Chapters authored
Fluid Overload in Peritoneal Dialysis
The prevalence of end-stage renal disease (ESRD) has increased globally to 10% due to diabetes mellitus, hypertension, and stroke. When chronic kidney disease (CKD) maintenance therapy fails, patients require renal replacement therapy (RRT) to survive, such as peritoneal dialysis (PD), hemodialysis, and renal transplantation. The most common therapy in Mexico is PD because it is a feasible, low-cost, and easy-to-perform procedure; however, fluid overload is a frequent condition in patients with this RRT modality. The usual adverse comorbidities in patients with PD are cardiovascular diseases (CVD) associated to atherosclerosis, uremia, inflammation, and oxidative stress. Fluid overload is intimately associated to hypertension, left ventricular hypertrophy, heart failure, and worsening of kidney failure, leading to increased hospital admissions, higher cardiovascular mortality, and reduced life expectancy. Two main pathologies are involved in the deterioration of both heart and kidney functions, namely, cardiorenal syndrome and uremic cardiomyopathy. Along with these phenomena, patients in PD with rapid peritoneal transport have reduced ultrafiltration, increased glucose absorption, and albumin loss in the dialysate, which lead to overhydration, hypertension, dyslipidemia, and malnutrition. This review focuses on the clinical, physiological, and biochemical mechanisms involved in fluid overload of patients with CKD undergoing PD.
Part of the book: Chronic Kidney Disease
Diagnosis, Prevention, and Treatment of Protein-Energy Wasting in Peritoneal Dialysis
Protein-energy wasting (PEW) is highly prevalent in peritoneal dialysis (PD) patients and is associated with mortality. Reduced protein and energy intake, comorbidity conditions, endocrine disorders, increased inflammatory cytokines, uremic toxins, metabolic acidosis, oxidative stress, nutrient losses into dialysate, continuous absorption of glucose from PD solutions, abdominal fullness induced by the dialysate, and peritonitis contribute to PEW. Assessment of nutritional status for the detection and management of PEW includes the PEW definition criteria, subjective global assessment (SGA), malnutrition-inflammation score (MIS), and geriatric nutritional risk index (GNRI). Diverse factors can affect nutritional and metabolic status in these patients so multiple strategies may be required to prevent or reverse PEW. Preventive measures include continuous nutritional counseling, optimizing dietary nutrient intake, and managing comorbidities. To treat PEW, the following may be used: administration of oral, intraperitoneal, enteral, or parenteral nutritional supplementation and adjunct therapies such as anabolic agents, appetite stimulants, anti-inflammatory interventions, and exercise. Diagnosis, prevention, and treatment of PEW in PD patients may favorably impact the prognosis and course of the disease.
Part of the book: Evolving Strategies in Peritoneal Dialysis
Increase of Oxidants and Antioxidant Consumption in Patients with Type 2 Diabetes Mellitus in Peritoneal Dialysis
Oxidative stress (OS) is implicated as a unifying factor between chronic kidney diseases and cardiovascular diseases. The objective of the study was to compare the oxidant and antioxidant status in patients with PD according to the state of DM. Lipoperoxides (LPO), 8-isoprostanes (8-IP) and nitric oxide (NO) were determined as oxidants and the activity of superoxide dismutase (SOD) and total antioxidant capacity (TAC) as antioxidants in patients with DM and without DM (No-DM). We included 35 patients with DM, 42 No-DM patients and 10 healthy people as a control group (HC). Patients with DM were older (p<0.0001), had higher BMI (p<0.0001), high glucose levels (p<0.0001) and more hypertension (p<0.0001). It was found that LPO levels increased in patients with DM and No-DM vs. HC (p<0.0001). There was a decrease in the levels of 8-IP in DM and No-DM compared to HC (p<0.0001). The levels of NO in patients with DM and No-DM decreased significantly compared to the HC group with 197.97±34.20 μM (p<0.0001). The activity of the SOD enzyme in patients with DM and No-DM was found to be increased compared to the HC group (p<0.0001). The levels of TAC in HC were 2.62±0.17 mM and decreased in patients with DM and No-DM (p<0.0001).
Part of the book: Antioxidants