CAP

Kapd is a solution used for peritoneal dialysis procedures.

Indications Together

It is used to treat such disorders:

• failure of renal function, which is chronic (in the terminal phase);
• Insufficiency of renal activity in acute degree (having a different origin).

[1], [2], [3], [4], [5]

Release form

The release is made in the form of a solution, inside a double system of special bags, having a volume of 2 or 2.5 liters. Inside the package there are 4 such bags.

[6], [7]

Pharmacodynamics

The medicine is an electrolyte liquid, which contains dextrose with lactate buffer. It is necessary to administer the medication intraperitoneally, by dialysis.

With continuous peritoneal dialysis of an outpatient nature, there is a more or less constant presence of dialysis fluid (often this volume is 2 liters) inside the peritoneum. This substance is replaced with a fresh medicamentous solution 3-5 times a day.

The main mechanism for conducting peritoneal dialysis sessions is the use of the peritoneum as a semipermeable wall through which the exchange of dissolved components and water (according to their physicochemical parameters) can be performed between the dialysis fluid and blood through diffusion.

The electrolyte content of the drug usually does not differ from the physiological fluid, although it is adapted (for example, by the presence of potassium) for use in people with uremia. This makes it possible to perform replacement renal treatment by intraperitoneal metabolism of drug components and fluids.

During the dialysis session, elements that are normally excreted in the urine (among them uremic toxins (creatinine with urea), uric acid, and in addition, inorganic phosphates, other dissolved components and water) are then removed together with the dialysate. To maintain the balance of the liquid can be using solutions that contain different indicators of glucose, helping to remove the liquid (the process of ultrafiltration).

The secondary stage of acidosis, which has a metabolic character, is compensated by the presence of lactate inside the dialysis fluid (this substance is fully metabolized, transforming into bicarbonate).

[8], [9], [10], [11], [12]

Dosing and administration

The medicine needs to be preheated to the body temperature level, and then injected into the peritoneum through a special peritoneal catheter, which is established by a surgical procedure.

The procedure of infusion takes 5-20 minutes. The liquid should remain inside the peritoneum for 4-8 hours (the doctor determines the exact time), after which it is drained and replaced with fresh. Often during the day, perform 4-time fluid exchanges in volumes of 1.5-2 liters. Between the exchange procedures, equal time intervals should be observed. Therapy is performed daily, in prescribed portions of the doctor, and continues throughout the period required for renal replacement therapy.

Fluids for peritoneal dialysis procedures are used separately to obtain the desired electrolyte composition and ultrafiltration, and can be used in combination with other substances for similar sessions.

To monitor the effectiveness of therapy should be at regular intervals check urea with creatinine. In the absence of other prescriptions, 2 liters of medicinal substance are used for the therapeutic session. If the patient has discomfort at the beginning of the session (because of the peritoneal wall tension), the portion is temporarily lowered to 0.5-1.5 liters per session.

Adult person for 1 session usually requires 2.5 or 3 liters of drug substance. The glucose values and infusion volumes are determined taking into account the weight, individual tolerability, and residual renal activity. The doctor who prescribes the volume of the fluid used should be in charge.

For 1 dialysis session, a maximum of 5 liters of medication should be used.

The medicine can be used for emergency conditions, but also for a long course, taking into account the indications determined by the treating doctor.

Use Together during pregnancy

Dialysis sessions can be used exclusively in the late stages of pregnancy, as well as with lactation, after a careful study of the benefits and the likelihood of complications.

Contraindications

The main contraindications to the implementation of the dialysis session:

• diseases that affect the integrity of the peritoneum or peritoneal cavity. Among them are:
  • burns, fresh wounds or other inflammations on the epidermis, having a large area (eg, dermatitis), and located in the exit zone of the catheter used during the procedure;
  • peritonitis;
  • perforation in the abdominal area;
  • previous operations inside the abdomen, after which there were spikes of a fibrous nature (in the anamnesis);
  • inflammation inside the intestine (ulcerative form of colitis, transmural ileitis and diverticulosis);
  • neoplasms within the peritoneum;
  • a recent operation inside the peritoneum;
  • intestinal obstruction;
  • a hernia inside the peritoneum;
  • located in the abdomen of the fistula, external or internal.
• sepsis;
• Pulmonary diseases, especially pulmonary inflammation;
• lactoacidosis;
• cachexia or significant loss of weight (especially if there is no possibility to eat normally);
• in situations where uremia can not be treated by peritoneal dialysis;
• hyperlipidemia, which has a pronounced character;
• use in people who are unable physically or mentally (due to dementia, psychosis and other diseases) to carry out medical instructions for conducting peritoneal dialysis sessions.

Specifically, this solution is not used for hypo- or hypercalcemia, which has a pronounced severity.

[13], [14]

Side effects Together

Some loss of proteins (for a day of 5-15 grams), as well as amino acids (per day for 1,2-3,4 g) during peritoneal dialysis sessions always occurs. In addition, loss of vitamins of water-soluble nature, as well as development of hypokalemia, can be noted.

Deficiency of these components should be compensated by appropriate diet. If the nutritional compensation of the lost protein is insufficient, the patient may develop hypoproteinemia.

In addition, the patient may develop flatulence. With the bay or discharge of the dialysate used, pain can occur inside the abdomen. Raising the diaphragm can provoke dyspnea and the appearance of pain in the area of the shoulder joint. Hernias, dyspeptic symptoms or peritonitis also develop, and the blood pressure level may also increase or decrease.

If the patient is diagnosed with diabetes mellitus, additional glucose administration can provoke hyperglycemia. Because of this, during therapy it is required to constantly monitor the blood values of sugar.

[15], [16], [17]

Overdose

Poisoning can provoke the development of hypo- or hypervolemia, a disorder in the processes of electrolyte exchange and hyperglycemia in diabetics.

Symptomatic procedures are used to treat disorders.

[18]

Interactions with other drugs

It is necessary to take into account that the drugs used can pass into the dialysate, and then excreted together with it from the body. In this regard, you may need to change their dosage.

In the case of using calcium-containing drugs or calciferol, the probability of hypercalcemia should be considered.

Combination with diuretic drugs can lead to a breakdown in VEB indicators.

Indicators of potassium should be closely monitored if, together with treatment, the use of digitalis means is carried out - due to the fact that the sensitivity with respect to these medications is enhanced with hypokalemia.

Before making a decision regarding the addition of a variety of drugs to the dialysis liquid, the doctor should take into account the pH and the presence of salts, and before starting the mixing, evaluate the compatibility of these substances.

To avoid the risk of fibrin deposition inside the catheter, it is possible to add heparin to the peritoneal fluid.

[19], [20], [21], [22]

Storage conditions

The plug must be kept out of the reach of small children. Do not freeze medicinal liquid. Temperature marks - not higher than 25 ° С.

Shelf life

The capsule is allowed to be used within 24 months from the date of manufacture of the drug.

Application for children

Children prescribe the drug in dosages calculated in the proportion of 30-40 ml / kg, taking into account also the age, height and weight of the child.

[23]

Analogues

The analogues of the drug are the preparations Balance, Nutrinil PD4 (contains 1.1% amino acids), Gambrosol Trio, Dialysis solution containing glucose and low calcium, Dianil PD4 supplemented with glucose, and in addition 2.27% solution for dialysis procedures and Physionyl 40 containing glucose.

[24], [25], [26], [27], [28]