Introduction: Peritoneal dialysis (PD) is a standard procedure for the treatment of chronic renal failure or, specifically in pediatric intensive care, acute renal failure. In peritoneal dialysis fluids (PDFs) glucose is employed to build up an osmotic gradient to drag water and compounds across the peritoneal membrane. However, PDFs containing glucose can induce morphological and functional changes that limit the duration of PD. We therefore investigated the hypothesis that a colloidosmotically active compound-hydroxyethyl starch 450/0.5 (HES) at various concentrations (1.5%, 3%, 6%) - might serve as an effective replacement for glucose. Methods: Three days after undergoing nephrectomy, 150 rats were started on PD for 1 to 5 days. The animals were randomized to 3 groups (group 1 HES 1.5%, group 2 HES 3%, group 3 HES 6%). The primary end points were 1) water removal (changes in body weight before/after PD, amount of dialysate, changes in haemoglobin concentration), 2) membrane transfer assessed by peritoneal equilibrium test (PET), creatinine clearance (Ct/V), and changes in creatinine, BUN, and electrolytes before/after PD, 3) concentration of HES in serum and organs. Blood and PDF samples were analyzed for potassium, sodium, chloride, phosphate, glucose, and protein. On the last day of PD organs were harvested and the HES concentration was measured in the serum, liver, spleen, and lungs. Kruskal-Wallis one-way ANOVA on ranks with Tukey-Kramer multiple comparison, Wilcoxon signed-rank test, or paired t-test were used, as appropriate. Results: Body weight decreased in group 3 (mean±SD, group 1 +2.2%±2.5, group 2 +0.29%±1.9, groups -2.7%±1.0 vs. baseline, p<;0.01), haemoglobin decreased in group 1 (-3.3%±2.2), and increased in groups 2 and 3, +5.2%±4.2 and +5.1%±6.1 respectively, (p<0.05 vs. baseline). PET did not differ between the groups (0.85-0.96), Kt/V was 0.58±0.04 in group 1, 0.51 ±0.06 in group 2, and 0.57±0.04 in group 3. Electrolytes, protein, creatinine and BUN concentrations were reduced by PD, with no differences seen between the groups. HES concentrations (mg/ml) in the serum were (median, interquartile range): 5.4, 4.0-5.9 (group 1); 9.8, 8.5-11.5 (group 2); 13.5, 11.2-14.6 (group 3). Increased HES in organs was dependant on the HES concentration in the PDF, and the duration of PD. Conclusions: Fluid shift across the peritoneal membrane was dependant on HES concentration. Elimination of creatinine or BUN was uninfluenced by HES concentration. The deposition of HES in the tissue represents a limiting factor for this application.
|Translated title of the contribution||Hydroxyethyl starch (HES) as a colloidosmotic agent for peritoneal dialysis solutions: Influence of HES concentration on effectiveness and tissue deposition|
|Number of pages||7|
|Journal||Anasthesiologie und Intensivmedizin|
|State||Published - Nov 1 2005|
- Dialysis Solutions
- Osmotic Pressure
- Peritoneal Dialysis