Measuring peritoneal absorption with the prolonged peritoneal equilibration test from 4 to 8 hours using various glucose concentrations.

BACKGROUND: Peritoneal fluid flows such as small-pore ultrafiltration and free water transport can now be calculated by means of the modified peritoneal equilibration test (PET). To calculate peritoneal fluid absorption, volume markers have been used, but that method is not easily applicable in clinical practice. Alternatively, absorption can be estimated using the personal dialysis capacity test. However, a method of measuring overall peritoneal absorption together with the PET is lacking. The aim of the present study was to assess whether overall peritoneal absorption was different when measured from the 4th to 8th hour in a prolonged PET using three different glucose solutions. METHODS: The study enrolled 32 stable peritoneal dialysis (PD) patients from a tertiary university hospital, who underwent three 8-hour prolonged PETs with 1.36%, 2.27%, and 3.86% glucose solution. The PETs were performed in random order over a period of less than 1 month. During the prolonged PET, the peritoneal volume was emptied and reinfused at 60 and 240 minutes and drained at 480 minutes. Peritoneal absorption was calculated as the volume difference between the 4th and the 8th hour. RESULTS: The dialysate-to-plasma ratio (D/P) of urea, the D/P creatinine, and the mass transfer area coefficient (MTC) of creatinine at 240 minutes were not significantly different with the three glucose solutions. The end-to-initial (D/D0) glucose, MTC urea, and MTC glucose were significantly different. All water transport parameters were significantly different, except for the 4- to 8-hour absorption volumes and rates. The peritoneal absorption rates were, for 1.36% solution, 1.03 ± 0.58 mL/min [95% confidence interval (CI): 0.83 to 1.24 mL/min]; for 2.27% solution, 0.86 ± 0.71 mL/min (95% CI: 0.61 to 1.11 mL/min); and for 3.86% solution, 1.05 ± 0.78 mL/min (95% CI: 0.77 to 1.33 mL/min). Peritoneal absorption volumes and rates from the 4th to the 8th hour showed good correlations for the various solutions. CONCLUSIONS: Using any glucose solution, the prolonged PET with voiding and reinfusion at the 4th hour could be a practical method for calculating overall peritoneal absorption from the 4th to the 8th hour in PD patients.

[Methods for the estimation of the renal function]. / Métodos para la estimación de la función renal.

The chronic kidney disease represents one of the pathologies with greater incidence and prevalence in the present sanitary systems. The ambulatory application of different methods that allow a suitable detection, monitoring and stratification of the renal functionalism is of crucial importance. On the basis of the vagueness obtained by means of the application of the serum creatinine, a set of predictive equations for the estimation of the glomerular filtration rate have been developed. Nevertheless, it is essential for the physician to know its limitations, in situations of normal renal function and hyperfiltration, certain associate pathologies and extreme situations of nutritional status and age. In these cases, the application of the isotopic techniques for the calculation of the renal function is more recommendable.

Métodos para la estimación de la función renal / Methods for the estimation of the renal function

La enfermedad renal crónica representa uno de los procesos con mayor incidencia y prevalencia en los sistemas sanitarios actuales. La aplicación ambulatoria de diferentes métodos que permitan una adecuada detección, seguimiento y estratificación del funcionalismo renal es de vital importancia en la práctica clínica habitual. Debido a la imprecisión que entraña la creatinina plasmática, se ha desarrollado todo un conjunto de ecuaciones predictivas para la estimación del filtrado glomerular. Sin embargo, es imprescindible que el clínico conozca sus limitaciones en situaciones de función renal normal e hiperfiltración, determinados procesos crónicos intercurrentes y situaciones extremas de estado nutricional y edad. En estos casos resulta más recomendable la aplicación de las técnicas isotópicas para el cálculo de la función renal

The chronic kidney disease represents one of the pathologies with greater incidence and prevalence in the present sanitary systems. The ambulatory application of different methods that allow a suitable detection, monitoring and stratification of the renal functionalism is of crucial importance. On the basis of the vagueness obtained by means of the application of the serum creatinine, a set of predictive equations for the estimation of the glomerular filtration rate have been developed. Nevertheless, it is essential for the physician to know its limitations, in situations of normal renal function and hyperfiltration, certain associate pathologies and extreme situations of nutritional status and age. In these cases, the application of the isotopic techniques for the calculation of the renal function is more recommendable

A prospective study of cardiovascular disease in patients with Type 2 diabetes. 6.3 years of follow-up.

OBJECTIVE: Type 2 diabetes mellitus (DM-2) is an important cardiovascular risk factor, although hardly any data are available in our country. Therefore, we decided to study the incidence of cardiovascular disease (CVD) and the related variables with its appearance in a group of patients with DM-2. RESEARCH DESIGN AND METHODS: 176 DM-2 patients without CVD at baseline (63.6% women, mean age 54+/-8.9), mean follow-up 6.3 years. We collected data at 6-month intervals concerning new micro- and macrovascular complications, glucose, HbA(1C), lipid profile, and renal function. We analyzed values at baseline and at the end of follow-up. For numeric variables, the mean value during follow-up was calculated. In renal function variables, we also worked out the difference between baseline and final values, considering the time until the first episode of CVD as the independent variable. Kaplan-Meier analysis was used in categorical variables and Cox regression tests for numeric data and also for multivariate analysis. In multivariate analysis, we included significant data in the univariate analysis, excluding those from the end of the follow-up with the aim of having some predictive meaning in our results. RESULTS: New episodes of CVD were detected in 28 patients (15.9%). These events were statistically related with baseline diagnosed hypertension, presence of diabetic nephropathy and retinopathy, HbA(1C), and total cholesterol. Among mean values during follow-up, the association was with HbA(1C), cholesterol, urinary albumin excretion rate (UAER), glomerular filtration rate (GFR), and systolic arterial pressure. There was also a relationship of CVD events with the new appearance or worsening of diabetic retinopathy or nephropathy, creatinine and UAER increase and the decrease of GFR and effective renal plasma flow (ERPF), during follow-up. In the multivariate analysis, we found an independent association with the appearance of CVD and mean HbA(1C), mean UAER and the presence of proliferative diabetic retinopathy at baseline. CONCLUSIONS: We have a rather low incidence of CVD in our patients with DM-2. The appearance of CVD is independently related with HbA(1C), the level of UAER, and the presence at baseline of diabetic retinopathy.