Effect of standard and neutral-pH peritoneal dialysis solutions upon fibroblasts proliferation / Efeito da solução de diálise peritoneal com pH neutro e padrão sobre a proliferação de fibroblastos

Introduction: Continuous exposition of the peritoneal membrane to conventional dialysis solutions is an important risk factor for inducing structural and functional alterations. Objective: To compare in vitro mouse fibroblast NIH-3T3 cell viability after exposition to a neutral pH dialysis solution in comparison to cells exposed to a standard solution. Methods: Experimental study to compare the effects of a conventional standard or a neutral-pH, low-glucose degradation products peritoneal dialysis solution on the viability of exposed fibroblasts in cell culture. Both solutions were tested in all the commercially available glucose concentrations. Cell viability was evaluated with tetrazolium salt colorimetric assay. Results: Fibroblast viability was significantly superior in the neutral pH solution in comparison to control, in all three glucose concentrations (Optical density in nm-means ± SD: 1.5% 0.295 ± 0.047 vs. 0.372 ± 0.042, p < 0.001; 2.3% 0.270 ± 0.036 vs. 0.337 ± 0.051, p < 0.001; 4.25% 0.284 ± 0.037 vs. 0.332 ± 0.032, p < 0.001; control vs. neutral pH respectively, Student t Test). There was no significant difference in cell viability between the three concentrations of glucose when standard solution was used (ANOVA p = 0.218), although cell viability was higher after exposition to neutral pH peritoneal dialysis fluid at 1.5% in comparison to 2.3 and 4.25% glucose concentrations (ANOVA p = 0.008: Bonferroni 1.5% vs. 2.3% p = 0.033, 1.5% vs. 4.25% p = 0.014, 2.3% vs. 4.25% p = 1.00). Conclusion: Cell viability was better in neutral pH dialysis solution, especially in the lower glucose concentration. A more physiological pH and lower glucose degradation products may be responsible for such results. .

Introdução: A exposição contínua da membrana peritoneal a soluções convencionais de diálise é um importante fator de risco para induzir alterações estruturais e funcionais. Objetivo: Comparar a viabilidade in vitro dos fibroblastos NIH-3T3 de camundongo após exposição à solução de diálise com pH neutro com células expostas à solução padrão. Métodos: Estudo experimental; ambas as soluções foram testadas em todas as concentrações de glicose comercialmente disponíveis. A viabilidade celular foi avaliada por ensaio colorimétrico de sal tetrazólio. Resultados: A viabilidade de fibroblastos foi melhor na solução de pH neutro em relação ao controle nas três concentrações de glicose (densidade óptica em nm-médias ± DP: 1,5% 0,295 ± 0,047 vs. 0,372 ± 0,042, p < 0,001; 2,3% 0,270 ± 0,036 vs. 0,337 ± 0,051, p < 0,001; 4,25% 0,284 ± 0,037 vs. 0,332 ± 0,032, p < 0,001; controle vs. pH neutro respectivamente, teste t de Student). Não houve diferença significativa na viabilidade celular entre as três concentrações de glicose quando solução padrão foi utilizada (ANOVA p = 0,218), embora a viabilidade celular tenha sido superior após exposição aos fluidos de diálise peritoneal neutros, pH 1,5% em comparação com 2,3 e 4,25% de concentrações de glicose (ANOVA p = 0,008: Bonferroni 1,5% vs. 2,3% p = 0,033, 1,5% vs. 4,25% p = 0,014, 2,3% vs. 4,25% p = 1,0). Conclusão: A viabilidade celular foi melhor em solução neutra de pH de diálise, especialmente nas menores concentrações de glicose. O pH fisiológico e com menos produtos de degradação de glicose podem ser responsáveis por estes resultados. .

La amuchina en concentración al 3 por ciento es tan efectiva como al 50 por ciento en la prevención de infección del sitio de salida en niños en dialisis peritoneal continúa ambulatoria / Amuchin at a concentration of 30% is as effective as it is in a concentration of 50% for prevention of outlet site infection in children with ambulatory continuous peritoneal dialysis

En una comunicación previa, hemos demostrado que, la Amuchina (cloroxidante electrolítico en solución hipertónico de cloruro de sodio) al 50 por ciento en la prevención de infección del sitio de salida (ISS), en niños, es más efectiva que la lodopovidona solución al 10 por ciento y ta efectiva como el Gluconato de Clorexidina al 4 por ciento pero con menos efectos adversos. En el presente estudio, pudimos mostrar, que la Amuchina al 50 por ciento en la prevención de la ISS en niños en Diálisis Peritoneal Continúa Ambulatoria en Argentina. Se trata de un estudio abierto, unicentrico y prospectivo en 32 niños (por edad: 7.8 años; r 1.7 menos 17) que usaron Amuchina al 3 por ciento como agente desinfectante para el cuidado diario del sitio de salida sano. De los 32 niños, 14 cambiaron la Amuchina al 50 por ciento por Amuchina al 3 por ciento y 18 usaron Amuchina al 3 por ciento desde el comienzo del tratamiento. El grupo control estaba compuesto por 18 pacientes, quienes habían usado Amuchina al 50 por ciento, como agente desinfectante. Se utilizaron las recomendaciones de la Internacional Society for Peritoneal Dialysis, para cuidado del sitio de salida. No fueron observados efectos secundarios con el uso de Amuchina en cualquiera de las concentraciones. Los pacientes que usaron Amuchina al 3 por ciento presentaron un índice ISS similar que aquellos que utilizaron Amuchina al 50 por ciento. El costo de la Amuchina al 3 por ciento fue significativamente menor que la Amuchina al 50 por ciento, y aún menor que el costo de la lodopovidona al 10 por ciento o de la Clorexidina al 4 por ciento. Si bien son necesarios más estudios para asegurar la eficacia de la Amuchina al 3 por ciento, en nuestra opinión la Amuchina es un efectivo y económico agente desinfectante para el cuidado diario del sitio de salida sano en niños en Diálisis Peritoneal Continúa y Ambulatoria. Palabras Claves: Diálisis Peritoneal Continua Ambulatoria, infección del sitio de salida, Amuchina

Correlation between intradialytic hypotension in patients undergoing routine hemodialysis and use of acetate compared in bicarbonate dialysate.

AIM: To determine the incidence of intradialytic hypertension (IDH) during hemodialysis (HD) in end-stage renal disease (ESRD) patients using acetate dialysate compared to those using bicarbonate dialysate. METHODS: This study was a double-blind cross-over randomized clinical trial. The effect of acetate and bicarbonate dialysate on blood pressure was analyzed in two consecutive HD sessions. The selected subjects were 41 stable ESRD patients scheduled for dialysis 2 times/week/from the HD unit of Dr.Soetom Hospital Surabaya, aged between 21-65 years old, with a hemoglobin level > or = 7 g/dL, serum albumin > or = 3 mg/dL and interdialytic weight gain < 4 Kg, and an average Qb 150-250 ml/minute. The dialysate sodium level was 138 mEq/L/ The study subjects were divided into tow groups: 21 patients in the group who received Acetate on the first session and Bicarbonate on the next (AB) and 20 patients in the group receiving Bicarbonate first (BA). Comparison of IDH during use of each dialysate was analyzed by Chi-Square and Mc Nemar Chi-Square test. RESULTS: No characteristic differences were found in both groups: HD duration (for AB) was 28.83 +/- 13.89 vs. 34.95 +/- 24.80 months (for BA) (p = 0.333); Age (for AB) was 47.61 +/- 9.49 vs. 47.75 +/- 11.80 years (for BA) (p = 0.969); Hemoglobin (Hb) level (for AB) 8.19 +/- 0.84 vs. 7.94 +/- 0.41 mg/dL (for BA) (p = 0.238); serum Albumin (for AB) was 3.79 +/- 0.26 vs. 3.82 +/- 0.30 g/dl (for BA) (p = 0.652). The number of patients with IDH during acetate dialysate with IDH during bicarbonate dialysate was 1 (2.4%). Overall, there were 11 patients with Diabetic Kidney Disease (26.8%). Six out of them (54.5%) had IDH during acetate dialysate and only and 1 patient (9.1%) had IDH during acetate and bicarbonate. CONCLUSION: The incidence of IDH in hemodialysis using acetate is significantly greater than that when bicarbonate is used (p = 0.000).

The Effects of Low Calcium Dialysate on Arterial Compliance and Vasoactive Substances in Patients with Hemodialysis

BACKGROUND: Considering that dialysate calcium concentration is potentially a main determinant of the serum ionized calcium level and vasoconstriction is associated with the blood calcium concentration, we conducted a study to evaluate the interdialytic effects of treatment with a low calcium dialysate (LdCa, 1.25 mmol/L) on the changes in arterial compliance (AC), blood pressure (BP), biochemical parameters and vasoactive substances. METHODS: Eight hemodialysis (HD) patients (mean age: 46.8 +/- 13.7 years, 4 men and 4 women) were included in the study. AC, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), mean arterial pressure (MAP), serum ionized Ca, intact-PTH, serum nitric oxide and aldosterone were compared after 10 sessions of treatment with LdCa. Right carotid artery diameter was measured 3 times using a real time B-mode ultrasound imager (Hewlett-Packard Sonos 2000 (R) ) and AC was calculated using the Hayoz method. RESULTS: 1) AC was recorded as 0.140 (0.080-0.170) mm2/kPa at the baseline (1.75 mmol/L calcium dialysate), 0.170 (0.050-0.290) mm2/kPa after LdCa treatment (p< 0.05 versus baseline), and 0.140 (0.070-0.250) mm2/kPa following the HdCa treatment (p< 0.05 versus LdCa data). 2) MAP and PP were calculated at 114.12 +/- 10.56 mmHg and 63.50 +/- 10.87 mmHg at the baseline; 98.37 +/- 15.14 mmHg and 56.50 +/- 5.95 mmHg after LdCa treatment (p< 0.05 versus baseline) ; and 115.75 +/- 9.64 mmHg and 62.00 +/- 15.71 mmHg following HdCa treatment (p< 0.05 versus LdCa data). 3) Serum ionized Ca and intact-PTH were measured at 4.66 +/- 0.40 mg/dL and 25.08 +/- 16.44 pg/mL at the baseline; 4.45 +/- 0.28 mg/dL and 90.71 +/- 27.03 pg/mL after LdCa treatment (p< 0.05 versus baseline) ; and 4.65 +/- 0.43 mg/dL and 24.08 +/- 15.44 pg/mL following HdCa treatment (p< 0.05 versus LdCa data). 4) Serum aldosterone concentration was 300.8 (65.5-836.1) pg/mL at the baseline, and 220.2 (42.8-527.9) pg/mL after LdCa treatment (p< 0.05). CONCLUSION: There were favorable changes in AC, BP, biochemical parameters after treatment with LdCa. These changes may be associated with the reduction in serum ionized calcium and decreased serum aldosterone concentration.

Peritoneo diálisis crónica intermitente: 12 años de experiencia / Intermittent peritoneal dialysis: a 12 years experience

Since 1981, we have treated 46 adults aged 56 ñ 21 years, of whom 17 were diabetic, with intermittent peritoneal dialysis. Their main time on dialysis has been 21 months with an accumulated experience of 493 months/patient. The program included 2 dialyses per week, 25 exchanges of 21 session and 30 min of dwell time. Arterial pressure control has been satisfactory. Diabetic patients had a lower levels of serum calcium, alkaline phosphatases and m-PTH. The incidence of peritonitis has been 1 episode/14 months/patient and the causative agent has been Staphylococcus aureus in 47 percent of episodes. Mean catheter duration has been 15 months and 1 episode/34 months/patient of exit site infection has been recorded and Staphylococcus aureus has beeb the causative agent in 83 percent episodes. The risk of acquiring the first peritonitis was 12 percent at 3 months, 23 percent at 6 months and higher for non diabetic patients. Actuarial survival of treated patients at 12 and 24 months was 89 and 67 percent respectively. No differences in survival were recorded between diabetic and non diabetic patients. Fifty two percent of patients that dropped out continued on hemidialysis, 23 percent, 11 percent abandoned treatment, 8 percent continued on chronic ambulatory peritonela dialysis and 60 percent received a kidney allograft. We conclude that intermittent peritoneal dialysis is a good alternative treatment of chronic renal failure, even in diabetic patients