Hypotensive effect of ultra-low sodium dialysate in CAPD patients A double-blind, randomized, crossover study


Enia, G.; Panuccio, V.; Parlongo, S.; Crucitti, S.; Biondo, A.; Pustorino, D.; Zoccali, C.

Journal of the American Society of Nephrology 9(Program and Abstract Issue): 282A

1998


Dialysis:
Complications
of
Peritoneal
Dialysis
A1434
T271
(PS)
HYPOTENSIVE
EFFECT
OF
ULTRA-LOW
SODIUM
DIALYSATE
IN
CAPD
PATIENTS:
A
DOUBLE-BLIND,
RANDOMIZED,
CROSSOVER
STUDY.
Enia
G,
Panuccio
V,
Parlongo
S.
Crucitti
S,
Biondo
A,
Pustorino
D
&
Zoccali
C.
Division
of
Nephrology
&
Centro
di
Fislologia
Clinica
del
C.N.R
Reggio
Calabria,
Italy.
Sodium
overload
is
the
main
factor
underlying
symptomatic
fluid
retention
and
hypertension
in
CAPD
patients.
Lowering
the
sodium
concentration
of
peritoneal
dialysate
enhances
sodium
removal
by
diffusive
transport
and
short
term
(1
week)
observations
have
shown
that
ultra-low
sodium
(98
mEq/L)
may
be
effective
in
decreasing
BP
in
over-hydrated
CAPD
patients
(Nakayama
M
et
al.
Clin
Neprol
1996:45,
188).
In
this
double
blind,
randomised.
crossover
study
we
tested
the
effect
on
arterial
pressure
of
ultra-low
sodium
(UL-Na)
dialysate
in
a
group
of
patients
on
CAPD
with
inadequate
arterial
pressure
control.Seven
CAPD
patients
(M:5
F:2:
mean
age:
67
years.
range
42-76)
were
selected
on
the
basis
of
clinical
signs
of
fluid
retention
and
hypertension
requiring
drug
treatment.
Patients
were
studied
during
two
experimental
periods,
each
lasting
1
month
[control
period
and
ultra
low
Na
dialysate
(UL-Na)).
Convective
transport
was
kept
identical
in
the
two
periods.
In
the
control
period
the
Na
dialysate
concentration
was
maintained
constant
(132
mEq/1).
In
the
UL-Na
period,
during
the
first
two
weeks
we
introduced
one
low
sodium
(Na=98
tnEq/1)
exchange
during
night
and
a
further
UL-Na
exchange
during
day-
time
during
the
following
two
weeks.
The
wash-out
period
between
the
two
experi-
mental
phases
lasted
2
weeks.
Blood
pressure
data
[10
measurements
over
30
minute
by
an
automatic
recorder
(Dynamap))
are
reported
in
the
Table
[Mean
(SD);
*
p<0.05
(week
4
vs
0)1:
Weeks
0
2
4
Control
period
Syst
BP
(mmHg)
146(243)
141(213)
147(17.9)
Diast
BP
(mmHg)
74(11.1)
74(10.1)
77(8.7)
Body
weight
(Kg)
68.9(12.0)
68.802.3)
69.3(12.0)
Study
period
Syst
BP
(mmHg)
165(27.8)
148(23,0)
136(19.0)'
Diast
BP
(mmHg)
81(11.6)
74(11.0)
71(8.9)
Body
weight
(Kg)
68.8(113)
68.8(10.10
69.0(11.1)
Systolic
and
Diastolic
pressure
fell
significantly
in
the
experimental
period
allowing
reduction
or
discontinuation
of
drug
treatment.
Serum
sodium.
osmolality
and
symptoms
did
non
differ
between
the
2
periods.Low
sodium
dialysate
lowers
arterial
pressure
in
apparently
drug-resistant
overhydrated
CAPD
patients.
This
study
represents
a
sound
basis
for
designing
a
larger
scale
trial
aimed
at
optimising
arterial
pressure
control
in
these
patients.
A1435
INTRAPERITONEAL
SULBACTAM
AMPICILLIN
(SAM)
THERAPY
IN
PATIENTS
WITH
CONTINUOUS
AMBULATORY
PERITONEAL
DIALYSIS
(CAPD)
RELATED
PERITONITIS.
Y
Erten.*
N
Ozclemir,*
G
Our,*
S
Sezer.*
C
Dogan,*
0
Pekkara,*
M
Haberal*
(intr.
by.
V.W
Dennis).
Dept.
of
Nephrology,
Baskent
University
Faculty
of
Medicine,
Ankara,
Turkey.
Peritonitis
is
the
most
common
complication
which
increases
morbidity
and
decreases
the
efficiency
of
CAPD
on
chronic
renal
failure
patients.
The
purpose
of
this
study
is
to
detect
low
risk
group
of
patients
for
peritonitis
and
to
evaluate
the
effect
of
SAM
as
the
first
choise
of
the
therapy.
Fourthy
patients
(23M.
17F,
mean
age
of
42±17
years,
mean
CAPD
duration
of
13±6
months)
were
included
in
the
study.
The
diagnosis
of
peritonitis
is
based
on
abdominal
pain
and
cloudy
peritoneal
fluid
(cell
count
more
than
100
cells/
ml
with
a
differential
count
of
more
than
50%
neutrophils).
A
total
32
episodes
of
peritonitis
were
seen
in
24
patients.
The
distrubition
of
the
responsible
microorganisms
were;
Staphylococcus
epidermidis
38%.
staphylococcus
aureus
32.2%
(MRSA
6%),
Escherichia
Coli
8.8%,
Streptococcus
viridans
6%,
Klebsiella
3%,
Pseudomanas
3%.
Moraxella
3%
and
negative
culture
6%.
We
administered
empirically
monotherapy
of
SAM
1.5
gr
bid
intraperitoneally
initially
until
the
culture
results
were
available.
At
the
day
three
82%
of
the
patients
clinically
improved
and
cell
count
decreased
to
300
cells/ml.
The
treatment
duration
was
14
days.We
only
had
to
modify
the
treatment
for
6
patients
according
to
culture
results
and
sensitivity.
All
patients
recovered
without
any
complication.
On
the
other
hand,
members
of
higher
socioeconomic groups
had
similar
episodes
of
peritonitis
with
members
of
lower
socioeconomic
groups.
Inter-
estingly
women
(especially
house
wives
no
matter
what
was
their
education)
were
found
to
be
the
lower
risk
group
of
peritonitis.
In
conclusion,
SAM
may
be
a
good
choice
for
empirical
monotherapy
of
CAPD
related
peritonitis.
On
the
other
hand
house
wives
were
the
lower
risk
group
for
peritonitis.
This
shows
that
self
behaviour
and
environmental
factors
are
more
important
than
socioeconornical
status.
A1436
T240
(PS)
PERITONEAL
MACROPHAGES
FROM
CAPD
PATIENTS
WITH
PERITO-
NITIS
HAVE
A
SUPPRESSED
CAPACITY
TO
RELEASE
THE
ANTI
INFLAMMATORY
CYTOKINE
IL-10.
Marien
WI.A.
Fieren,
Wendy
M.
Mol.
Willem
Weimar.
intr.
by
Robert
Zietse.
Dept.
in:.
Med
1,
Erasmus
University
Rotterdam.
The
Netherlands.
Previously
we
reported
that
peritoneal
macrophages
(PM0)
isolated
from
CAPD
patients
during
an
episode
of
peritonitis
(P).
have.
as
compared
to
those
from
an
infection
free
period
(IFP),
an
increased
capacity
(are
"primed")
to
release
the
pro
inflammatory
cytokines
TNFot
and
IL-113.
These
cytokines,
mainly
produced
by
MO.
play
an
important
role
in
host
defence.
To
investigate
the
working
of
the
PM0
cytokine
network
in
the
peritoneal
cavity.
we
studied
the
release
of
the
strongly
anti-inflammatory
cytokine
IL-10
from
PM0
isolated
during
IFP
and
P.
PM0
were
isolated
during
8
IFP's
and
8P's
and
incubated
(10
°
cells)
with
or
without
5pg/m1
of
LPS.
IL-10
levels
were
measured
in
supernatants
by
ELISA.
During
IFP.
IL-10
levels
were
249
s
62
pg/mI
(MiSEM)
and
7570
±
813
pg/ml
in
the
absence
and
presence
of
LPS
respectively.
During
P,
IL-10
was
275
±
124
pg/mI
and
3181
±
916
pg/ml
respectively.
These
findings
show
that
l)
IL-10
secretion
is
strongly
stimulated
by
LPS.
2)
IL-10
secretion
by
LPS
stimulated
PM0
from
peritonitis
patients
is
far
lower
than
that
by
PM0
from
infection
free
patients
(p<0,01).
The
finding
that
peritonitis
PM0
have
an
impaired
capacity
to
release
the
anti-inflammatory
IL-10,
is
in
line
with
earlier
findings
on
the
anti
inflammatory
prostanoids
(PGE
2
,
PGI
2
).
We
suggest
that
the
suppressed
release
of
IL-10
during
P
contributes
to
PM0's
increased
capacity
to
release
pro
inflammatory
cytokines.
A1437
T238
(PS)
T1051
(FC)
PRO-IL-113
PROCESSING
AND
RELEASE
RATHER
THAN
ITS
PRODUC-
TION
ARE
INCREASED
IN
PERITONEAL
MACROPHAGES
(PM0)
FROM
CAPD-PATIENTS
WITH
PERITONITIS
(P).
Marien
WJ.A.
Fieren,
Wendy
M.
Mol,
Carla
C.
Baan,
Willem
Weimar.
intr.
by
Robert
Zietse.
Dept.
Int.
Med.
1.
Erasmus
University
Rotterdam.
The
Netherlands.
Previously
we
reported,
that
PM0
isolated
from
CAPD-patients
during
P
com-
pared
to
those
from
an
infection
free
period
(IFP)
have
an
increased
capacity
(are
"primed")
to
release
IL-1
p
after
stimulation
in
vitro
with
LPS.
In
order
to
investigate
the
molecular
mechanisms
of
priming
of
PM0,
we
studied
the
gene
expression,
as
well
as
the
production
and
secretion
of
active
mature
11.-113
(mIL-113)
and
its
precursor
pro
IL-113
by
infection-free
and
infection
PM0's.
PM0's
were
isolated
during
IFP's
and
P's
and
incubated
(10
°
cells)
with
5pg/m1
of
LPS.
Pro
IL-113
and
mIL-1[3
levels
were
measured
in
lysates
and
in
supernatants
using
specific
ELISA's:
IL-I
3.
mRNA
levels
were
quantitated
exactly
using
a
competitive
reverse
transcripusse
polymerise
chain
reaction
(RT-PCR).
In
supernatants
mIL-113
was
2339
pg/10
°
cells
and
7889
pg/10
°
cells
during
IFP
(n=7)
and
P
(n=8)
respectively,
(p<0.05).
In
lysates
pro
IL-
1
fl
was
12431pg/10
6
cells
and
7499
pg
during
IFP
and
P.
Total
IL-I)
production
(supernatants
+
lysates
i.e.
that
released
+
that
remaining
in
the
cell),
expressed
in
pmol,
did
not
differ
significantly,
between
these
groups
in
line
with
the
findings
on
IL-113
mRNA
levels
in
PMO
from
IFP
and
P
(382
and
97
attomoles/10
5
cells,
N.S.).
The
fraction
of
total
IL-Ii)
released
as
mIL-113
was
23
*4%
(m
±
SEM)
and
55
t
8%
during
IFP
and
P
(p
<
0.05).
In
conclusion:
In
LPS
stimulated
PM0
from
peritonitis
patients
processing
and
export
of
IL-1
rather
its
production
are
increased,
pointing
to
the
key
role
of
processing
in
the
regulation
of
IL-
III
activity
in
MO
during
infection.
A1438
T278
(PS)
ACCUMULATION
OF
CARBONYL
COMPOUNDS
MODIFYING
PERI-
TONEAL
TISSUE
AND
CELLULAR
PROTEINS
(CARBONYL
STRESS)
IN
CAPD
PATIENTS.
Yuil
Fulita.*
Toshio
Miyata,*
Takehiko
Wada.*
Yasuhiko
Ueda,*
Ryoji
Tanabe,*
Akira
Saito
&
Kiyoshi
Kurokawa.
Taal
Univ.
Sch.
Med..
Kanagawa,
Japan.
Advanced
glycation
end
products
(AGEs)
accumulate
in
serum
and
tissue
pro-
teins
of
patients
with
end-stage
renal
failure,
as
a
result
of
an
increased
protein
modification
by
carbonyl
compounds
derived
from
autoxidation
of
carbohydrates
and
lipids
("carbonyl
stress").
Carbonyl
stress
has
been
implicated
in
the
pathogenesis
of
long-term
complications
in
hemodialysis
patients.
Carbonyl
stress
appears
relevant
not
only
to
hemodialysis
but
also
to
CAPD,
because
peritoneal
tissue
and
cellular
proteins
are
continuously
exposed
not
only
to
carbonyl
compounds
transferred
from
uremic
circulation,
hut
also
to
a
high
glucose
CAPE)
solution
which
contains
carbonyl
compounds
generated
during
the
heat
sterilization
process
or
formed
within
the
peritoneum.
To
address
this
hypothesis,
we
measured
the
levels
of
carbonyl
compounds
both
in
CAPD
solutions
and
peritoneal
effluents
from
CAPD
patients.
The
reaction
of
2,4-dinitrophenylhydradine
with
carbonyl
compounds
yields
stable
hydrazone
adducts
which
can
be
measured
by
a
spectrophotometric
assay.
The
levels
of
carbonyl
compounds
measured
by
this
method
in
CAPD
solutions
were
increased
after
the
heat
sterilization
(pre-
and
post-heat
sterilization
2.5%
glucose
CAPD
solutions
are
0
and
4.31
nmol/ml,
respectively)
and
increased
with
the
glucose
concentrations
(1.5
and
2.5
%
glucose
CAPD
solutions
are
2.96
and
5.45
nmol/ml,
respectively).
The
levels
of
carbonyl
compounds
are
markedly
higher
in
effluents
after
overnight
CAPE)
than
in
the
original
CAPD
solution
(5.45
vs.
30.76
nmol/ml.
P
<0.000.
In
conclusion,
the
CAPD
peritoneum
appears
to
be
a
state
of
severe
overload
of
carbonyl
compounds
derived
from
a
CAPD
solution
and
from
uremic
circulation.
The
accumulated
carbonyl
compounds
may
cross-link
peritoneal
matrix or
cellular
proteins
and
alter
their
structures
and
functions,
implicating
carbonyl
stress
in
peritoneal
sclerosis.
A1439
1'263
(PS)
PERITONEAL
DIALYSIS
ELICITS
ACUTE,
CONCURRENT
CATABOLIC
AND
ANABOLIC
EVENTS
IN
SKELETAL
MUSCLE.
Giacomo
Garibotto,
Russo
R.,
Saffioti
S.,
Sofia
A.,
Sacco
P..
Dertenois
L.
Pastorino
N.,
Deferrari
G.
Genoa
Univ..
Dept
of
Intern.
Med.,
Nephml
Div.,
Genoa.
Italy.
In
order
to
evaluate
the
acute
effects
of
peritoneal
dialysis
(PD)
on
muscle
protein
synthesis
(PS).
breakdown
(PB)and
protein
balance
(NB).
muscle
protein
turnover
has
been
evaluated
by
the
forearm
perfusion
technique
associated
with
the
kinetics
of
3H-phenylalanine
in
six
ambulatory
CAPD
patients.
The
study
has
been
performed
in
the
basal
state
and
during
PD,
200-235
min
after
three
2-liter
(1.36%
Codes:
FC-Free
Communication;
PS-Poster
Session.
282A