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Peritoneal sodium removal compared to glucose absorption in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis and automated peritoneal dialysis with and without a daytime exchange
Author(s) -
Tangwonglert Theerasak,
Davenport Andrew
Publication year - 2021
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/1744-9987.13619
Subject(s) - icodextrin , medicine , peritoneal dialysis , continuous ambulatory peritoneal dialysis , urology , sodium , peritoneal equilibration test , dialysis , confidence interval , ambulatory , extracellular fluid , gastroenterology , biochemistry , extracellular , chemistry , organic chemistry
Sodium removal in peritoneal dialysis (PD) depends on convective clearance, typically generated by a glucose gradient, but this can result in glucose absorption. We wished to determine which factors determine peritoneal sodium losses to glucose absorption (PD Na/Gluc). Peritoneal sodium losses and glucose absorption were calculated from measured 24‐h collections of PD effluent, in patients attending for assessment of peritoneal membrane function. Five hundred and fifty eight patients; 317 (56.8%) males, mean age 56.1 ± 16.0 years, were studied, 281 treated by automated peritoneal dialysis (APD) with a daytime exchange (50.4%); 179 (32.1%) by APD and 98 (17.6%) by continuous ambulatory peritoneal dialysis (CAPD). All patients used glucose containing dialysates, with 352 (63.1%) using icodextrin and 210 (37.6%) hypertonic (22.7 g/L glucose) dialysates. The ratio of PD Na/Gluc was 0.14 (0.02–0.29). Patients using icodextrin had a higher ratio (0.16 (0.03–0.32) versus 0.11 (−0.02–0.26), P < .001), as did those using 22.7 g/L glucose versus 13.6 g/L (0.16 (0.06–0.32) versus 0.13 (−0.01–0.19), P < .01), and CAPD versus APD (0.18 (0.05–0.36) versus 0.11 (0.0–0.27), P < .05), respectively. A multivariable model showed that 24‐h ultrafiltration (odds ratio [OR] 7.6 (95% confidence interval [3.9–14.8]), P < .001 was associated with increased PD Na/Gluc, whereas APD (OR 0.19 (0.06–0.62), P < .01 and increased extracellular water to total body water (OR 0.001 [0–0.08], P = .03) were associated with lower ratios. Twenty four‐hour peritoneal ultrafiltration was strongly associated with PD Na/Gluc, whereas patients treated with APD cyclers without a daytime icodextrin exchange and those with an increased extracellular water to total body water had lower peritoneal sodium losses but with greater peritoneal glucose absorption.