At the end of the first dialysis session of the week, serum bicarbonate was 22.3 [+ or -] 2.7 mEq/L, which is 9 mEq/L below the
dialysate bicarbonate concentration.
It is also advised that the APD machine be equipped with a complete automatic monitoring and alarm device to ensure the safety of the treatment,[17],[18] which includes a temperature control system,
dialysate measurement system,
dialysate sequential flow control system, pressure sensing control system, and liquid discharge alarm system.
In most cases,
dialysate sodium and bicarbonate modification was dictated by researchers and clinicians' experience, as well as baseline bicarbonate level (Apsner et al., 2001; Apsner et al., 2005; Buturovic et al., 2008; Buturovic-Ponikvar et al., 2005; Buturovic-Ponikvar et al., 2008a; Evenepoel et al., 2007; Gubensek et al., 2007; Richtrova et al., 2011; Singer et al., 2016; Strobl et al., 2013; Wright et al., 2011).
Risks to Individuals of Exposure to Improperly Prepared Water or
DialysateIn PD patients, the cloudy
dialysate may lead to initiation of unnecessary antibiotics and delayed investigations.
Water (pre- and post-osmosis) and
dialysate samples of approximately 200 mL were collected using sterile flasks.
All other microbiological techniques and estimation of lipolytic activity in cell-free
dialysate (x 10) were as mentioned before.
Potential protective strategies against DDS have been proposed in the literature, including slower blood and
dialysate flows, smaller surface area dialyzer membranes, and high sodium and low bicarbonate concentrations in the
dialysate [14].
The method can be applied with
dialysates prepared with albumin in classic hemodialysis devices and therefore it seems that it will have a wider area of use compared with complex and high-cost systems including molecular adsorbent recirculating system (MARS).
Very few nephrologists will choose to continue PD treatment while the patient has persistent leaking of
dialysate. The usual management is cessation of PD and conversion to temporary haemodialysis for 2-4 weeks.2,3 In order to avoid the inconvenience of changing to heamodialysis, some authors dialyze patients by using low volume intermittent PD;4 or Automated PD at night with icodextrin at daytime.5 Use of hypertonic solutions with "night time rest" had been described as well.5 Patients with recurrent pleural effusion can be managed by pleurodesis with tetracycline, talc or autologous blood.6 Diagnostic and therapeutic video-assisted thoracoscopy (VATS) allows identification and closure of any defects in the diaphragm.
The side holes and enlarged diameter of the lumen enhance drainage and absorption of
dialysate. The Tenckhoff catheter also has a low incidence of leakage (Cullis et al., 2014).
Physicians usually use clinical parameters such as abdominal pain and
dialysate white blood cells (WBC) to monitor treatment response.
