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- Stachowska-Pietka, J, et al.
(författare)
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Alterations of peritoneal transport characteristics in dialysis patients with ultrafiltration failure: tissue and capillary components
- 2019
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Ingår i: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. - : Oxford University Press (OUP). - 1460-2385. ; 34:5, s. 864-870
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundUltrafiltration failure (UFF) in peritoneal dialysis (PD) patients is due to altered peritoneal transport properties leading to reduced capacity to remove excess water. Here, with the aim to establish the role of local alterations of the two major transport barriers, peritoneal tissue and capillary wall, we investigate changes in overall peritoneal transport characteristics in UFF patients in relation to corresponding local alterations of peritoneal tissue and capillary wall transport properties.MethodsSix-hour dwell studies using 3.86% glucose solutions and radioisotopically labelled serum albumin added to dialysate as a volume marker were analysed in 31 continuous ambulatory PD patients, 20 with normal ultrafiltration (NUF) and 11 with UFF. For each patient, the physiologically based parameters were evaluated for both transport barriers using the spatially distributed approach based on the individual intraperitoneal profiles of volume and concentrations of glucose, sodium, urea and creatinine.ResultsUFF patients as compared with NUF patients had increased solute diffusivity in both barriers, peritoneal tissue and capillary wall, decreased tissue hydraulic conductivity and increased local lymphatic absorption and functional decrease in the fraction of the ultra-small pores. This resulted in altered distribution of fluid and solutes in the peritoneal tissue, and decreased penetration depths of fluid and solutes into the tissue in UFF patients.ConclusionsMathematical modelling using a spatially distributed approach for the description of clinical data suggests that alterations both in the capillary wall and in the tissue barrier contribute to UFF through their effect on transport and distribution of solutes and fluid within the tissue.
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- Debowska, M, et al.
(författare)
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Association between Biomarkers of Mineral and Bone Metabolism and Removal of Calcium and Phosphate in Hemodialysis
- 2020
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Ingår i: Blood purification. - : S. Karger AG. - 1421-9735 .- 0253-5068. ; 49:1-2, s. 71-78
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> A significant drop of serum phosphate and calcium removal or loading during hemodialysis induce reactions in mineral and bone remodeling that may inversely affect phosphate and calcium removal during dialysis. <b><i>Objectives:</i></b> We aimed to analyze the interdependencies between biomarkers of mineral and bone metabolism and removal of phosphate and calcium during hemodialysis, as this complex relationship is not fully understood. <b><i>Methods:</i></b> Three subsequent hemodialysis sessions during a 1-week treatment cycle with interdialytic periods of 2–2-3 days were monitored in 25 anuric patients. Calcium and phosphate concentrations were measured in serum before, at 1, 2, and 3 h, at the end, and 45 min after each session and in the outlet dialysate every 30 min. Biomarkers associated with mineral and bone metabolism: parathyroid hormone (PTH 1–34 and PTH 1–84), calcitonin, 25(OH)-vitamin D, fetuin-A, osteopontin, osteocalcin 1–43/49, and intact osteocalcin were assayed once in each patient before the midweek hemodialysis session. <b><i>Results:</i></b> Post-dialytic and intra-dialytic serum phosphate of midweek hemodialysis session and phosphate mass removed within 1 week correlated positively with serum PTH (0.40 < rho <0.46, <i>p</i> value <0.05). Higher concentration of serum PTH was associated with an increased level of osteocalcin. Pre-dialytic, post-dialytic, average for treatment time and average weekly concentrations of ionized calcium in serum correlated positively with serum osteocalcin. Serum osteocalcin and osteopontin levels were associated with the masses of total and ionized calcium, respectively, removed during 3 hemodialysis sessions. <b><i>Conclusions:</i></b> During hemodialysis, phosphate removal was associated with serum PTH, whereas calcium kinetics was influenced by serum osteocalcin and osteopontin. These results demonstrate that active processes involving biomarkers of mineral and bone metabolism are affected by the phosphate and calcium kinetics already within 4 h hemodialysis sessions.
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- Debowska, M, et al.
(författare)
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Phosphate clearance in peritoneal dialysis
- 2020
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 10:1, s. 17504-
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Tidskriftsartikel (refereegranskat)abstract
- In renal failure, hyperphosphatemia is common and correlates with increased mortality making phosphate removal a key priority for dialysis therapy. We investigated phosphate clearance, removal and serum level, and factors associated with phosphate control in patients undergoing continuous ambulatory (CAPD), continuous cyclic (CCPD) and automated (APD) peritoneal dialysis (PD). In 154 prevalent PD patients (mean age 53.2 ± 17.6 year, 59% men, 47% anuric), 196 daily collections of urine and 368 collections of dialysate were evaluated in terms of renal, peritoneal and total (renal plus peritoneal) phosphorus removal (g/week), phosphate and creatinine clearances (L/week) and urea KT/V. Dialytic removal of phosphorus was lower in APD (1.34 ± 0.62 g/week) than in CAPD (1.89 ± 0.73 g/week) and CCPD (1.91 ± 0.63 g/week) patients; concomitantly, serum phosphorus was higher in APD than in CAPD (5.55 ± 1.61 vs. 4.84 ± 1.23 mg/dL; p < 0.05). Peritoneal and total phosphate clearances correlated with peritoneal (rho = 0.93) and total (rho = 0.85) creatinine clearances (p < 0.001) but less with peritoneal and total urea KT/V (rho = 0.60 and rho = 0.65, respectively, p < 0.001). Phosphate removal, clearance and serum levels differed between PD modalities. CAPD was associated with higher peritoneal removal and lower serum level of phosphate than APD.
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