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Background: Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability., Objectives: An evaluation of dialysate-to-plasma ratio (D/P) of urea, DIP creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS hi patients treated with continuous ambulatory peritoneal dialysis (CAPD)., Design: Single-center prospective study with PG-DS; retrospective selection of the control group., Setting: Peritoneal dialysis unit in a university hospital., Patients: Fourteen patients (11 males; age 45.1 +/- 8.5 years) treated with CAPD for 17.5 +/- 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPO duration and peritoneal permeability of the patients in the PG-DS group at the start of the study., Methods: Standard PET was carried out at 1.6 +/- 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 +/- 0.6 months' use of PG-DS (study period II, n = 14), after 4.4 +/- 0.8 months' use of PG-DS (study period Ill, n = 11), after 8.8 +/- 2.2 months' use of PG-DS (study period IV, n = 9), and at 2.0 +/- 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I-V)., Results: In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II-IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but K90 glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III., Conclusion: Changes in peritoneal permeability are observed In CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.

In peritoneal dialysis patients, polyglucose dialysis solution (PG-DS) influences serum levels of sodium, amylase, and lipase, and of iron parameters. We aimed to examine, in the blood or serum of continuous ambulatory peritoneal dialysis (CAPD) patients treated with PG-DS, changes in the concentrations of Na+, K+, Ca++, total Ca, phosphorus, urea nitrogen, creatinine, uric acid, total protein, albumin, and intact parathyroid hormone (iPTH); in lipid profile [total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, HDL:total cholesterol ratio]; and in acid-base status. We started studies in 14 CAPD patients in whom 7.5% PG-DS was applied for the overnight 2-L exchange (duration: about 10 hours). Determinations of blood chemistry were carried out at 1.6 +/- 0.8 months before the introduction of PG-DS (period I, n = 14); after 1.2 +/- 0.6 months (period II, n = 14), 4.4 +/- 0.8 months (period III, n = 11), and 8.8 +/- 2.4 months (period IV, n = 9) of PG-DS administration; and 2.0 +/- 0.6 months after PG-DS discontinuation (period V, n = 11). The most pronounced (significant) differences in the examined parameters were seen between periods I and III or periods I and IV for Na+ (140 +/- 3 mmol/L vs 136 +/- 4 mmol/L), K+ (4.2 +/- 0.6 mmol/L vs 4.8 +/- 0.6 mmol/L), total Ca (9.4 +/- 1.1 mg/dL vs 10.5 +/- 1.3 mg/dL), urea nitrogen (61.3 +/- 25.9 mg/dL vs 79.4 +/- 20.9 mg/dL), creatinine (10.7 +/- 2.6 mg/dL vs 12.8 +/- 4.3 mg/dL), uric acid (4.8 +/- 2.3 mg/dL vs 7.1 +/- 1.7 mg/dL), and total protein (61.7 +/- 10.8 g/L vs 70.5 +/- 8.0 g/L). Serum lipid levels were stable during PG-DS administration, but they increased after discontinuation of the PG-DS. Other studied parameters usually returned to pre-treatment values after PG-DS discontinuation. All patients were in good clinical status during the study. The changes in blood chemistry did not cause clinical intervention. Our results indicate that PG-DS influences blood chemistry. The observed differences need to be clinically analyzed.

Polyglucose dialysis solution (PG-DS) decreases serum amylase activity owing to interference in the analytical method. The interference can make it difficult to diagnose pancreatitis. Our aim was to check whether, during PG-DS administration, serum lipase activity changes simultaneously with serum amylase activity, and, if so, what the reason is for the detected change. Studies were started in 14 continuous ambulatory peritoneal dialysis (CAPD) patients in whom 7.5% PG-DS was applied for the overnight exchange. In addition to standard clinical and laboratory data, serum activity of lipase and of total amylase were evaluated at 1.6 +/- 0.8 months before PG-DS introduction (period I, n = 14), after 1.2 +/- 0.6 months of PG-DS administration (period II, n = 14), after 4.4 +/- 0.8 months of PG-DS administration (period III, n = 11), after 8.8 +/- 2.2 months of PG-DS administration (period IV, n = 9), and at 2.0 +/- 0.6 months after PG-DS discontinuation (period V, n = 11). The PG-DS was also added to serum from CAPD patients with known activity of amylase and of lipase. Immediately and 3 hours after PG-DS addition, a significant decrease in total amylase activity was seen; lipase activity was unchanged. In consecutive study periods, the results (median and range) were: for lipase activity--50 U/L (12-131 U/L), 59 U/L (25-160 U/L; p < 0.05 vs period I), 73 U/L (26-158 U/L; p < 0.05 vs period I), 66 U/L (30-203 U/L; p < 0.05 vs period I), and 44 U/L (15-112 U/L); for amylase activity--81 U/L (43-249 U/L), 14 U/L (5-82 U/L; p < 0.05 vs period I and period V), 15 U/L (5-192 U/L; p < 0.05 vs period I), 15 U/L (10-93 U/L; p < 0.05 vs period I and period V), and 118 U/L (4-221 U/L). An increase in serum lipase activity over the normal range (27-65 U/L) was not accompanied by clinical symptoms of pancreatic dysfunction, but rises were simultaneously shown in blood urea nitrogen, in serum level of creatinine and of total calcium, and in calcium phosphorus product. Our results confirm PG-DS influence on amylase determinations, exclude PG-DS interference in lipase measurements, and indicate that long-term PG-DS administration influences pancreatic exocrine function at a subclinical level.

Owing to the lack of data dealing with the influence of polyglucose dialysis solution (PG-DS) on serum indicators of iron status, our study aimed at examining this problem in patients receiving PG-DS for the overnight exchange during treatment with continuous ambulatory peritoneal dialysis. We evaluated serum concentrations of iron, ferritin, and transferrin, total iron binding capacity (TIBC), and transferrin saturation (TSAT) at 1.6 +/- 0.8 months before introducing 7.5% PG-DS for an overnight 2 L exchange lasting about 10 hours (period I, n = 14), after 1.2 +/- 0.6 months of PG-DS administration (period II, n = 14), after 4.4 +/- 0.8 months of PG-DS administration (period III, n = 11), after 8.8 +/- 2.2 months of PG-DS administration (period IV, n = 9), and at 2.0 +/- 0.6 months after PG-DS discontinuation (period V, n = 11). Interference owing to PG-DS in laboratory determinations of serum iron parameters was excluded. Indices of nutritional status were also evaluated in all study periods. Significant differences in iron parameters were seen between periods I and III, or I and IV for transferrin (212 +/- 41 mg/dL vs 253 +/- 36 mg/dL), TIBC (304 +/- 40 micrograms/dL vs 338 +/- 31 micrograms/dL) and TSAT (34% +/- 15% vs 24% +/- 4%). After PG-DS withdrawal, these parameters all returned to pre-treatment values. Improvement in nutritional status was indicated by increases in total body mass (73.9 +/- 15.6 kg vs 77.4 +/- 13.8 kg), lean body mass (54.5 +/- 9.7 kg vs 56.9 +/- 8.5 kg), and serum total protein concentration (61.7 +/- 10.8 g/L vs 70.5 +/- 8.0 g/L). We conclude that serum transferrin concentration increases during PG-DS administration without enhanced iron binding to transferrin. An increase in transferrin level can be related to improved nutritional status.

In the presented review paper we have shown a role of glucose polymers, including icodextrin, in the treatment of uraemia with continuous ambulatory peritoneal dialysis or cyclic continuous peritoneal dialysis. Glucose polymers as a component of peritoneal dialysis solution exert significant ultrafiltration during dialysis solution exchanges lasting 10-16 hpurs. This is especially advantageous in patients with high peritoneal permeability and results in prolongation of peritoneal dialysis treatment by several months. Dialysis solution containing glucose polymers sustains ultrafiltration during peritonitis. In this paper there are also described icodextrin kinetics after intraperitoneal administration, its influence on peritoneal transport and adverse effects observed in some patients using icodextrin solution.