Solutions for peritoneal dialysis - instructions for use, dose, side effects, contraindications

The solution for peritoneal dialysis with a glucose concentration of 1.5%, 2.3% and 4.25% is a solution of electrolytes containing glucose and a lactate buffer administered intraperitoneally to treat the terminal stage of chronic renal failure and acute renal failure of various genesis by peritoneal dialysis (PD).

The method of permanent ambulatory peritoneal dialysis (CAPD) is provided by the presence of a dialysis solution (usually 2 liters) in the abdominal cavity, which is replaced with fresh solution from 3 to 5 times a day.

The basic principle underlying the peritoneal dialysis is the use of the peritoneum as a semipermeable membrane through which the exchange of dissolved substances and water between the blood and the dialysis solution through diffusion is possible in accordance with their physico-chemical properties.

The electrolyte composition of the solution does not differ from the physiological one, although it is adapted (for example, potassium content) for use in patients with uremia in order to make possible renal replacement therapy by intraperitoneal metabolism and fluid.

During the dialysis procedure, substances normally excreted in the urine, such as the products of nitrogen metabolism (urea, creatinine), inorganic phosphates, uric acid, other solutes, and water, are excreted from the body with dialysate.

Water balance can be maintained by applying solutions with different concentrations of glucose, providing liquid removal (ultrafiltration). Secondary metabolic acidosis is compensated by the presence of lactate in the dialysis solution. Lactate is completely metabolized to bicarbonate.

Ultrafiltration of peritoneal fluid (removal of substances normally excreted in the urine - urea, creatinine, inorganic phosphates, uric acid, other substances and water).

Compensation of metabolic acidosis (for solutions containing lactate)

Pharmacokinetics:Penetration of ions through the peritoneal membrane by osmosis and diffusion. Absorbed electrolytes are included in the cellular metabolism. Glucose is metabolized in various ways: by glycolysis - to pyruvate, in the pentose-phosphate cycle - to carbon dioxide and water. Elimination in an unchanged form is carried out by the kidneys.

Indications:

Acute or chronic renal failure, marked hyperhydration, electrolyte imbalance, xenobiotic intoxication.

Peritoneal dialysis in patients with malnutrition syndrome (serum albumin concentration is less than 35 g / l).

ICD-10

XIV.N17-N19.N17 Acute kidney failure

XIV.N17-N19.N18.0 Terminal stage of kidney damage

Contraindications:

Contraindications for peritoneal dialysis as a method:

- Diseases affecting the integrity of the abdominal wall or peritoneal cavity, such as: fresh wound, burns or extensive inflammatory skin lesions (dermatitis) in the area of the exit site of the catheter, peritonitis; perforation of the hollow organs of the abdominal cavity; abdominal surgery in history with the development of fibrous adhesions, inflammatory bowel disease (Crohn's disease, ulcerative colitis, diverticulosis), intra-abdominal tumors, recent surgery on the abdominal cavity, paralytic intestinal obstruction, abdominal hernia; internal or external abdominal fistulas;

- Diseases of the respiratory system, especially pneumonia;

- sepsis;

- lactate acidosis;

- cachexia and a significant decrease in body weight, especially if adequate nutrition is not possible;

- in cases when uremia, it is not amenable to therapy with peritoneal dialysis; severe hyperlipidemia;

- use in patients who are physically or mentally (psychosis, dementia) are unable to comply with the doctor's instructions for peritoneal dialysis procedures.

Contraindications for a solution with a glucose content of 1.5%, 2.3%, 4.25%:

- pronounced hypokalemia;

Contraindications for a solution with a glucose content of 4.25% in addition:

- hypovolemia;

- arterial hypotension.

Contraindications for a solution with a calcium content of 1.75 mmol / l:

severe hypercalcemia.

Carefully:Hypersensitivityhypokalemia, extensive adhesive process in the abdominal cavity, inflammatory bowel diseases, hernia, intestinal obstruction; lung diseases (especially pneumonia), infectious skin diseases, cachexia, hypoproteinemia, blindness, tetraplegia, arthritis (severe course), mental retardation; psychosis, colostomy, hyperlipidemia, pregnancy, breast-feeding. For the drug nutrinil PD 4 with a 1.1% amino acid content: uncontrolled acidosis, severe hepatic insufficiency, hyperammonemia, hypersensitivityto one or more amino acids that make up the drug, children's age (efficacy and safety not established)

Pregnancy and lactation:

Category of recommendations FDA is not defined. Adequate and well-controlled studies in humans and animals have not been conducted. Use with caution.

There is no information on the penetration into breast milk. Use with caution.

The solution for peritoneal dialysis should be used in pregnant and / or breast-feeding women only after careful comparison of the possible benefits for the mother and the risk to the fetus and the baby.

Dosing and Administration:

Acute or chronic renal failure, severe hyperhydration, electrolyte imbalance, xenobiotic intoxication:

Intraperitoneal infusion (via peritoneal catheter) is performed in accordance with the rules of asepsis. Entered volume (in each cycle) depends on the patient's body weight - 1,5-2 l (30-40 ml / kg per procedure). The injection time is 5-20 minutes.

The solution must be heated to body temperature. The time of the solution in the abdominal cavity depends on the indications and the condition of the patient is determined by the doctor (usually 3-5 daily changes of the solution in a volume of 2 liters after 4-8 hours and the introduction of hypertonic solution overnight).If the abdominal wall tension is detected before the procedure begins, the dose should be reduced. Patients with excess body weight and / or resistant to large volumes of filling are injected with 2.5-3 liters of solution.

Peritoneal dialysis in patients with malnutrition syndrome (serum albumin concentration less than 35 g / L):

It is intraperitoneal. A 2 L solution containing 1.1% amino acids provides the introduction of 22 g of amino acids, equivalent to 0.3 g / kg per day for an adult patient weighing about 70 kg.

The recommended daily intake of protein is about 1.2-1.3 g / kg for adults and 3 g / kg for children. In certain catabolic processes, large amounts can be administered. The need for re-treatment is assessed by clinical and biochemical parameters after 3 months.

Use in children.

Acute or chronic renal failure, marked hyperhydration, electrolyte imbalance, xenobiotic intoxication.

It is intraperitoneal. To introduce 1 liter of solution.

Side effects:

Violations of water-electrolyte metabolism, including hypokalemia, hypoproteinemia, increase or decrease in blood pressure, violation of the acid-base state.

Convulsions, hyperglycemia (in patients with diabetes mellitus), loss of amino acids and water-soluble vitamins, metabolic acidosis, hyperaemia.

Due to the dialysis procedure: abdominal pain, a feeling of distension in the abdomen, dyspepsia, a hernia; pain in the shoulder girdle, dyspnea (due to elevation of the diaphragm), bleeding, peritonitis, diarrhea, intestinal spasms, intestinal obstruction, hypo- or hypervolemia, displacement or occlusion of the catheter, infection of the catheter site, and reduction of ultrafiltration.

Overdose:

Symptoms: dyspnea.

Treatment: with excessive administration - removal of the solution from the abdominal cavity at any time.

Interaction:

When mixing different drugs, you need to pay attention to the pH and the presence of salts, be sure to check compatibility.

It is possible to reduce the concentration of drugs taken simultaneously; correction of their dose is necessary.

Due to the low pH of the solution, it may be necessary to administer sodium bicarbonate.

Diuretics - increased risk of development of violations of water-electrolyte balance.

To prevent the deposition of fibrin in the catheter, it is possible to addperitoneal solution of sodium heparin.

Calcium-containing medicines or vitamin D - the risk of hypercalcemia.

You may need to adjust the dose of insulin or hypoglycemic drugs taken orally.

Cardiac glycosides - strengthening of their arrhythmogenic action, control of K + concentration is necessary.

Special instructions:

A cross-over hypersensitivity to the drugs of this group is possible.

Do not use the solution if leakage is detected.

Penetration of ions through the peritoneal membrane is due to osmosis and diffusion; absorbed electrolytes are included in the cellular metabolism.

Solutions differ in the degree of osmotic pressure (depending on the content of dextrose); Hyperosmolar with respect to plasma solution promotes fluid filtration from it into the abdominal cavity and electrolytes into the plasma.

Separable (two-pack and Y-shaped) systems outperform conventional systems for the prevention of peritonitis associated with prolonged outpatient peritoneal dialysis. The advantages of using two-pack or Y-shaped systems are unknown, although the number of studies is limited.Further randomized clinical trials comparing the use of two-pack and Y-shaped systems (as a standard of care) with new peritoneal dialysis techniques are needed.

To prevent dehydration, hypovolemia and reduce protein loss, it is recommended to choose a solution with the least necessary osmolarity.

A solution for peritoneal dialysis is used for emergency and long-term therapy, either alone or in combination with other solutions.

The use of hypertonic solutions for peritoneal dialysis can lead to dehydration.

The development of peritonitis reduces the possibility of effective ion exchange through the peritoneal membrane.

With prolonged peritoneal dialysis (peritonitis), a diet with a high protein content (not less than 1.2-1.5 g / kg per day) is recommended to compensate for losses.

The loss of protein, amino acids, water-soluble vitamins during peritoneal dialysis requires their replenishment.

With prolonged peritoneal dialysis, an increase in body weight due to glucose uptake from the dialysate solution is possible; it is necessary to follow a low-calorie diet.

When choosing the dialysate solution (dextrose concentration, Na +, Ca2 + and K +), it is necessary to take into account the nature of metabolic disorders in patients with uremia, nutrition features and therapeutic aspects.

During the procedure, it is necessary to follow the rules of asepsis and to control biochemical and hematological parameters, hydration indices and osmolarity of the plasma.

Turbidity (filaments of fibrin) in the withdrawn solution, abdominal pain can indicate the development of infection.

Do not use intravenously ..

It is necessary to control the concentration of electrolytes in blood plasma (Ca2 +, Mg2 + and bicarbonate), body weight, biochemical and hematological parameters, balance of injected and withdrawn liquid.

Do not apply 5 liters of solution or more in one procedure.

Contained in solution dextrose can lead to hyperglycemia. Regular monitoring of glucose concentration, correction of insulin dose in diabetes mellitus is necessary.

Once the protective wrap is opened, check the tightness of the bag by squeezing it.

The drug is intended for single use only! The introduction of residual solutions from the previous introduction is unacceptable.

Never use packages with opaque content. All unused portions of the solution should be discarded. Solutions for peritoneal dialysis can not be administered intravenously. Due to the existing risk of incompatibility and microbial contamination, other medicines can be added to the peritoneal solution only for the purpose of the attending physician. In this case, the solution should be used immediately (without storage) after thorough mixing and checking for transparency.

Instructions

Solutions for peritoneal dialysis (Peritoneal dialysis solutions)