urea Kt/V), urine output and dialysis ultrafiltration did not differ between the groups, either at baseline or at study termination. Conclusions Bicarbonate PD solution appears to be similar to standard fluid in the impact on hydration status and on acid/base balance. Longitudinal studies are needed to assess long-term advantages of these biocompatible solutions.
Background: Biocompatible fluids were introduced to improve dialysis and patient outcome in end-stage renal disease. However, being buffered with lactate, they may insufficiently correct metabolic acidosis, and lead to changes in peritoneum structure. Bicarbonate buffered fluids might mitigate these complications. The aim of the study was to evaluate the influence of a bicarbonate dialysis fluid on clinical and laboratory indices of dialysis adequacy. Material and methods: 20 prevalent peritoneal dialysis (PD) patients created two groups. One group continued on lactate fluid, the other changed to bicarbonate solution. Clinical and laboratory indices of dialysis adequacy were evaluated at baseline, and at six weeks intervals for 24 weeks. Results: In bicarbonate group, pH was 7.36±0.03, HCO3 22.1±1.8 mmol/l at baseline and 7.36±0.04 and 21.2± 2.3 mmol/l at 24 weeks, while in controls pH equaled 7.35±0.12, HCO3 22.2±1.4 mmol/l, at baseline, and 7.40±0.03, and 22.3±1.8 mmol/l, at 24 weeks, with no significant differences. Dialysis adequacy (urea Kt/V), urine output and dialysis ultrafiltration did not differ between the groups, either at baseline or at study termination. Conclusions: Bicarbonate PD solution appears to be similar to standard fluid in the impact on hydration status and on acid/base balance. Longitudinal studies are needed to assess long-term advantages of these biocompatible solutions.
Malnutrition remains one of the major predictors of mortality in peritoneal dialysis (PD) patients. The aim of the study was to evaluate the nutritional status of prevalent PD patients, and to determine the best predictors of outcome among anthropometric and laboratory indices of nutrition. The study included 106 prevalent PD patients from a single university-based unit. Anthropometric assessment at baseline included: body mass, body mass index (BMI), skinfold thickness, lean body mass (LBM), content of body fat (%F), mid-arm muscle circumference (MAMC). Laboratory analysis comprised of albumin and total cholesterol. Additionally, each patient underwent a subjective global assessment (SGA). The patients were followed for 36 months. Survival analyses were made with the Kaplan-Meier survival curve and the Cox proportional hazard model. Following SGA, malnutrition was diagnosed in 30 (28%) patients. Importantly, eight of the malnourished patients (27%) were nevertheless overweight or obese. Body weight and BMI showed complete lack of association with the outcome. In Kaplan-Meier analysis low: LBM, MAMC, albumin and cholesterol were significantly related to mortality. Cox analysis revealed that, following adjustment, LBM below median was independently associated with poor outcome (hazard ratio [HR] 3.15, 95% confidence interval [CI] 1.17-8.49, p=0.02). Moreover, the lowest quartile of total cholesterol showed independent association with mortality (HR 8.68, CI 2.14-35.21, p<0.01). Malnutrition is prevalent in patients undergoing PD, and overweight/obesity does not preclude its appearance. The most valuable nutritional indices in predicting outcome in this cohort were LBM and total cholesterol concentration.
Malnutrition is a common clinical problem in dialysis patients. So far the management of malnutrition in this population has not been fully successful. The aim of the study was to evaluate the efficacy and safety of use of megestrol acetate suspension in malnourished dialysis patients. Twenty-six hypoalbuminemic (albumin ≤ 3.8 g/dl) dialysis patients took 160 mg of megestrol acetate daily for a period of two months. Anthropometry (dry weight, body mass index) and biochemical measurements of nutrition (serum albumin, triglycerides, total cholesterol) and inflammation (hsCRP, IL-1β, IL-6) were performed on a monthly basis. The treatment led to a statistically significant increase (P < 0.05) in anthropometry and albumin concentration, with no statistically significant changes in total cholesterol, triglycerides and indices of inflammation. Side effects included overhydration, diarrhoea and hyperglycaemia. Thus, megestrol acetate may be an effective therapeutic agent in improving the nutritional status of carefully selected dialysis patients, while it might not mitigate inflammation. Because of the prevalent side effects it must be monitored closely.
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