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1.
Cir Cir ; 90(2): 151-156, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35349560

RESUMO

OBJECTIVE: Postoperative intraabdominal adhesions are obvious cause of postoperative morbidity. In this experimental study, our aim is to compare the effects of 4% icodextrin produced for adhesion prevention, magnesium sulfate used as an anticonvulsant in obstetrics and also as a thickening lubricant in the detergent industry, and saline, which we use most frequently in abdominal irrigation, on adhesion formation. MATERIALS AND METHODS: A total of 4 groups were formed, 8 in the control group (K), 8 in the icodextrin group (I), 8 in the magnesium sulfate group (M), and 8 in the saline group (SF). Adhesions were quantitatively evaluated with the classification defined by Nair and microscopic grading defined by Zuhlke. RESULTS: The macroscopic staging degree was statistically significantly lower in Group M, I, and SF compared to Group K. Again, the degree of microscopic staging was significantly lower in Group M and I compared to Group K. CONCLUSIONS: Three different materials were used in our study. It was observed that they significantly reduced adhesions. This study once again demonstrates the limited ability of these materials to prevent adhesion, despite the wide variety of materials used, and the need for careful adherence to tissue-respectful surgical techniques.


OBJETIVO: As aderências intra-abdominais pós-operatórias (PIA) são causa óbvia de morbidade pós-operatória. Neste estudo experimental, nosso objetivo é comparar os efeitos da icodextrina 4% produzida para prevenção de aderências, sulfato de magnésio usado como anticonvulsivante em obstetrícia e também como lubrificante espessante na indústria de detergentes e soro fisiológico, que usamos mais frequentemente em abdominais irrigação, na formação de aderências. MATERIAIS E MÉTODOS: Foram formados 4 grupos, 8 no grupo controle (K), 8 no grupo da icodextrina (I), 8 no grupo sulfato de magnésio (M) e 8 no grupo solução salina (SF). As aderências foram avaliadas quantitativamente com a classificação definida por Nair e graduação microscópica definida por Zuhlke. RESULTADOS: O grau de estadiamento macroscópico foi estatisticamente significativamente menor no Grupo M, I e SF em comparação com o Grupo K. Novamente, o grau de estadiamento microscópico foi significativamente menor nos Grupos M e I em comparação com o Grupo K. CONCLUSÕES: Três materiais diferentes foram usados em nosso estudo. Foi observado que eles reduziram significativamente as aderências. Este estudo demonstra mais uma vez a capacidade limitada desses materiais em prevenir a adesão, apesar da grande variedade de materiais usados, e a necessidade de uma adesão cuidadosa a técnicas cirúrgicas que respeitem o tecido.


Assuntos
Sulfato de Magnésio , Cloreto de Sódio , Humanos , Icodextrina , Sulfato de Magnésio/farmacologia , Sulfato de Magnésio/uso terapêutico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle
2.
Medicina (Kaunas) ; 58(3)2022 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-35334562

RESUMO

Background and objective: Anti-adhesion barriers are currently used during ovarian cancer surgery to decrease adhesion-related morbidity. Adept® (4% icodextrin) solution, a liquid anti-adhesion material, has been widely used during gynecologic surgeries, though the risk of this barrier for oncologic surgery is controversial. The aim of this study was to determine the effect of Adept® solution on the proliferation of ovarian cancer cells. Materials and methods: We assessed the dose- and time-dependent effects of icodextrin on the growth and proliferation of OVCAR-3 and A2780 human ovarian tumor cell lines in vitro. Cell growth was determined by cell number counting. Expressions of cell cycle-regulation proteins (cyclin D1 and cyclin B1) were determined using Western blot analysis. Results: Adept® did not significantly increase ovarian cancer cell growth when tested at various concentrations (0, 1, 5, 10, 15, and 20%, equal to 0, 0.04, 0.2, 0.4, 0.6 and 0.8% icodextrin) and different time points (1-3 days) compared to control cells. Moreover, the protein levels of cyclin D1 and B1 were not overexpression-elevated in icodextrin-treated ovarian cancer cells, either with an increasing concentration or with an increasing treated time. These results demonstrated that Adept® does not activate the growth or proliferation of ovarian cancer cells in either a dose- or time-dependent manner. Conclusions: This study supports the use of Adept® solution as a safe anti-adhesion barrier for ovarian cancer surgery, though further in vivo studies are necessary.


Assuntos
Apoptose , Neoplasias Ovarianas , Linhagem Celular Tumoral , Proliferação de Células , Feminino , Humanos , Icodextrina , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia
3.
Ther Apher Dial ; 26(1): 197-204, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33683800

RESUMO

Peritoneal equilibration test (PET) is the gold standard for evaluating peritoneal transport, and measurement of the drain volume after 4-h dwell time with glucose 4.25% is a simple means of evaluating failure of ultrafiltration. The study objective was to verify if the measurement of the volume drained after 4 h dwell of icodextrin at 7.5% (ICO), has a better correlation with the parameters of PET. Patients in a peritoneal dialysis program (N = 35) underwent three procedures: PET; determination of the drain volume after a 4-h dwell with glucose 4.25%; and determination of the drain volume after a 4-h dwell with ICO. Among patients who were classified as high transporters, the ultrafiltration volume was greater after ICO use. The ICO ultrafiltration volume correlated negatively with the ratio between the 4- and 0-h dialysate glucose concentrations (D4/D0 ratio, r = -0.579; P = 0.002), correlating positively with the dialysate-to-plasma ratio for creatinine (D/PCr ratio, r = 0.474; P = 0.002). For ICO, the area under the receiver operating characteristic curve was 0.867 and 0.792 for the D/PCr and D4/D0 ratios (P < 0.0001 and P = 0.004, respectively), compared with 0.738 and 0.710 for glucose 4.25% (P = 0.020 and P = 0.041, respectively). A cut-off volume of 141 mL discriminated high/high-average transporters from low/low-average transporters. Volume drained after ICO use better predicts peritoneal transport patterns than does that drained after the use of glucose 4.25%.


Assuntos
Soluções para Diálise/farmacocinética , Icodextrina/farmacocinética , Diálise Peritoneal , Peritônio/fisiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Nanoscale ; 13(46): 19399-19411, 2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34755744

RESUMO

Imaging-guided diagnosis and chemo-photothermal combination therapy have promising applications for the treatment of cancer. Nevertheless, the accurate diagnosis and efficient treatment of tumors are not yet satisfactory. Herein, a tumor targeting DiR loaded cisplatin-icodextrin prodrug nanoparticle, with selective drug release, was fabricated as a multifunctional theranostic nanoplatform for chemo-photothermal combination therapy. By loading DiR into the hydrophobic domain of folic acid-icodextrin-polycaprolactone (FA-ICO-PCL, FIP) and cisplatin-icodextrin-polycaprolactone (Pt-ICO-PCL, PtIP) co-assembly, the resultant DiR@(PtIP + FIP) (DPtFIP) NPs had a diameter of around 70 nm and showed excellent tumor targeting ability and negligible side effects. Moreover, the DPtFIP NPs achieved real-time NIR fluorescence imaging of solid tumors with high contrast. By the accurate tumor imaging, local laser irradiation dramatically enhanced the chemotherapy for triple-negative breast cancer. Such a biocompatible nanotherapeutic holds great potential for tumor diagnosis and imaging-guided combinational cancer therapy.


Assuntos
Hipertermia Induzida , Nanopartículas , Neoplasias , Pró-Fármacos , Cisplatino/farmacologia , Doxorrubicina , Humanos , Icodextrina , Neoplasias/terapia , Fototerapia , Medicina de Precisão , Pró-Fármacos/farmacologia , Nanomedicina Teranóstica
5.
G Ital Nefrol ; 38(5)2021 Oct 26.
Artigo em Italiano | MEDLINE | ID: mdl-34713640

RESUMO

Peritoneal dialysis is an efficient renal replacement therapy for uremic patients but is currently under-prescribed. This is partly due to the unfavorable effects on peritoneal morphology and function (bioincompatibility) of current glucose-based solutions. Use of standard solutions can cause several peritoneal alterations including inflammation, mesothelial to mesenchymal transition, and neo-angiogenesis. The final step is fibrosis, which reduces the peritoneal filtration capacity and can lead to ultrafiltration failure and transfer of the patient to hemodialysis. Bioincompatibility can be local (peritoneum) but also systemic, due to the excessive absorption of glucose from the dialysate. Several strategies have been adopted to improve the biocompatibility of peritoneal dialysis solutions, based on the alleged causal factors. Some new solutions available on the market contain low glucose degradation products and neutral pH, others contain icodextrin or aminoacids. Clinical benefits have been associated with the use of these solutions, which however have some limitations and a debated biocompatibility profile. More recent strategies include the use of cytoprotective agents or osmo-metabolic agents in the dialysate. In this article, we review the different approaches currently under development to improve the biocompatibility of peritoneal dialysis solution and hence the clinical outcome and the viability of the technique.


Assuntos
Diálise Peritoneal , Soluções para Diálise , Glucose , Humanos , Icodextrina , Peritônio
6.
Ren Fail ; 43(1): 651-657, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33820495

RESUMO

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease. Although several cases of BP in end-stage renal disease patients receiving peritoneal dialysis (PD) or hemodialysis have been reported, the incidence of BP in these patients remains unknown. We recently experienced three PD patients diagnosed with BP. The skin injury was likely to be a trigger of BP in all the three PD patients. Nifedipine and icodextrin exposures were possible factors directly or indirectly affecting the onset of BP, because they were common in the three cases. We also report that the incidence of BP in PD patients was 3/478.3 person-years in a single-center 10-year study. This case series with a literature survey describes that the skin and tissue injuries are potential triggers responsible for the onset of BP in dialysis patients and that the incidence of BP in these patients seems to be much higher than that in the general population.


Assuntos
Falência Renal Crônica/terapia , Penfigoide Bolhoso/etiologia , Diálise Peritoneal/efeitos adversos , Pele/patologia , Idoso , Autoanticorpos/metabolismo , Feminino , Humanos , Icodextrina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nifedipino/efeitos adversos , Penfigoide Bolhoso/imunologia
7.
Eur J Surg Oncol ; 47(6): 1434-1440, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33637371

RESUMO

BACKGROUND: Icodextrin (IDX) is an antiadhesive polymer that can be used as a carrier solution for intraperitoneal (IP) delivery of chemotherapeutic drugs. METHODS: We investigated the suitability of IDX solution as a carrier of Cisplatin and Doxorubicin for delivery as pressurized intraperitoneal aerosol chemotherapy (PIPAC). We examined the sprayability of IDX, the aerosol characteristics, the stability of the molecule after aerosolization, the effects of IDX on the adhesion of MKN45 human gastric cancer cells, the synergistic effect of aerosolized IDX with Cisplatin and Doxorubicin, and the chemical stability of IDX, Cisplatin, and Doxorubicin in combination. RESULTS: Delivery of IDX as PIPAC is feasible with no particular restrictions. The median droplet size of 35.7 µm did not change at increasing concentrations. IDX withstood the shear forces applied by the nebulizer and remained stable after aerosolization (ANOVA, p = 0.97). IDX did not impair the cytotoxic effects of Cisplatin and Doxorubicin (ns). IDX had a significant antiadhesive impact alone (p < 0.03) and in combination with Cisplatin and Doxorubicin (p < 0.02). IDX as a carrier for Cisplatin and Doxorubicin remained stable at 4 °C for three months and did not cause degradation of those two substances. CONCLUSION: The proposed combination takes advantage of the antiadhesive properties of IDX, the cytotoxic effect of Cisplatin and Doxorubicin, and an advanced drug delivery system.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Adesão Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Soluções para Diálise/administração & dosagem , Icodextrina/administração & dosagem , Aerossóis , Protocolos de Quimioterapia Combinada Antineoplásica/química , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Linhagem Celular Tumoral , Cisplatino/administração & dosagem , Cisplatino/química , Soluções para Diálise/química , Doxorrubicina/administração & dosagem , Doxorrubicina/química , Estabilidade de Medicamentos , Humanos , Icodextrina/química , Icodextrina/farmacologia , Peritônio , Pressão
8.
Perit Dial Int ; 41(4): 352-372, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33563110

RESUMO

GUIDELINE 1: A pathophysiological taxonomy: A pathophysiological classification of membrane dysfunction, which provides mechanistic links to functional characteristics, should be used when prescribing individualized dialysis or when planning modality transfer (e.g. to automated peritoneal dialysis (PD) or haemodialysis) in the context of shared and informed decision-making with the person on PD, taking individual circumstances and treatment goals into account. (practice point). GUIDELINE 2A: Identification of fast peritoneal solute transfer rate (PSTR): It is recommended that the PSTR is determined from a 4-h peritoneal equilibration test (PET), using either 2.5%/2.27% or 4.25%/3.86% dextrose/glucose concentration and creatinine as the index solute. (practice point) This should be done early in the course dialysis treatment (between 6 weeks and 12 weeks) (GRADE 1A) and subsequently when clinically indicated. (practice point). GUIDELINE 2B: Clinical implications and mitigation of fast solute transfer: A faster PSTR is associated with lower survival on PD. (GRADE 1A) This risk is in part due to the lower ultrafiltration (UF) and increased net fluid reabsorption that occurs when the PSTR is above the average value. The resulting lower net UF can be avoided by shortening glucose-based exchanges, using a polyglucose solution (icodextrin), and/or prescribing higher glucose concentrations. (GRADE 1A) Compared to glucose, use of icodextrin can translate into improved fluid status and fewer episodes of fluid overload. (GRADE 1A) Use of automated PD and icodextrin may mitigate the mortality risk associated with fast PSTR. (practice point). GUIDELINE 3: Recognizing low UF capacity: This is easy to measure and a valuable screening test. Insufficient UF should be suspected when either (a) the net UF from a 4-h PET is <400 ml (3.86% glucose/4.25% dextrose) or <100 ml (2.27% glucose /2.5% dextrose), (GRADE 1B) and/or (b) the daily UF is insufficient to maintain adequate fluid status. (practice point) Besides membrane dysfunction, low UF capacity can also result from mechanical problems, leaks or increased fluid absorption across the peritoneal membrane not explained by fast PSTR. GUIDELINE 4A: Diagnosing intrinsic membrane dysfunction (manifesting as low osmotic conductance to glucose) as a cause of UF insufficiency: When insufficient UF is suspected, the 4-h PET should be supplemented by measurement of the sodium dip at 1 h using a 3.86% glucose/4.25% dextrose exchange for diagnostic purposes. A sodium dip ≤5 mmol/L and/or a sodium sieving ratio ≤0.03 at 1 h indicates UF insufficiency. (GRADE 2B). GUIDELINE 4B: Clinical implications of intrinsic membrane dysfunction (de novo or acquired): in the absence of residual kidney function, this is likely to necessitate the use of hypertonic glucose exchanges and possible transfer to haemodialysis. Acquired membrane injury, especially in the context of prolonged time on treatment, should prompt discussions about the risk of encapsulating peritoneal sclerosis. (practice point). GUIDELINE 5: Additional membrane function tests: measures of peritoneal protein loss, intraperitoneal pressure and more complex tests that estimate osmotic conductance and 'lymphatic' reabsorption are not recommended for routine clinical practice but remain valuable research methods. (practice point). GUIDELINE 6: Socioeconomic considerations: When resource constraints prevent the use of routine tests, consideration of membrane function should still be part of the clinical management and may be inferred from the daily UF in response to the prescription. (practice point).


Assuntos
Diálise Peritoneal , Adulto , Soluções para Diálise , Glucanos , Glucose , Humanos , Icodextrina , Peritônio , Sódio , Ultrafiltração
9.
Ther Apher Dial ; 25(5): 654-662, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33403730

RESUMO

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.


Assuntos
Glucose/metabolismo , Diálise Peritoneal/métodos , Sódio/metabolismo , Soluções para Diálise/uso terapêutico , Feminino , Humanos , Icodextrina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal Ambulatorial Contínua/métodos , Estudos Retrospectivos , Tempo
10.
Perit Dial Int ; 41(1): 115-117, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32037957

RESUMO

The majority of peritoneal dialysates contain glucose, which can potentially be absorbed from the peritoneal cavity. Previous studies have reported an observation between dialysate glucose exposure and increases in total cholesterol (TC), low-density lipoproteins (LDLs) and triglycerides (TGs). As most of these studies reported glucose exposure in peritoneal dialysis (PD) patients treated by continuous ambulatory peritoneal dialysis (CAPD), we wished to determine whether measured peritoneal glucose absorption resulted in an increase in lipid profile with CAPD and automated PD (APD) cycler treatments. Glucose absorption was measured in 143 patients; 89 (62.2%) males, 53 (37.1%) diabetics, mean age 61.3 ± 14.9 years, with 90 (62.1%) using a daytime icodextrin exchange; 37 (25.9%) CAPD, attending for their first assessment of peritoneal membrane function, when PD prescriptions were then individualised for peritoneal transporter status and repeated after 12 months. Median glucose absorption was 172.5 (75.5-265.5) mmol/day. Although glycated haemoglobin increased (42 ± 16 to 45.4 ± 17.7 mmol/mol, p = 0.006), there was no change in TC (4.8 ± 1.3 to 4.7 ± 1.3 mmol/L), high-density lipoproteins (1.39 ± 0.45 to 1.33 ± 0.51 mmol/L), LDL (2.48 ± 1.12 to 2.21 ± 0.87 mmol/L) or TGs (2.0 (1.3-2.6) to 2.0 (1.3-2.8) mmol/L, adjusted p > 0.05). We found no association between glucose absorption and either lipid profiles or changes in serum lipids. In the current era of APD cyclers and icodextrin, PD prescriptions can be individualised to accommodate patients with a different peritoneal transport status, so that despite daily glucose absorption from dialysates, and a minor increase in glycated haemoglobin, we were unable to demonstrate any significant increase in standard lipid profiles.


Assuntos
Glucose , Diálise Peritoneal , Idoso , Soluções para Diálise , Humanos , Icodextrina , Lipídeos , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/efeitos adversos
11.
J Nephrol ; 34(2): 503-519, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32767274

RESUMO

Peritoneal dialysis (PD) is a viable but under-prescribed treatment for uremic patients. Concerns about its use include the bio-incompatibility of PD fluids, due to their potential for altering the functional and anatomical integrity of the peritoneal membrane. Many of these effects are thought to be due to the high glucose content of these solutions, with attendant issues of products generated during heat treatment of glucose-containing solutions. Moreover, excessive intraperitoneal absorption of glucose from the dialysate has many potential systemic metabolic effects. This article reviews the efforts to develop alternative PD solutions that obviate some of these side effects, through the replacement of part of their glucose content with other osmolytes which are at least as efficient in removing fluids as glucose, but less impactful on patient metabolism. In particular, we will summarize clinical studies on the use of alternative osmotic ingredients that are commercially available (icodextrin and amino acids) and preclinical studies on alternative solutions under development (taurine, polyglycerol, carnitine and xylitol). In addition to the expected benefit of a glucose-sparing approach, we describe an 'osmo-metabolic' approach in formulating novel PD solutions, in which there is the possibility of exploiting the pharmaco-metabolic properties of some of the osmolytes to attenuate the systemic side effects due to glucose. This approach has the potential to ameliorate pre-existing co-morbidities, including insulin resistance and type-2 diabetes, which have a high prevalence in the dialysis population, including in PD patients.


Assuntos
Glucose , Diálise Peritoneal , Soluções para Diálise/efeitos adversos , Humanos , Icodextrina , Diálise Peritoneal/efeitos adversos , Peritônio
12.
Perit Dial Int ; 41(1): 79-85, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32063216

RESUMO

BACKGROUND: Preservation of peritoneal function is crucial for the continuation of peritoneal dialysis (PD). A previous study suggested that blood cholesterol is involved in the preservation of peritoneal function; therefore, we determined whether adipocytokines can predict peritoneal function preservation. METHODS: Eighty patients were enrolled. Serum adiponectin, leptin, apelin, various blood components, and estimated glomerular filtration rate (eGFR) (mL/min/m2) were measured. In addition, the duration of PD, presence or absence of peritonitis and diabetes mellitus, body mass index, urine output, peritoneal Kt/V, renal Kt/V, weekly Kt/V, peritoneal creatinine clearance rate (CCr), renal CCr, weekly CCr, use or nonuse of statin products, dialysate volume, glucose exposure, and use or nonuse of icodextrin dialysate were assessed. Peritoneal equilibration tests were performed at 6-month intervals, and dialysate-to-plasma [D/P] ratio and glucose uptake ratio [D/D0] were measured. Associations of the baseline values and their percent changes with various adipocytokines and test items were evaluated. RESULTS: Multiple regression analyses identified adiponectin (p = 0.0392, p = 0.0348) as a significant predictive factor of D/P and D/D0 ratios. eGFR was identified as a significant predictive factor (p = 0.015) of percent change in the D/P ratio. Apelin (p = 0.0484), high-density lipoprotein cholesterol (p = 0.0066), dialysate volume (p = 0.0223), and urine output (p = 0.0020) were identified as factors affecting the duration of PD. CONCLUSIONS: Adipocytokines are a predictive factor of peritoneal function and the duration of PD in patients undergoing PD.


Assuntos
Adipocinas , Diálise Peritoneal , Creatinina , Soluções para Diálise , Humanos , Icodextrina , Diálise Peritoneal/efeitos adversos , Peritônio
13.
Cochrane Database Syst Rev ; 7: CD001298, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32683695

RESUMO

BACKGROUND: Adhesions are fibrin bands that are a common consequence of gynaecological surgery. They are caused by conditions that include pelvic inflammatory disease and endometriosis. Adhesions are associated with comorbidities, including pelvic pain, subfertility, and small bowel obstruction. Adhesions also increase the likelihood of further surgery, causing distress and unnecessary expenses. Strategies to prevent adhesion formation include the use of fluid (also called hydroflotation) and gel agents, which aim to prevent healing tissues from touching one another, or drugs, aimed to change an aspect of the healing process, to make adhesions less likely to form. OBJECTIVES: To evaluate the effectiveness and safety of fluid and pharmacological agents on rates of pain, live births, and adhesion prevention in women undergoing gynaecological surgery. SEARCH METHODS: We searched: the Cochrane Gynaecology and Fertility Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and Epistemonikos to 22 August 2019. We also checked the reference lists of relevant papers and contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials investigating the use of fluid (including gel) and pharmacological agents to prevent adhesions after gynaecological surgery. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures recommended by Cochrane. We assessed the overall quality of the evidence using GRADE methods. Outcomes of interest were pelvic pain; live birth rates; incidence of, mean, and changes in adhesion scores at second look-laparoscopy (SLL); clinical pregnancy, miscarriage, and ectopic pregnancy rates; quality of life at SLL; and adverse events. MAIN RESULTS: We included 32 trials (3492 women), and excluded 11. We were unable to include data from nine studies in the statistical analyses, but the findings of these studies were broadly in keeping with the findings of the meta-analyses. Hydroflotation agents versus no hydroflotation agents (10 RCTs) We are uncertain whether hydroflotation agents affected pelvic pain (odds ratio (OR) 1.05, 95% confidence interval (CI) 0.52 to 2.09; one study, 226 women; very low-quality evidence). It is unclear whether hydroflotation agents affected live birth rates (OR 0.67, 95% CI 0.29 to 1.58; two studies, 208 women; low-quality evidence) compared with no treatment. Hydroflotation agents reduced the incidence of adhesions at SLL when compared with no treatment (OR 0.34, 95% CI 0.22 to 0.55, four studies, 566 women; high-quality evidence). The evidence suggests that in women with an 84% chance of having adhesions at SLL with no treatment, using hydroflotation agents would result in 54% to 75% having adhesions. Hydroflotation agents probably made little or no difference to mean adhesion score at SLL (standardised mean difference (SMD) -0.06, 95% CI -0.20 to 0.09; four studies, 722 women; moderate-quality evidence). It is unclear whether hydroflotation agents affected clinical pregnancy rate (OR 0.64, 95% CI 0.36 to 1.14; three studies, 310 women; moderate-quality evidence) compared with no treatment. This suggests that in women with a 26% chance of clinical pregnancy with no treatment, using hydroflotation agents would result in a clinical pregnancy rate of 11% to 28%. No studies reported any adverse events attributable to the intervention. Gel agents versus no treatment (12 RCTs) No studies in this comparison reported pelvic pain or live birth rate. Gel agents reduced the incidence of adhesions at SLL compared with no treatment (OR 0.26, 95% CI 0.12 to 0.57; five studies, 147 women; high-quality evidence). This suggests that in women with an 84% chance of having adhesions at SLL with no treatment, the use of gel agents would result in 39% to 75% having adhesions. It is unclear whether gel agents affected mean adhesion scores at SLL (SMD -0.50, 95% CI -1.09 to 0.09; four studies, 159 women; moderate-quality evidence), or clinical pregnancy rate (OR 0.20, 95% CI 0.02 to 2.02; one study, 30 women; low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. Gel agents versus hydroflotation agents when used as an instillant (3 RCTs) No studies in this comparison reported pelvic pain, live birth rate or clinical pregnancy rate. Gel agents probably reduce the incidence of adhesions at SLL when compared with hydroflotation agents (OR 0.50, 95% CI 0.31 to 0.83; three studies, 538 women; moderate-quality evidence). This suggests that in women with a 46% chance of having adhesions at SLL with a hydroflotation agent, the use of gel agents would result in 21% to 41% having adhesions. We are uncertain whether gel agents improved mean adhesion scores at SLL when compared with hydroflotation agents (MD -0.79, 95% CI -0.82 to -0.76; one study, 77 women; very low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. Steroids (any route) versus no steroids (4 RCTs) No studies in this comparison reported pelvic pain, incidence of adhesions at SLL or mean adhesion score at SLL. It is unclear whether steroids affected live birth rates compared with no steroids (OR 0.65, 95% CI 0.26 to 1.62; two studies, 223 women; low-quality evidence), or clinical pregnancy rates (OR 1.01, 95% CI 0.66 to 1.55; three studies, 410 women; low-quality evidence). No studies in this comparison reported on adverse events attributable to the intervention. AUTHORS' CONCLUSIONS: Gels and hydroflotation agents appear to be effective adhesion prevention agents for use during gynaecological surgery, but we found no evidence indicating that they improve fertility outcomes or pelvic pain, and further research is required in this area. It is also worth noting that for some comparisons, wide confidence intervals crossing the line of no effect meant that clinical harm as a result of interventions could not be excluded. Future studies should measure outcomes in a uniform manner, using the modified American Fertility Society score. Statistical findings should be reported in full. No studies reported any adverse events attributable to intervention.


Assuntos
Anticoagulantes/uso terapêutico , Glucocorticoides/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Substitutos do Plasma/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Soluções para Reidratação/uso terapêutico , Aderências Teciduais/prevenção & controle , Coeficiente de Natalidade , Soluções para Diálise/uso terapêutico , Feminino , Géis/uso terapêutico , Humanos , Icodextrina/uso terapêutico , Infertilidade Feminina/prevenção & controle , Dor Pélvica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Cirurgia de Second-Look , Aderências Teciduais/epidemiologia
15.
Perit Dial Int ; 40(5): 509-512, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32063180

RESUMO

The osmolar gap increases with kidney failure. A number of equations have been proposed to calculate serum osmolality, allowing determination of the osmolar gap by comparison with measured osmolality. As glucose and icodextrin absorption can potentially interfere with the laboratory measurement of serum sodium, a key component in equations calculating osmolality, we reviewed the performance of 14 equations used to calculate serum osmolality compared to the measurement of serum osmolality in 144 patients with peritoneal dialysis (PD); 81 (56.3%) males, 76 (52.5%) diabetics, mean age of 64.4 ± 16.3 years, 115 (79.9%) prescribed icodextrin and 38 (26.4%) 22.7 g/L glucose dialysates. Measured serum osmolality was 311 (304-320) mosmo/kg (mmol/kg), whereas calculated osmolality for the 14 equations ranged from a median of 274 (269-284) mosmo/kg to 307 (300-316) mosmo/kg. Bland-Altman mean bias showed that measured serum osmolality was greater than the calculated osmolality ranging from 4.0 mosmo/kg to 36.2 mosmo/kg between the 14 equations, with wide 95% limits of agreement (LoA) ranging from -27.1 mosmo/kg to 19.4 mosmo/kg and from -58.5 mosmo/kg to -13.8 mosmo/kg. Only 2 of the 14 equations gave a mean osmolar gap of <10 mosmo/kg and showed no systematic bias, median serum osmolality of 307 (300-316) and 303 (298-312) mosmo/kg, Spearman ρ of 0.57, 0.62, both p < 0.001, respectively. Our study would suggest that only 2 of the 14 equations we compared with measured serum osmolality showed no systematic bias, but still had too great a bias to be useful in clinical practice. As such we propose a new equation to calculate serum osmolality in patients with PD.


Assuntos
Diálise Peritoneal , Idoso , Idoso de 80 Anos ou mais , Soluções para Diálise , Glucose , Humanos , Icodextrina , Masculino , Pessoa de Meia-Idade , Concentração Osmolar
16.
Perit Dial Int ; 40(2): 209-219, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32063201

RESUMO

BACKGROUND: Icodextrin is a high molecular weight, starch-derived glucose polymer that is used as an osmotic agent in peritoneal dialysis (PD) to promote ultrafiltration. There has been wide variation in its use across Australia and the rest of the world, but it is unclear whether these differences are due to patient- or centre-related factors. METHODS: Using the Australia and New Zealand Dialysis and Transplant Registry, all adult patients (>18 years) who started PD in Australia between 1 January 2007 and 31 December 2014 were included. The primary outcome was icodextrin use at PD commencement. Hierarchical logistic regression clustered around the treatment centre was applied to determine the patient- and centre-related characteristics associated with icodextrin use. The impact of centre-level practice pattern variability on icodextrin uptake was estimated using the intra-cluster correlation coefficient (ICC). RESULTS: Of 5948 patients starting on PD in 58 centres during the study period, 2002 (33.7%) received icodextrin from the outset. Overall uptake of icodextrin increased from 29% in 2010 to 42.5% in 2014. Patient-level characteristics associated with an increased likelihood of commencing PD with icodextrin included male sex (adjusted odds ratio (OR) 1.55, 95% confidence interval (CI) 1.35-1.77; p < 0.001), prior haemodialysis or kidney transplantation (OR 1.26, 95% CI 1.09-1.47), obesity (OR 1.66, 95% CI 1.41-1.96), diabetes mellitus (OR 2.32, 95% CI 2.03-2.64) and residing in a postcode with the highest decile of socio-economic status (OR 1.43, 95% CI 1.11-1.85). The centre-level characteristic associated with an increased likelihood of commencing PD with icodextrin was routine assessment of a peritoneal equilibration test (OR 1.45, 95% CI 1.27-1.66). Centres with fewer patients on automated peritoneal dialysis (APD) were less likely to start on icodextrin (APD proportion <57%; OR 0.45, 95% CI 0.20-0.99). Centre factors accounted for 25% of the variation in icodextrin use solution among incident PD patients (ICC 0.25). CONCLUSIONS: Icodextrin use in incident Australian PD patients is increasing variable and associated with both patient and centre characteristics. Centre-related factors explained 25% of variability in icodextrin use.


Assuntos
Soluções para Diálise/uso terapêutico , Icodextrina/uso terapêutico , Falência Renal Crônica/terapia , Diálise Peritoneal , Adulto , Idoso , Austrália , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Razão de Chances , Seleção de Pacientes , Padrões de Prática Médica , Sistema de Registros
17.
Am J Kidney Dis ; 75(6): 830-846, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32033860

RESUMO

RATIONALE & OBJECTIVE: The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. STUDY DESIGN: Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. SETTING & STUDY POPULATIONS: Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. SELECTION CRITERIA FOR STUDIES: Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. DATA EXTRACTION: 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. ANALYTIC APPROACH: Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. RESULTS: 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, -40.84 [95% CI, -48.09 to-33.59] g/long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (-0.50 [95% CI, -1.19 to 0.18] mmol/L; low certainty) and hemoglobin A1c levels (-0.14% [95% CI, -0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. LIMITATIONS: Trial quality was variable. The follow-up period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. CONCLUSIONS: Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and cost-effectiveness associated with icodextrin is needed.


Assuntos
Glucose/farmacologia , Icodextrina/farmacologia , Falência Renal Crônica/terapia , Diálise Peritoneal , Soluções para Diálise/farmacologia , Humanos , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
18.
Int J Artif Organs ; 43(7): 461-467, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31960740

RESUMO

BACKGROUND AND AIMS: Glucose-containing peritoneal dialysates are used to generate an osmotic gradient for the convective removal of water and sodium. Predictive equations were developed to estimate glucose absorption without having to formally measure changes in dialysate glucose. In view of the changes in peritoneal dialysis prescriptions over time, we compared predicted and measured glucose absorption. SUBJECTS/METHODS: We measured peritoneal glucose losses when peritoneal dialysis patients attended their first assessment of peritoneal membrane function, and compared this to glucose exposure and Kidney Disease Outcomes Quality Initiative, Grodstein and Bodnar predictive equations. RESULTS: We studied 689 patients; 329 (56.9%) males, 53 (37.1%) diabetics, with mean age 57.1 ± 16.2 years, with 186 treated by automated peritoneal dialysis cyclers and 377 by automated peritoneal dialysis with a daytime icodextrin exchange and 126 by continuous ambulatory peritoneal dialysis. Using Bland -Altman analysis, all equations demonstrated systematic bias overestimating glucose absorption with increasing glucose absorption. For continuous ambulatory peritoneal dialysis patients, the Kidney Disease Outcomes Quality Initiative formula underestimated glucose absorption (bias 188 (-39 to 437) mmol/day, as did Grodstein (bias 37.9 (-105 to 29) mmol/day, whereas mean bias for Bodnar was -29 (-130 to 180)). There was systematic overestimation for all equations for both automated peritoneal dialysis with and without a daytime exchange, with increasing bias with greater glucose absorption. CONCLUSION: Although formally measuring peritoneal glucose absorption is time consuming and requires patient co-operation, current predictive equations overestimate glucose absorption and do not provide accurate estimations of glucose absorption particularly for automated peritoneal dialysis patients.


Assuntos
Soluções para Diálise/farmacocinética , Glucose/farmacocinética , Icodextrina/farmacocinética , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritônio/metabolismo , Valor Preditivo dos Testes
19.
J Nephrol ; 33(2): 365-370, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31401794

RESUMO

BACKGROUND: Hypertension is common in peritoneal dialysis (PD) patients and associated with adverse outcomes. Besides solute clearance, PD convective clearance is used to control extracellular water (ECW) volume and sodium balance. Previous studies have reported on hypertension in PD patients treated with continuous ambulatory peritoneal dialysis (CAPD) using hypertonic glucose dialysates. However, increasing numbers of PD patients are now treated with automated peritoneal dialysis (APD) and icodextrin dialysates. As such, we wished to explore factors associated with systolic blood pressure (SBP) in a modern cohort to identify targets to improve blood pressure control in PD patients. METHODS: We retrospectively reviewed the results from PD patients attending for peritoneal membrane assessment who had corresponding bioimpedance ECW and brain natriuretic peptide (NT-proBNP) measurements. RESULTS: We studied 510 PD patients: 317 (72.2%) male, 216 (42.4%) diabetics, median age 59 (47-72) years, and 51% treated by APD with a day-time icodextrin exchange. Mean systolic blood pressure (SBP) was 140 ± 24.8 mmHg. SBP was independently associated with 4-hour dialysate to plasma creatinine ratio (ß = 29.5 (95% confidence limits 11.4-47.5, p = 0.001), N-terminal brain natriuretic peptide [ß = 11.9 (7.2-16.7), p < 0.001], and daily urine sodium excretion [ß = 1.7 (1.0-2.3), p < 0.001]. CONCLUSION: In the era of APD cyclers and icodextrin, SBP is associated with increased NT-proBNP, a marker of ECW expansion, and faster peritoneal transport, a risk factor for a positive sodium balance, and increased urinary sodium suggestive of higher dietary sodium intake. Patients should be encouraged to restrict sodium intake and PD prescriptions targeted to control ECW to improve SBP control.


Assuntos
Hipertensão/epidemiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Diálise Peritoneal , Idoso , Soluções para Diálise , Líquido Extracelular , Feminino , Humanos , Icodextrina , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Medicine (Baltimore) ; 98(50): e18391, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852155

RESUMO

During second-look surgery or hospitalization, intra-abdominal surgeries may cause severe postoperative complications, such as pelvic adhesion, postoperative ileus, and severe pain. However, only few studies have analyzed the outcomes of antiadhesive barriers in second-look surgery. This retrospective study aims to identify the outcomes of different antiadhesive barriers by analyzing surgical images. The study included patients who received an adhesion barrier during second-look surgery between January 2011 and November 2017. Four brands of adhesive barriers were used: Interceed, Seprafilm, Adept, and SurgiWrap. Adhesion scores were calculated for four quadrants of the uterus and surrounding structures before and after the use of antiadhesive barriers. The differences between the data of 2 observers and surgery times were also determined. A total of 18 patients were enrolled in the study. The adhesion scores were not significantly different before and after the placement of antiadhesive barriers. The difference in the adhesion scores between the two observers was also not significant, except in the Seprafilm group (P = .029). Furthermore, no significant change in the adhesion scores was observed between the first and second surgeries. Therefore, using adhesion barriers may not decrease the adhesion scores in the current setting.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Aderências Teciduais/prevenção & controle , Adulto , Celulose Oxidada/uso terapêutico , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Ácido Hialurônico/uso terapêutico , Icodextrina/uso terapêutico , Estudos Retrospectivos , Cirurgia de Second-Look/métodos , Resultado do Tratamento
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