Fluid and Solute Transport using Different Sodium Concentrations in Peritoneal Dialysis Solutions

2001 ◽  
Vol 21 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Hui-Hong Cheng ◽  
Tao Wang ◽  
Olof Heimbürger ◽  
Jonas Bergström ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Sodium Transport ◽  
Concentration Gradient ◽  
Peritoneal Fluid ◽  
Glucose Solution ◽  
Sodium Concentration ◽  
Transport Rate ◽  
Diffusive Transport ◽  
Sodium Removal ◽  
Dialysis Solutions

Background Fluid and sodium balance is important for the success of long-term peritoneal dialysis. Convective transport is the major determinant for sodium removal during peritoneal dialysis using conventional dialysis solutions. However, recent studies showed that lower sodium concentration in dialysate could significantly increase sodium removal by increasing the diffusion gradient, thereby increasing diffusive transport. In the present study, we investigated the influence of the sodium concentration gradient on the diffusive transport coefficient, KBD for sodium. Methods A 4-hour dwell study was done in Sprague–Dawley rats using 25 mL 5% glucose (NS), 5% glucose + 0.3% NaCl (LS), 5% glucose + 0.6% NaCl (MS), or 5% glucose + 0.9% NaCl (HS), with frequent dialysate and blood sampling. Radiolabeled human albumin (RISA) was added to the solution as an intraperitoneal volume marker. The peritoneal fluid and sodium transport characteristics were evaluated. Results Significant ultrafiltration (both net ultrafiltration and transcapillary ultrafiltration) was observed in each group despite the osmolality of the 5% glucose solution being slightly lower than the plasma osmolality. There was no difference in peritoneal fluid absorption rate and direct lymphatic absorption among the four groups. With the sieving coefficient for sodium set to 0.55, a significantly higher KBD for sodium was found in the NS compared to the HS group. The KBD for sodium was 0.21 ± 0.01, 0.20 ± 0.01, 0.17 ± 0.01, and 0.09 ± 0.01 mL/min for the NS, LS, MS, and HS groups, respectively. The KBD values for glucose were significantly lower in the NS and LS groups compared to the MS and HS groups. Conclusions Our results suggest that ( 1 ) sodium concentration may affect peritoneal sodium KBD — as the sodium concentration gradient increased, the KBD decreased; ( 2 ) 5% glucose solution could induce significant peritoneal ultrafiltration in normal rats despite its initial hypo-osmotic nature, this was due to the significantly lower glucose transport rate than sodium transport rate; and ( 3 ) a lower dialysate sodium concentration may decrease peritoneal glucose absorption.

Evaluation of the Peritoneal Equilibration Test in Children on Chronic Peritoneal Dialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 260-262 ◽  
Author(s):  
Alberto Edefonti ◽  
Marina Picca ◽  
Raffaele Galato ◽  
Sophie Guez ◽  
Marisa Giani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Glucose Solution ◽  
Transport Rate ◽  
Chronic Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Equilibration Test ◽  
Blood Samples ◽  
Mean Values ◽  
Significant Difference

The peritoneal equilibration test (PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. Only a few and not well-standardized studies on the PET have been reported in children. Twenty-six PETs were performed In 16 children, mean age 10.9±4.9 years, mean body weight (BW) 26.8±11.9 kg, treated with nightly intermittent peritoneal dialysis (NIPD). The PET was performed according to Twardowski. Forty mL/kg BW of 2.27% glucose solution were Infused at a rate of 10 mL/kg BW every 2 minutes. In the simplified test, dialysate samples were taken at dwell times 0, 2 and 4 hours for glucose and creatinine. A blood sample was taken after a 2-hour dwell time for the same parameters. The standard PET (8 patients) consisted of dialysate samples at 0, 15, 30, 60, 120, and 240 minutes and blood samples at 0 and 240 minutes. Mean DIP ratio for corrected creatinine and DIDo ratio for glucose at 2 hours were 51.6±11.6 and 50.4±9, respectively; at 4 hours 69.6± 12 and 34.4±9.8, respectively. There was good correlation between DIP creatinine and DIDo glucose at 4 hours (p<0.0001). Patients were classified as high (3 cases), high-average (5), low-average (6), and low (2) transporters. A statistically significant difference was found between the curves obtained by the simplified PET and those of the standard PET In the first hour (r=0.66; p<0.05). In conclusion, the PET, modified for use in children, gave reliable and reproducible results. Mean values of DIP creatinine for children were higher and DIDo glucose lower than those of adults as reported by Twardowskl. A consistent percentage of children had, nevertheless, a low-average or low transport rate. Standard PET is required in case of automated peritoneal dialysis prescription.

HYPERALDOSTERONISM IN THE SODIUM-DEPLETED RAT: MECHANISM OF ALDOSTERONE STIMULATION BY PERITONEAL DIALYSIS WITH GLUCOSE SOLUTION

1979 ◽  
Vol 82 (1) ◽  
pp. 17-25 ◽  
Author(s):  
A. SPÄT ◽  
K. NAGY ◽  
TARJÁN ÉVA
Keyword(s):  
Peritoneal Dialysis ◽  
Plasma Renin Activity ◽  
Enzyme Inhibitor ◽  
Glucose Solution ◽  
Plasma Renin ◽  
Sodium Concentration ◽  
Renin Activity ◽  
Plasma Sodium ◽  
Sodium Depletion ◽  
Total Body

SUMMARY Peritoneal dialysis with 5% glucose solution was carried out in dexamethasone-pretreated rats. Dialysis brought about a severe loss of sodium and a slight loss of potassium into the peritoneal fluid. This kind of sodium depletion took place without any decrease in total body-water space, thus it evoked a severe fall in plasma sodium concentration. Plasma renin activity and the serum concentration of aldosterone increased in response to dialysis. Peak values in renin activity were attained within 60 min, whereas aldosterone concentrations exhibited a continuous rise until at least 120 min. Despite the correlation of renin and aldosterone values, neither the administration of an angiotensin I converting enzyme inhibitor (SQ 20,881) nor the reduction of plasma renin activity by indomethacin could reduce hyperaldosteronism evoked by peritoneal dialysis. Therefore, it is assumed that there is no causal relationship between renin and aldosterone in this kind of acute, severe sodium depletion.

The Effects of Ouabain and Potassium on Peritoneal Fluid and Solute Transport Characteristics

1998 ◽  
Vol 18 (4) ◽  
pp. 402-409 ◽  
Author(s):  
Min Sun Park ◽  
Eun Young Lee ◽  
Nam Soo Lee ◽  
Jacek Waniewski ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Transport Coefficient ◽  
Intracellular Transport ◽  
Potassium Transport ◽  
Dilution Method ◽  
Diffusive Transport ◽  
Sieving Coefficient ◽  
Dialysis Solution ◽  
Peritoneal Dialysis Solution ◽  
Dialysis Solutions

Background We reported anomalous transport characteristics of potassium during experimental peritoneal dialysis in rats and suggested that mechanisms of peritoneal potassium transport could be other than simple passive transport. Intracellular transport of potassium in cultured human mesothelial cells was reported to be regulated by three different pathways, such as channels blocked by ouabain, channels blocked by furosemide, and other. Objective To investigate the effect of ouabain on peritoneal potassium and water transport characteristics. Methods A single 4-hour peritoneal dwell was performed in 28 5prague-Dawley rats. To minimize the diffusive transport of potassium, 4.5 mmol/L of KCI was added into conventional dialysis solution with 3.86% glucose [acidic peritoneal dialysis solution (APD)]. To evaluate the effect of the pH of dialysis solution on the transport of potassium and water, 4 mmol/L of NaOH was added into the potassium -containing study solutions [neutral peritoneal dialysis solution (NPD)]. To evaluate the effect of a potassium channel blocker on peritoneal potassium transport ATPase sensitive Na+-K+-transport inhibitor, ouabain (10–5 mmol/L) was added to dialysis solutions immediately before the dwell study in eight rats with APD (APD-O) and six rats with NPD (NPD-O). Ouabain was not added in eight and six rats with APD and NPD (APD-C and NPD-C, respectively). They were used as control. Infusion volume was 30 mL. The intraperitoneal volume (V D) was estimated by using a volume marker dilution method with corrections for the elimination of volume marker, radioiodinated human serum albumin (RI5A), from the peritoneal cavity (KE). The diffusive mass transport coefficient (KBD) and sieving coefficient (5) were estimated using the modified Babb-Randerson-Farrell model. Results VD was significantly higher (p < 0.05 from 90 min to 240 min) and KE (0.027 ± 0.018 mL/min for APD-O, 0.026 ± 0.017 mL/min for NPD-O, and 0.030 ± 0.022 mL/min for NPD-C, vs 0.058 ± 0.030 mL/min for APD-C, p < 0.05 for each) significantly lower during dialysis with APD -O, NPD -O, and NPD-C than with APD-C. The intraperitoneal glucose expressed as a percentage of the initial amount was significantly higher with APD-O, NPD-C, and NPD-Q than with APD-C (p < 0.05 from 90 min to 240 min). KBD for sodium was higher during dialysis with ouabain than without ouabain, while KBD for urea, glucose, and potassium, and 5 for urea, glucose, sodium, and potassium did not differ between the four groups. Conclusions The physiologic potassium concentration in neutral dialysis solutions and the use of ouabain decreased the intraperitoneal fluid absorption. The diffusive transport coefficient and sieving coefficient for potassium did not differ, while the diffusive transport coefficient for sodium increased during use of ouabain.

Peritoneal Transport in Peritoneal Dialysis Patients Using Glucose-Based and Amino Acid-Based Solutions

2007 ◽  
Vol 27 (5) ◽  
pp. 544-553 ◽  
Author(s):  
Anna Olszowska ◽  
Jacek Waniewski ◽  
Andrzej Werynski ◽  
Björn Anderstam ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Total Protein ◽  
Glucose Solution ◽  
Transport Coefficients ◽  
Transport Rate ◽  
Mean Values ◽  
Peritoneal Transport ◽  
Significant Difference ◽  
Dialysate Volume

Objective To evaluate peritoneal transport of fluid and solutes in continuous ambulatory peritoneal dialysis (CAPD) patients using amino acid (AA)-based versus glucose-based dialysis solutions. Methods Using iodine-labeled human serum albumin (125I-HSA) as intraperitoneal volume marker, peritoneal transport was investigated in a group of 20 clinically stable patients (11 females and 9 men, age 53 ± 15 years) on CAPD for 15 – 101 months. Two paired 4-hour dwells, one with 1.36% glucose and one with 1.1% AA dialysis solution, were performed in each patient. Intraperitoneal dialysate volume, fluid absorption rate, and diffusive mass transport coefficients (KBD) and sieving coefficients (S) for glucose, creatinine, urea, potassium, and total protein were estimated for each dwell study. Dwell studies with AA solution were used to estimate KBD values for individual AAs. Results Intraperitoneal dialysate volume was higher for AA solution in comparison with glucose solution due to the higher osmolality of the AA solution. No statistically significant difference was found for KBD or S for creatinine, urea, potassium, or total protein in the dwell studies with either solution, whereas KBD for glucose was higher with AA than with glucose solution. Mean values of KBD of AA were similar but with high standard deviation, reflecting inter-individual variations in peritoneal transport rate. Conclusion Our results indicate that the AA peritoneal transport rate is strongly dependent on transport characteristics of the individual peritoneal membrane.

Sodium removal and sodium concentration during peritoneal dialysis: effects of three methods of sodium measurement

2004 ◽  
Vol 19 (7) ◽  
pp. 1849-1855 ◽  
Author(s):  
V. La Milia ◽  
S. Di Filippo ◽  
M. Crepaldi ◽  
S. Andrulli ◽  
L. Del Vecchio ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Sodium Concentration ◽  
Sodium Removal

Computer simulations of steady concentration peritoneal dialysis

2020 ◽  
Vol 40 (1) ◽  
pp. 76-83
Author(s):  
Kyoung Jin Lee ◽  
Dong Ah Shin ◽  
Hee Su Lee ◽  
Jung Chan Lee
Keyword(s):  
Peritoneal Dialysis ◽  
Computer Simulations ◽  
Glucose Concentration ◽  
Infusion Rate ◽  
Dwell Time ◽  
Fluid Overload ◽  
Glucose Solution ◽  
Glucose Absorption ◽  
Osmotic Gradient ◽  
Sodium Removal

Background: Steady concentration peritoneal dialysis (SCPD), which maintains transperitoneal osmotic gradient by infusing 50% glucose solution throughout the dwell time, has been proposed as a potent treatment for peritoneal dialysis (PD) patients with fluid overload. However, SCPD has yet to be explored theoretically. Here, we investigated SCPD via computer simulations. Methods: A model was developed by adding the variables for infusing 50% glucose solution to a traditional three-pore model for continuous ambulatory PD. The simulated scenarios involved the instillation of 2-L dialysate, 1.36% or 2.27%, followed by the infusion of 50% glucose solution, varying the rate from 0 mL/h to 90 mL/h. A dwell with 3.86% dialysate was also simulated for the purpose of comparison. Four sets of patient parameters corresponding to peritoneal transport categories were used. Results: The net ultrafiltration (UF) during SCPD increased with time as well as with glucose infusion rate. The glucose absorption and sodium removal of SCPD were slightly higher than those of the conventional dwell with 3.86% dialysate under the condition of the same net UF and dwell time. SCPD resulted in the larger UF and the lower peak intraperitoneal glucose concentration when it was simulated with the higher transport properties. Conclusions: These simulations indicate that SCPD can improve UF beyond those achievable by a conventional 3.86% glucose exchange while also exhibiting a lower peak osmolarity in the dialysate as compared to a conventional 3.86% dwell. However, further studies are needed to confirm these theoretical findings.

MO687FREE WATER TRANSPORT AND ABSOLUTE DIP OF DIALYSATE SODIUM CONCENTRATION: EARLY CLINICAL PARAMETERS FOR PERITONEAL FIBROSIS IN PD PATIENTS?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marisa Roldão ◽  
Rachele Escoli ◽  
Hernâni Gonçalves ◽  
Francisco Ferrer ◽  
Karina Lopes
Keyword(s):  
Peritoneal Dialysis ◽  
Water Transport ◽  
Pearson Correlation ◽  
Statistical Significance ◽  
Sodium Concentration ◽  
Ca 125 ◽  
Sodium Removal ◽  
Small Pore ◽  
Dialysate Sodium ◽  
Sodium Sieving

Abstract Background and Aims Reduction of peritoneal salt and water removal is an important cause of shortened patient and technique survival in peritoneal dialysis (PD). The aim of this study was to longitudinally analyze changes in fluid and solute transport parameters in PD patients during the first year of treatment, using peritoneal equilibration test (PET). Method Retrospective observational study of incident PD patients who underwent 4-hour 3.86% glucose PET with additional measurement of ultrafiltration at 1 hour, 1 month after PD initiation and 12 months later. Parameters of peritoneal transport such as dialysate-to-plasma ratio of creatinine (D/Pcreat), ultrafiltration at 1 and 4 hours, small-pore ultrafiltration (SPUF), free water transport (FWT), sodium removal and absolute dip of dialysate sodium concentration (ΔDNa) at 1 hour (as an expression of sodium sieving), were calculated. Serum cancer antigen 125 (CA-125) was also assessed. Clinical, analytical and demographic data were analyzed. Statistical analysis was performed using SPSS (Version 23 for Mac OSX). Results The average age of 16 incident PD patients was 58.69 ± 8.51 years, 10 (62.5%) were male and 5 (31.8%) were diabetic. Ten patients (62.5%) were on automated peritoneal dialysis (APD). One month after PD initiation, membrane characteristics were: D/P = 0.684 ± 0.589, total UF at 4h = 0.696 ± 0.283L, UF at 1h = 0.487 ± 0.162L, SPUF = 0.303 ± 0.359L, FWT = 0.207 ± 0.738L, %FWT = 51.855 ± 11.828%, sodium removal = 38.048 ± 16.087mmol/L and ΔDNa = 11.125 ± 3.34mmol/L. Average serum CA-125 was 51.206 ± 22.6U/mL. A paired sample t-test was performed to compare these parameters 1 and 12 months after PD initiation and revealed a statistically significant increase of 0.11± 0.196L (p=0.042) on SPUF and 18.607 ± 7.1mmol/L (p=0.019) on sodium removal. ΔDNa showed a decrease of 2.5 ± 0.743mmol/L (p=0.005) and % FWT of 11.782 ± 12.831% (p=0.002). FWT also showed a decrease of 0.168 ± 0.019L, total UF at 4h of 0.206 ± 0.142L and UF at 1h of 0.114 ± 0.243L, however did not reach statistical significance. D/Pcreat remained stable. CA-125 showed a mild decrease of 3.644 ± 22.364U/mL although not statistically significant. Pearson correlation revealed a positive correlation between the variation of total UF at 4h and the variation of FWT (r=0.553, p=0.026) and ΔDNa (r=0.503, p=0.047), but not with SPUF, sodium removal, D/Pcreat or CA-125, during the study follow-up period. Conclusion The reduction of FWT through aquaporins and, particularly, the reduction of ΔDNa as a sodium sieving measure, appear to be the first functional changes in peritoneal membrane, suggesting that fibrosis may begin soon after PD initiation. Our results indicate that FWT and ΔDNa can be used to access fibrotic peritoneal alterations earlier than other conventional parameters such as D/Pcreat.

Combination of Crystalloid (Glucose) and Colloid (Icodextrin) Osmotic Agents Markedly Enhances Peritoneal Fluid and Solute Transport during the Long PD Dwell

2007 ◽  
Vol 27 (3) ◽  
pp. 267-276 ◽  
Author(s):  
Philippe Freida ◽  
Magda Galach ◽  
Jose C. Divino Filho ◽  
Andrzej Werynski ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Residual Renal Function ◽  
Transport Rate ◽  
Dialysis Patients ◽  
Fluid Removal ◽  
Sodium Removal ◽  
Ultra Filtration ◽  
Osmotic Agents ◽  
Peritoneal Solute Transport Rate

Background Fluid and sodium removal is often inadequate in peritoneal dialysis patients with high peritoneal solute transport rate, especially when residual renal function is declining. Method We studied the effects of using simultaneous crystalloid (glucose) and colloid (icodextrin) osmotic agents on the peritoneal transport of fluid, sodium, and other solutes during 15-hour single-dwell exchanges using 3.86% glucose, 7.5% icodextrin, and a combination fluid with 2.61% glucose and 6.8% icodextrin in 7 prevalent peritoneal dialysis patients with fast peritoneal solute transport rate. Results The combination fluid enhanced net ultrafiltration (mean 990 mL) and sodium removal (mean 158 mmol) compared with 7.5% icodextrin (mean net ultrafiltration 462 mL, mean net sodium removal 49 mmol). In contrast, the 3.86% glucose-based solution yielded negligible ultra-filtration (mean -85 mL) and sodium removal (mean 16 mmol). The combination solution resulted in significantly improved urea (+41%) and creatinine (+26%) clearances compared with 7.5% icodextrin. Conclusion A solution containing both crystalloid (glucose 2.61%) and colloid (icodextrin 6.8%) osmotic agents enhanced fluid removal by twofold and sodium removal by threefold compared with 7.5% icodextrin solution during a dwell of 15 hours, indicating that such a combination solution could represent a new treatment option for anuric peritoneal dialysis patients with high peritoneal solute transport rate.

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