Pathophysiology of Peritoneal Transport

2006 ◽  
pp. 13-19 ◽  
Author(s):  
Zbylut J. Twardowski
Keyword(s):  
Peritoneal Transport

The Effect of a Nitric Oxide Inhibitor (L-Name) on Peritoneal Transport during Dialysis in Rats

1998 ◽  
Vol 18 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Andrzej Breborowicz ◽  
Katarzyna Wieczorowska Tobis ◽  
Katarzyna Korybalska ◽  
Alicja Polubinska ◽  
Maciej Radkowski ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Peritoneal Dialysis ◽  
Significant Decline ◽  
Nitric Oxide Synthesis ◽  
Dialysis Fluid ◽  
Large Molecules ◽  
Acute Peritonitis ◽  
Important Mediator ◽  
Peritoneal Transport ◽  
Nitric Oxide Inhibitor

Objective To assess the effect of an inhibitor of nitric oxide synthesis [NG-nitro-L-arginine methyl ester (L-NAME)] on peritoneal transport during peritoneal dialysis (PD) and peritonitis in rats. Methods The authors studied peritoneal transport of small and large solutes, and net ultrafiltration (UF) in rats during PD with Dianeal 3.86 (Baxter, McGaw Park, IL, U.S.A.). They evaluated the effect of L-NAME used as an additive to dialysis fluid in concentrations 0.5 -5 mg/m L on peritoneal transport of small and large molecules and on transperitoneal UF. In addition, they studied the effect of L-NAME (5 mg/mL) during acute peritonitis induced by lipopolysaccharides (5 μg/mL) given intraperitoneally. Results The addition of L-NAME to dialysis fluid increased the selectivity of the peritoneum and net UF during dialysis. Lipopolysaccharides used as an additive to the dialysis fluid, together with L-NAME, did not induce changes in transperitoneal transport of small and large solutes and did not cause a significant decline in net UF. L-NAME given intraperitoneally reduced both local and systemic production of nitric oxide, which might explain its effects on peritoneal transport. Conclusions Nitric oxide is an important mediator of changes in peritoneal transport and its effect is especially significant during peritonitis.

scholarly journals A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis

2016 ◽  
Vol 36 (5) ◽  
pp. 555-561 ◽  
Author(s):  
Vicente Pérez-Díaz ◽  
Alfonso Pérez-Escudero ◽  
Sandra Sanz-Ballesteros ◽  
Guadalupe Rodríguez-Portela ◽  
Susana Valenciano-Martínez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glucose Concentration ◽  
Fluid Overload ◽  
Glucose Solution ◽  
Osmotic Gradient ◽  
Single Session ◽  
Peritoneal Equilibration Test ◽  
Peritoneal Transport ◽  
Constant Rate ◽  
Limited Power

Background Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. Methods We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). Results Ultrafiltration averaged 653 ± 363 mL/4 h — twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload ( p < 0.01) and inversely proportional to final peritoneal glucose concentration ( p < 0.05). Conclusion This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.

Adverse Effects of Pantoea Peritonitis on Peritoneal Transport

2009 ◽  
Vol 29 (2) ◽  
pp. 234-235
Author(s):  
M. Borràs ◽  
J. Roig ◽  
M. Garcia ◽  
E. Fernández
Keyword(s):  
Adverse Effects ◽  
Peritoneal Transport

Fluid and Solute Transport in CAPD Patients before and after Permanent Loss of Ultrafiltration Capacity

2005 ◽  
Vol 28 (10) ◽  
pp. 976-984 ◽  
Author(s):  
J. Waniewski ◽  
D. Sobiecka ◽  
M. DĘbowska ◽  
O. Heimbürger ◽  
A. Werynski ◽  
...  
Keyword(s):  
Solute Transport ◽  
Absorption Rate ◽  
Fluid Absorption ◽  
Transport Parameters ◽  
Normal Range ◽  
Peritoneal Transport ◽  
High K ◽  
Before And After ◽  
Permanent Loss ◽  
High Fluid

Background Two major types of permanent loss of ultrafiltration capacity (UFC) were previously distinguished among patients treated with CAPD: 1) type HDR with high diffusive peritoneal transport rate of small solutes and low osmotic conductance, but with normal fluid absorption rate, and 2) type HAR with high fluid absorption rate, but with normal diffusive peritoneal transport rate of small solutes and normal osmotic conductance. However, the detailed pattern of changes in peritoneal transport parameters in patients developing loss of ultrafiltration capacity is not known. Objective Analysis of solute and fluid transport parameters in the same patient before and after UFC loss. Patients Seven CAPD patients who had undergone repeated dwell studies, which were carried out before and/or after the onset of UFC loss. Methods Dialysis fluids (2 L) with glucose or a mixture of amino acids as osmotic agent at three basic tonicities were applied during 6 hour dwell studies. Fluid and solute transport parameters were previously shown not to be affected by these dialysis solutions (except by hypertonic amino acid-based solution). Intraperitoneal dialysate volume and fluid absorption rate were assessed using radiolabeled human serum albumin (RISA). Osmotic conductance (aOS) was estimated by a mathematical model as ultrafiltration rate induced by unit osmolality gradient. Diffusive mass transport coefficients, KBD, for glucose, urea, and creatinine were estimated using the modified Babb-Randerson-Farrell model. Results Five patients had increased KBD for small solutes after the onset of UFC loss, and three of them had decreased aOS, whereas two patients had normal aOS. In one of them, aOS decreased with time after the onset of UFC loss with concomitant normalization of glucose absorption. In all studies of these five patients the fluid absorption rate was within the normal range. Two other patients had increased fluid absorption rate (about 5 ml/min), and one of them also had increased KBD for small solutes, in two consecutive dwell studies in each patient with the second study being carried out at 1 and 7 months respectively after the first one. In all four studies in these two patients, the aOS was within the normal range. The sodium dip during dialysis with 3.86% glucose-based solution was lost, not only among most patients with UFC loss related to reduced osmotic conductance, but also in patients with increased KBD. Conclusions The occurrence of two major types of UFC loss was confirmed. However, a case of a mixed type of UFC loss with high fluid absorption rate and high KBD for small solutes, but normal osmotic conductance, and with normalization of initially high KBD for small solutes, linked with decreasing initially normal osmotic conductance, was also found. As a reduced sodium dip with hypertonic glucose solution is not only seen in patients with reduced osmotic conductance, it cannot reliably be used as a single measure of decreased aquaporin function. Permanent ultrafiltration capacity loss may be a dynamic phenomenon with a variety of alterations in peritoneal transport characteristics.

A Comparison of Peritoneal Equilibration Tests Performed 1 and 4 Weeks after PD Commencement

2004 ◽  
Vol 24 (5) ◽  
pp. 460-465 ◽  
Author(s):  
David W. Johnson ◽  
David W. Mudge ◽  
Sophie Blizzard ◽  
Mary Arndt ◽  
Amanda O'Shea ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Clinical Decision Making ◽  
Tertiary Care ◽  
Clinical Decision ◽  
Glucose Measurement ◽  
Altman Analysis ◽  
Princess Alexandra Hospital ◽  
Peritoneal Equilibration Test ◽  
Bland Altman Analysis ◽  
Peritoneal Transport

Objective The aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement. Design Prospective observational study of an incident PD cohort at a single center. Setting Tertiary-care institutional dialysis center. Participants The study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 ± 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD. Main Measurements Measurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0 glucose), and drain volumes at 4 hours. Results When paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 ± 0.07 vs 0.94 ± 0.07 respectively; p < 0.05), D/P creatinine (0.55 ± 0.12 vs 0.66 ± 0.11, p < 0.001), and D/D0 glucose (0.38 ± 0.08 vs 0.36 ± 0.10, p < 0.05). Using Bland–Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0 glucose (weighted κ 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement ( n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements. Conclusions Peritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0 glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.

Peritoneal Kinetics and Mesothelial Markers in CCPD Using Icodextrin for Daytime Dwell for Two Years

2000 ◽  
Vol 20 (2) ◽  
pp. 174-180 ◽  
Author(s):  
Nynke Posthuma ◽  
Henri A. Verbrugh ◽  
Ab J.M. Donker ◽  
Wim Van Dorp ◽  
Hubertina A.Th. Dekker ◽  
...  
Keyword(s):  
Residual Renal Function ◽  
University Hospital ◽  
Type I ◽  
Clinical Effects ◽  
Local Production ◽  
Peritoneal Membrane ◽  
Membrane Markers ◽  
Related Data ◽  
Peritoneal Transport

Objective To evaluate the safety, efficacy, and biocompatibility of icodextrin (Ico), continuous cycling peritoneal dialysis (CCPD) patients were treated for 2 years with either Ico- or glucose (Glu)-containing dialysis fluid for their daytime dwell (14 – 15 hours). Prior to entry into the study, all patients used standard Glu solutions (Dianeal, Baxter BV, Utrecht, The Netherlands). Design Open, randomized, prospective two-center study. Setting University hospital and teaching hospital. Patients Both established patients and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years or with peritonitis in the previous month, and women of childbearing potential unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients entered the study (19 Glu, 19 Ico). Main Outcome Measures Daytime dwell peritoneal effluents were collected every 3 months in combination with other study variables (clinical data, laboratory measurements, dialysis-related data, and urine collection). Peritoneal transport studies were carried out every 6 months. Results In Glu- and Ico-treated patients, peritoneal transport of low molecular weight solutes and protein clearances neither changed during follow-up nor differed between the two groups. Peritoneal membrane markers (CA125, interleukin-8, carboxyterminal propeptide of type I procollagen, and aminoterminal propeptide of type III procollagen) measured in effluents did not differ between the groups and did not change over time. All these markers showed a dialysate/plasma ratio of more than 1, suggesting local production. Residual renal function remained stable during follow-up and adverse clinical effects were not observed. Conclusions Peritoneal membrane transport kinetics and markers remained stable in both groups over a 2-year follow-up period. Membrane markers were higher in effluents than in serum, suggesting local production. No clinical side effects were demonstrated. Icodextrin was a well-tolerated effective treatment.

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