The contribution of combined crystalloid and colloid osmosis to fluid and sodium management in peritoneal dialysis

The achievement of euvolemia is essential to the successful management of peritoneal dialysis patients. However, the concern that hypertonic glucose exchanges may have a role in long-term changes to the peritoneal membrane has lead to an alternative strategy to enhance ultrafiltration (UF) over the...

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Veröffentlicht in:Kidney international 2008-04, Vol.73 (S108), p.S102-S111
Hauptverfasser: Freida, P., Wilkie, M., Jenkins, S., Dallas, F., Issad, B.
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container_issue S108
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container_title Kidney international
container_volume 73
creator Freida, P.
Wilkie, M.
Jenkins, S.
Dallas, F.
Issad, B.
description The achievement of euvolemia is essential to the successful management of peritoneal dialysis patients. However, the concern that hypertonic glucose exchanges may have a role in long-term changes to the peritoneal membrane has lead to an alternative strategy to enhance ultrafiltration (UF) over the long dwell by combining crystalloid and colloid osmosis. This review summarizes the experience of mixing glucose or amino acids with polyglucose (icodextrin), with particular focus given to data from studies using glucose/icodextrin in combinations of 1.36%/7.5% and 2.61%/6.8%. Both combinations demonstrate a significant increment of UF volume and sodium removal compared with the component osmotic agents used individually over long dwells, with the 2.61%/6.8% mixture having an effect over dwells extending to 15 h. Hypothetically, the mechanism of the enhanced UF is the attenuation by the colloid osmotic force of the backflow of water through small pores from dialysate to the peritoneal capillary circulation once the crystalloid osmotic force has dissipated. This experience provides promising data that deserves further examination in longer term clinical studies.
doi_str_mv 10.1038/sj.ki.5002610
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source MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; ProQuest Central UK/Ireland; Alma/SFX Local Collection
subjects Colloids - metabolism
combination dialysate
Crystalloid Solutions
Dialysis Solutions - metabolism
Glucans - metabolism
glucose
Glucose - metabolism
Humans
Icodextrin
Isotonic Solutions - metabolism
Osmosis - physiology
Peritoneal Dialysis, Continuous Ambulatory - methods
Sodium - metabolism
ultrafiltration
Water-Electrolyte Balance - physiology
title The contribution of combined crystalloid and colloid osmosis to fluid and sodium management in peritoneal dialysis
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