Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2024 Feb 1;19(2):224-232.
doi: 10.2215/CJN.0000000000000342. Epub 2023 Oct 30.

Effects of Steady Glucose Concentration Peritoneal Dialysis on Ultrafiltration Volume and Sodium Removal: A Pilot Crossover Trial

Olof Heimbürger  1 , Jörgen Hegbrant  2 , Giedre Martus  3 , Martin Wilkie  4 , Charlotte De Leon  5 , Ola Carlsson  5 , Ann-Cathrine Johansson  6
Affiliations
Clinical Trial

Effects of Steady Glucose Concentration Peritoneal Dialysis on Ultrafiltration Volume and Sodium Removal: A Pilot Crossover Trial

Olof Heimbürger et al. Clin J Am Soc Nephrol. .

Abstract

Background: Volume overload is common in patients treated with peritoneal dialysis (PD) and is associated with poor clinical outcome. Steady concentration PD is where a continuous glucose infusion maintains the intraperitoneal glucose concentration and as a result provides continuous ultrafiltration throughout the dwell. The primary objective of this study was to investigate the ultrafiltration rate and glucose ultrafiltration efficiency for steady concentration PD in comparison with a standard continuous ambulatory PD (CAPD) dwell, using the novel Carry Life UF device.

Methods: Eight stable patients treated with PD (six fast and two fast average transporters) were investigated four times: a standard 4-hour CAPD dwell with 2 L of 2.5% dextrose solution as control and three 5-hour steady concentration PD treatments (glucose dose 11, 14, 20 g/h, initial fill 1.5 L of 1.5% dextrose solution). All investigations were preceded by an overnight 2 L 7.5% icodextrin dwell.

Results: Intraperitoneal glucose concentration increased during the first 1-2 hours of the steady concentration PD treatments and remained stable thereafter. Ultrafiltration rates were significantly higher with steady concentration PD treatments (124±49, 146±63, and 168±78 mL/h with 11, 14, and 20 g/h, respectively, versus 40±60 mL/h with the control dwell). Sodium removal and glucose ultrafiltration efficiency (ultrafiltration volume/gram glucose uptake) were significantly higher with steady concentration PD treatments versus the control dwell, where the 11 g/h glucose dose was most efficient.

Conclusions: Steady concentration PD performed with the Carry Life UF device resulted in higher ultrafiltration rates, more efficient use of glucose (increased ultrafiltration volume/gram glucose absorbed), and greater sodium removal compared with a standard 2.5% dextrose CAPD dwell.

Clinical trial registry name and registration number: A Performance Analysis of the Peritoneal Ultrafiltration (PUF) Achieved With the Carry Life ® UF, NCT03724682 .

PubMed Disclaimer

Conflict of interest statement

O. Carlsson and C. De Leon report employment with Triomed AB. J. Hegbrant reports employment with JBA Medical AB; consultancy for Triomed AB; ownership interest in Diaverum AB, LundaTec AB, NorrDia AB, Redsense Medical AB, and Triomed AB; and advisory or leadership roles for Board of Directors of NorrDia AB and Redsense Medical AB. O. Heimbürger reports research funding from AstraZeneca, Baxter, and Triomed; honoraria from AstraZeneca, Baxter Healthcare, Fresenius Medical Care, and Vifor for presentations at company-organized courses; speakers bureau for AstraZeneca; and other interests or relationships as Secretary of Swedish Society of Renal Medicine (2021); and role on Editorial Boards of Blood Purification, Clinical Nephrology, Peritoneal Dialysis International, and Turkish Journal of Nephrology. G. Martus reports research funding from The Swedish Kidney Foundation to Lunds University and from The Swedish Foundation for Kidney Disease to Lunds University and other interests or relationships from Triomed AB (Lund, Sweden) as a clinical study principal investigator. M. Wilkie reports consultancy for Triomed, research funding from Baxter, honoraria from Baxter and Fresenius, speakers bureau for Baxter, and other interests or relationships with International Society for Peritoneal Dialysis. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Carry Life UF device used in the study.
Figure 2
Figure 2
Dialysate glucose concentration decreased with the 2.5% dextrose CAPD dwell, whereas it increased initially during 1–2 hours and then remained stable during the three steady concentration PD treatments. Data are presented as mean±SD. CAPD, continuous ambulatory peritoneal dialysis; PD, peritoneal dialysis.
Figure 3
Figure 3
Ultrafiltration rate, glucose ultrafiltration efficiency, and sodium removal increased with the three different glucose doses of steady concentration PD, whereas glucose absorption rate only increased for the higher glucose doses. Ultrafiltration rate (A), glucose absorption rate (B), glucose ultrafiltration (UF) efficiency calculated as ultrafiltration volume in milliliter per gram glucose absorbed (C), sodium removal (D), and calculated sodium concentration in UF volume (E), with the 2.5% dextrose CAPD dwell and with the three steady concentration PD treatments. Data are presented as mean±SD. Significant differences are denoted #P < 0.05, ##P < 0.01, ###P < 0.001 versus the CAPD dwell.
Figure 4
Figure 4
Dialysate sodium concentration only had a small initial decline during the 2.5% dextrose CAPD dwell but decreased continuously during the three steady concentration PD treatments. Data are presented as mean±SD.
See this image and copyright information in PMC

References

    1. Fresenius Medical Care AG & Co. KGaA. Fresenius Medical Care Annual Report 2021 Table 2.20, page 38. 2021. Accessed November 7, 2023. https://www.freseniusmedicalcare.com/fileadmin/data/com/pdf/Media_Center...
    1. Perl J Davies SJ Lambie M, et al. . The peritoneal dialysis outcomes and practice patterns study (PDOPPS): unifying efforts to inform practice and improve global outcomes in peritoneal dialysis. Perit Dial Int. 2016;36(3):297–307. doi:10.3747/pdi.2014.00288 - DOI - PMC - PubMed
    1. Mehrotra R, Devuyst O, Davies SJ, Johnson DW. The current state of peritoneal dialysis. J Am Soc Nephrol. 2016;27(11):3238–3252. doi:10.1681/ASN.2016010112 - DOI - PMC - PubMed
    1. Ng JK Kwan BC Chow KM, et al. . Asymptomatic fluid overload predicts survival and cardiovascular event in incident Chinese peritoneal dialysis patients. PLoS One. 2018;13(8):e0202203. doi:10.1371/journal.pone.0202203 - DOI - PMC - PubMed
    1. Vrtovsnik F Verger C Van Biesen W, et al. . The impact of volume overload on technique failure in incident peritoneal dialysis patients. Clin Kidney J. 2021;14(2):570–577. doi:10.1093/ckj/sfz175 - DOI - PMC - PubMed

Associated data