Abstract
The advantages of peritoneal dialysis (PD) over hemodialysis (HD) are well-documented. Notwithstanding, only a small proportion of patients with end-stage renal disease (ESRD) are managed with PD. This may be related to the high glucose load that PD solutions in current use have on the patient. The effects of such excess glucose include the relatively early limitation of the ultrafiltration capacity of the peritoneal membrane, and the metabolic effects associated with hyperglycemia, e.g., decreased insulin sensitivity. This article describes the advantages that may be realized by the glucose-sparing effects of substituting part of the glucose load with other osmotically active metabolites, particularly L-carnitine. The latter is anticipated to have metabolic advantages of its own, especially as in PD patients, high plasma concentrations can be achieved in the absence of renal clearance. Besides its better biocompatibility, L-carnitine demonstrates anti-anemia action due to its effects on erythropoiesis, and positive effects on the longevity and deformability of erythrocytes. Observations from our trials on the use of carnitine-enriched PD solutions have demonstrated the effectiveness of L-carnitine as an efficient osmolyte in PD, and its favorable effect on the insulin sensitivity of the patients. The significance of these findings for future developments in the use of PD in the management of patients with ESRD is discussed.
Highlights
Peritoneal dialysis (PD) represents an established home-care, cost-effective modality of renal replacement therapy (RRT) for patients suffering from end-stage renal disease (ESRD)
ESRD requiring RRT is a growing problem worldwide and that it represents a significant economic burden to any health system [2], it is likely that PD will become more and more frequently used over the years
As APD has become increasingly popular as a PD modality, we explored the feasibility of adding L-carnitine to the PD solution in APD-treated ESRD patients [17]
Summary
Peritoneal dialysis (PD) represents an established home-care, cost-effective modality of renal replacement therapy (RRT) for patients suffering from end-stage renal disease (ESRD). Removal of excess water and retained uremic solutes provides benefits to the ESRD patient. PD solution ( called PD fluid; dialysate) is composed of physiological concentrations of electrolytes (sodium, calcium, magnesium, chloride), a buffer (lactate and/or bicarbonate), and an osmotic agent needed to remove excess water from the patient (peritoneal ultrafiltration). Glucose is the standard osmotic agent used in PD solution It has a molecular weight of 180 Da, a high osmotic capacity, low cost, an acceptable safety profile, and represents an energy source for patients who are often not well nourished. Prolonged exposure to the high glucose content in PD solution is thought to be associated with acceleration of the progressive changes in peritoneal membrane function, causing ultrafiltration failure [6].
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