ABSTRACT
The beneficial effects of novel peritoneal dialysis solutions low in glucose degradation products regarding peritoneal cell apoptosis and necrosis are well established in vitro, however in vivo data is lacking. Cell-free DNA quantification is a possible method to determine cell damage through apoptosis and necrosis in vivo. We performed a prospective, cross-over study on 26 stable continuous ambulatory peritoneal dialysis (CAPD) patients, treating each patient for 3 months in a randomized order with a conventional, lactate-buffered, acidic solution (solution D) and a novel, bicarbonate/lactate-buffered neutral solution (solution P). The timed overnight peritoneal effluent was sampled for cell-free DNA quantification using a fluorometric assay. The effluent samples of eighteen patients were finally available for DNA quantification. The concentration range of cell-free DNA in the peritoneal effluents was 1.8-9.5 microg/L. The coefficient of intrapatient variation in overnight effluent cell-free DNA appearance was 15.6 +/- 12.4%. Cell-free DNA peritoneal appearance using solutions D and P was 14.9 +/- 6.8 microg and 11.8 +/- 3.4 microg, respectively (P = 0.02), with the average difference of 3.1 microg (95% CI, 0.7-5.6 microg). Our results show that cell-free DNA is present in the overnight peritoneal effluent of stable CAPD patients. A significant decrease in the cell-free DNA appearance with solution P was found; however, before accepting this as an indicator of a more biocompatible profile causing less peritoneal membrane cell necrosis and apoptosis, confirmatory data on larger patient samples are needed. Our results indicate the potential future role of cell-free DNA in the diagnosis and prognosis of therapy-related peritoneal membrane degeneration.
Subject(s)
Ascitic Fluid/metabolism , Cell-Free System/metabolism , DNA/metabolism , Dialysis Solutions/chemistry , Peritoneal Dialysis, Continuous Ambulatory/methods , Apoptosis , Bicarbonates/administration & dosage , Biomarkers/metabolism , Buffers , Cell-Free System/drug effects , Cross-Over Studies , DNA/drug effects , Dialysis Solutions/metabolism , Feasibility Studies , Female , Fluorometry/methods , Humans , Lactic Acid/administration & dosage , Male , Middle Aged , Necrosis , Pilot Projects , Prospective StudiesABSTRACT
BACKGROUND: This study was designed to compare the effects of a conventional lactate-based peritoneal dialysis (PD) solution (D) and a new biocompatible bicarbonate/lactate-based solution with a low concentration of glucose degradation products (P) on peritoneal ultrafiltration (UF) and other peritoneal membrane indices. METHODS: Twenty-six stable, prevalent PD patients were enrolled in this prospective study. They sequentially underwent 3 months of therapy with the D solution and 3 months with the P solution in a randomized order. Daily, overnight and 4-h UF on PET were measured and other peritoneal membrane indices were also assessed using PET with 2.27% glucose solution. RESULTS: Twenty-one patients successfully completed the study. The mean daily peritoneal UF with D was 1324 +/- 602 ml and 881 +/- 633 ml with P (P < 0.001) and this lower daily UF of 443 ml (95% CI 275-610 ml) with P was associated with a similarly lower daily total fluid removal of 394 ml (95% CI 210-577 ml), as urine volume did not differ between D and P. The decrement in UF with the P solution was reversible. There were no significant differences in other peritoneal membrane indices (D/P creatinine, D/D0 glucose, 4-h UF at PET, weekly creatinine clearance, weekly urea Kt/V) or blood pressure and body weight between the solutions whereas calculated peritoneal fluid absorption rate was significantly higher with the P than with the D solution. CONCLUSION: This study shows that the daily UF with the P solution may be lower than with the D solution. The mechanism for this short-term and reversible effect that conceivably reflects differences in biocompatibility is not clear although our results implicate that the peritoneal fluid absorption rate may differ between the two solutions.
Subject(s)
Bicarbonates , Dialysis Solutions , Hemodiafiltration/methods , Kidney Diseases/therapy , Lactates , Peritoneal Dialysis, Continuous Ambulatory/methods , Adult , Aged , Blood Glucose/metabolism , Blood Pressure/physiology , Body Weight/physiology , Creatinine/blood , Cross-Over Studies , Female , Humans , Kidney Diseases/metabolism , Kidney Diseases/physiopathology , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
In 1933, at the 5th Regional Sokol Meeting in Ljubljana which was at the time a place in the Yugoslav Kingdom, Skerlj carried out the first measurements of 189 gymnasts, active competitors; in 2000, at the World Cup Meeting in Ljubljana, Cuk and associates carried out measurements of 40 top gymnasts. Our analysis of identical variables has shown that there is no difference in body height and weight of the gymnasts in 1933 and those in 2000, while there is a significant difference in the width of their shoulders and pelvis, the contemporary athletes being wider in their shoulders and narrower in their pelvis. The differences can be assigned to the new requirements in contemporary gymnastics as exercises are becoming more difficult, including more rotation around the vertical and horizontal axis.
