Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients

James B. Moberly, Michael Sorkin, Andrew Kucharski, Kristen Ogle, James Mongoven, Line Skoufos, Lawrence Lin, Susan Bailey, Helen Rodela, Lou Mupas, Aziz Walele, Francis Ogrinc, Darci White, Marsha Wolfson, Leo Martis, Andrzej Breborowicz, Dimitrios G. Oreopoulos

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Hyaluronan (HA) is a glycosaminoglycan found in connective tissues and tissue spaces, including the peritoneal cavity. In vivo studies in a rat model of peritoneal dialysis (PD) have shown that addition of HA to PD solution during an intraperitoneal dwell can alter peritoneal fluid transport and protect the peritoneal membrane from the effects of inflammation and repeated infusions of dialysis solution. The current study sought to evaluate the safety of intraperitoneal HA and its effect on peritoneal fluid and solute transport when administered during a dialysis dwell in humans. Methods: 13 PD patients were enrolled in a prospective, randomized crossover study involving three dialysis treatments using the following PD solutions: (1) a commercially available PD solution (Dianeal PD-4, 1.36% glucose; Baxter Healthcare Corporation, Alliston, Ontario, Canada); (2) Dianeal PD-4 containing 0.1 g/L HA, and (3) Dianeal PD-4 containing 0.5 g/L HA. Each 6-hour dialysis exchange was separated from the other exchanges by a 2-week washout period. Radioiodinated human serum albumin (RISA) was administered with the dialysis solution to evaluate intraperitoneal volume, net ultrafiltration (UF), and fluid reabsorption. Peritoneal clearances, dialysate/plasma ratios (D/P), and mass transfer area coefficients (MTACs) were determined for sodium, urea, creatinine, albumin, and glucose. Safety was evaluated by monitoring adverse events and changes in serum chemistries. Ten patients completed all three dialysis exchanges and two additional patients completed at least one treatment exchange. Results: There were no reported adverse events related to HA administration and no significant changes in serum chemistries. There were no significant differences in net UF or peritoneal volume profiles among the three treatments. Mean net UF calculated using residual volumes, estimated by RISA dilution, tended to be slightly higher during treatment with solution containing 0.1 g/L HA and 0.5 g/L HA [74 ± 86 (SE) and 41 ± 99 mL, respectively] compared to control treatment (-58 ± 129 mL). Although not statistically significant, there was a trend toward decreased fluid reabsorption during treatment with HA. Solute clearances, D/P ratios, and MTACs were similar for the three treatments. Serum levels of HA were also unaffected by the two treatment solutions. Conclusions: These data support the acute safety of HA when administered intraperitoneally with the dialysis solution to PD patients. Due to the small sample size and variability in net UF and fluid reabsorption, statistically significant differences were not demonstrated for these parameters. However, a trend toward decreased fluid reabsorption was observed, suggesting that HA may act by a mechanism similar to that observed in animal studies. Further studies are necessary to evaluate whether the beneficial effects of HA observed in animal studies can be shown in humans.

Original languageEnglish (US)
Pages (from-to)63-73
Number of pages11
JournalPeritoneal Dialysis International
Volume23
Issue number1
StatePublished - Jan 2003
Externally publishedYes

Fingerprint

Ascitic Fluid
Peritoneal Dialysis
Hyaluronic Acid
Dialysis Solutions
Ultrafiltration
Dialysis
Radio-Iodinated Serum Albumin
Therapeutics
Safety
Serum
Glucose
Residual Volume
Peritoneal Cavity
Ontario
Glycosaminoglycans
Connective Tissue
Sample Size
Cross-Over Studies
Canada
Urea

Keywords

  • Glycosaminoglycan
  • Hyaluronic acid
  • Peritoneal membrane

ASJC Scopus subject areas

  • Nephrology

Cite this

Moberly, J. B., Sorkin, M., Kucharski, A., Ogle, K., Mongoven, J., Skoufos, L., ... Oreopoulos, D. G. (2003). Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients. Peritoneal Dialysis International, 23(1), 63-73.

Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients. / Moberly, James B.; Sorkin, Michael; Kucharski, Andrew; Ogle, Kristen; Mongoven, James; Skoufos, Line; Lin, Lawrence; Bailey, Susan; Rodela, Helen; Mupas, Lou; Walele, Aziz; Ogrinc, Francis; White, Darci; Wolfson, Marsha; Martis, Leo; Breborowicz, Andrzej; Oreopoulos, Dimitrios G.

In: Peritoneal Dialysis International, Vol. 23, No. 1, 01.2003, p. 63-73.

Research output: Contribution to journalArticle

Moberly, JB, Sorkin, M, Kucharski, A, Ogle, K, Mongoven, J, Skoufos, L, Lin, L, Bailey, S, Rodela, H, Mupas, L, Walele, A, Ogrinc, F, White, D, Wolfson, M, Martis, L, Breborowicz, A & Oreopoulos, DG 2003, 'Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients', Peritoneal Dialysis International, vol. 23, no. 1, pp. 63-73.
Moberly JB, Sorkin M, Kucharski A, Ogle K, Mongoven J, Skoufos L et al. Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients. Peritoneal Dialysis International. 2003 Jan;23(1):63-73.
Moberly, James B. ; Sorkin, Michael ; Kucharski, Andrew ; Ogle, Kristen ; Mongoven, James ; Skoufos, Line ; Lin, Lawrence ; Bailey, Susan ; Rodela, Helen ; Mupas, Lou ; Walele, Aziz ; Ogrinc, Francis ; White, Darci ; Wolfson, Marsha ; Martis, Leo ; Breborowicz, Andrzej ; Oreopoulos, Dimitrios G. / Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients. In: Peritoneal Dialysis International. 2003 ; Vol. 23, No. 1. pp. 63-73.
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abstract = "Background: Hyaluronan (HA) is a glycosaminoglycan found in connective tissues and tissue spaces, including the peritoneal cavity. In vivo studies in a rat model of peritoneal dialysis (PD) have shown that addition of HA to PD solution during an intraperitoneal dwell can alter peritoneal fluid transport and protect the peritoneal membrane from the effects of inflammation and repeated infusions of dialysis solution. The current study sought to evaluate the safety of intraperitoneal HA and its effect on peritoneal fluid and solute transport when administered during a dialysis dwell in humans. Methods: 13 PD patients were enrolled in a prospective, randomized crossover study involving three dialysis treatments using the following PD solutions: (1) a commercially available PD solution (Dianeal PD-4, 1.36{\%} glucose; Baxter Healthcare Corporation, Alliston, Ontario, Canada); (2) Dianeal PD-4 containing 0.1 g/L HA, and (3) Dianeal PD-4 containing 0.5 g/L HA. Each 6-hour dialysis exchange was separated from the other exchanges by a 2-week washout period. Radioiodinated human serum albumin (RISA) was administered with the dialysis solution to evaluate intraperitoneal volume, net ultrafiltration (UF), and fluid reabsorption. Peritoneal clearances, dialysate/plasma ratios (D/P), and mass transfer area coefficients (MTACs) were determined for sodium, urea, creatinine, albumin, and glucose. Safety was evaluated by monitoring adverse events and changes in serum chemistries. Ten patients completed all three dialysis exchanges and two additional patients completed at least one treatment exchange. Results: There were no reported adverse events related to HA administration and no significant changes in serum chemistries. There were no significant differences in net UF or peritoneal volume profiles among the three treatments. Mean net UF calculated using residual volumes, estimated by RISA dilution, tended to be slightly higher during treatment with solution containing 0.1 g/L HA and 0.5 g/L HA [74 ± 86 (SE) and 41 ± 99 mL, respectively] compared to control treatment (-58 ± 129 mL). Although not statistically significant, there was a trend toward decreased fluid reabsorption during treatment with HA. Solute clearances, D/P ratios, and MTACs were similar for the three treatments. Serum levels of HA were also unaffected by the two treatment solutions. Conclusions: These data support the acute safety of HA when administered intraperitoneally with the dialysis solution to PD patients. Due to the small sample size and variability in net UF and fluid reabsorption, statistically significant differences were not demonstrated for these parameters. However, a trend toward decreased fluid reabsorption was observed, suggesting that HA may act by a mechanism similar to that observed in animal studies. Further studies are necessary to evaluate whether the beneficial effects of HA observed in animal studies can be shown in humans.",
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T1 - Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients

AU - Moberly, James B.

AU - Sorkin, Michael

AU - Kucharski, Andrew

AU - Ogle, Kristen

AU - Mongoven, James

AU - Skoufos, Line

AU - Lin, Lawrence

AU - Bailey, Susan

AU - Rodela, Helen

AU - Mupas, Lou

AU - Walele, Aziz

AU - Ogrinc, Francis

AU - White, Darci

AU - Wolfson, Marsha

AU - Martis, Leo

AU - Breborowicz, Andrzej

AU - Oreopoulos, Dimitrios G.

PY - 2003/1

Y1 - 2003/1

N2 - Background: Hyaluronan (HA) is a glycosaminoglycan found in connective tissues and tissue spaces, including the peritoneal cavity. In vivo studies in a rat model of peritoneal dialysis (PD) have shown that addition of HA to PD solution during an intraperitoneal dwell can alter peritoneal fluid transport and protect the peritoneal membrane from the effects of inflammation and repeated infusions of dialysis solution. The current study sought to evaluate the safety of intraperitoneal HA and its effect on peritoneal fluid and solute transport when administered during a dialysis dwell in humans. Methods: 13 PD patients were enrolled in a prospective, randomized crossover study involving three dialysis treatments using the following PD solutions: (1) a commercially available PD solution (Dianeal PD-4, 1.36% glucose; Baxter Healthcare Corporation, Alliston, Ontario, Canada); (2) Dianeal PD-4 containing 0.1 g/L HA, and (3) Dianeal PD-4 containing 0.5 g/L HA. Each 6-hour dialysis exchange was separated from the other exchanges by a 2-week washout period. Radioiodinated human serum albumin (RISA) was administered with the dialysis solution to evaluate intraperitoneal volume, net ultrafiltration (UF), and fluid reabsorption. Peritoneal clearances, dialysate/plasma ratios (D/P), and mass transfer area coefficients (MTACs) were determined for sodium, urea, creatinine, albumin, and glucose. Safety was evaluated by monitoring adverse events and changes in serum chemistries. Ten patients completed all three dialysis exchanges and two additional patients completed at least one treatment exchange. Results: There were no reported adverse events related to HA administration and no significant changes in serum chemistries. There were no significant differences in net UF or peritoneal volume profiles among the three treatments. Mean net UF calculated using residual volumes, estimated by RISA dilution, tended to be slightly higher during treatment with solution containing 0.1 g/L HA and 0.5 g/L HA [74 ± 86 (SE) and 41 ± 99 mL, respectively] compared to control treatment (-58 ± 129 mL). Although not statistically significant, there was a trend toward decreased fluid reabsorption during treatment with HA. Solute clearances, D/P ratios, and MTACs were similar for the three treatments. Serum levels of HA were also unaffected by the two treatment solutions. Conclusions: These data support the acute safety of HA when administered intraperitoneally with the dialysis solution to PD patients. Due to the small sample size and variability in net UF and fluid reabsorption, statistically significant differences were not demonstrated for these parameters. However, a trend toward decreased fluid reabsorption was observed, suggesting that HA may act by a mechanism similar to that observed in animal studies. Further studies are necessary to evaluate whether the beneficial effects of HA observed in animal studies can be shown in humans.

AB - Background: Hyaluronan (HA) is a glycosaminoglycan found in connective tissues and tissue spaces, including the peritoneal cavity. In vivo studies in a rat model of peritoneal dialysis (PD) have shown that addition of HA to PD solution during an intraperitoneal dwell can alter peritoneal fluid transport and protect the peritoneal membrane from the effects of inflammation and repeated infusions of dialysis solution. The current study sought to evaluate the safety of intraperitoneal HA and its effect on peritoneal fluid and solute transport when administered during a dialysis dwell in humans. Methods: 13 PD patients were enrolled in a prospective, randomized crossover study involving three dialysis treatments using the following PD solutions: (1) a commercially available PD solution (Dianeal PD-4, 1.36% glucose; Baxter Healthcare Corporation, Alliston, Ontario, Canada); (2) Dianeal PD-4 containing 0.1 g/L HA, and (3) Dianeal PD-4 containing 0.5 g/L HA. Each 6-hour dialysis exchange was separated from the other exchanges by a 2-week washout period. Radioiodinated human serum albumin (RISA) was administered with the dialysis solution to evaluate intraperitoneal volume, net ultrafiltration (UF), and fluid reabsorption. Peritoneal clearances, dialysate/plasma ratios (D/P), and mass transfer area coefficients (MTACs) were determined for sodium, urea, creatinine, albumin, and glucose. Safety was evaluated by monitoring adverse events and changes in serum chemistries. Ten patients completed all three dialysis exchanges and two additional patients completed at least one treatment exchange. Results: There were no reported adverse events related to HA administration and no significant changes in serum chemistries. There were no significant differences in net UF or peritoneal volume profiles among the three treatments. Mean net UF calculated using residual volumes, estimated by RISA dilution, tended to be slightly higher during treatment with solution containing 0.1 g/L HA and 0.5 g/L HA [74 ± 86 (SE) and 41 ± 99 mL, respectively] compared to control treatment (-58 ± 129 mL). Although not statistically significant, there was a trend toward decreased fluid reabsorption during treatment with HA. Solute clearances, D/P ratios, and MTACs were similar for the three treatments. Serum levels of HA were also unaffected by the two treatment solutions. Conclusions: These data support the acute safety of HA when administered intraperitoneally with the dialysis solution to PD patients. Due to the small sample size and variability in net UF and fluid reabsorption, statistically significant differences were not demonstrated for these parameters. However, a trend toward decreased fluid reabsorption was observed, suggesting that HA may act by a mechanism similar to that observed in animal studies. Further studies are necessary to evaluate whether the beneficial effects of HA observed in animal studies can be shown in humans.

KW - Glycosaminoglycan

KW - Hyaluronic acid

KW - Peritoneal membrane

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