Faculty Opinions recommendation of The time course of peritoneal transport parameters in peritoneal dialysis patients who develop encapsulating peritoneal sclerosis.

The transitory change of fluid and solute transport parameters occurring during the initial phase of a peritoneal dialysis dwell is a well-documented phenomenon; however, its physiological interpretation is rather hypothetical and has been disputed. Two different explanations were proposed: (1) the prevailing view—supported by several experimental and clinical studies—is that a vasodilatory effect of dialysis fluid affects the capillary surface area available for dialysis, and (2) a recently presented alternative explanation is that the molecular radius of glucose increases due to the high glucose concentration in fresh dialysis fluid and that this change affects peritoneal transport parameters. The experimental bases for both phenomena are discussed as well as the problem of the accuracy necessary for a satisfactory description of clinical data when the three-pore model of peritoneal transport is applied. We show that the correction for the change of transport parameters with dwell time provides a better fit with clinical data when applying the three-pore model. Our conclusion is in favor of the traditional interpretation namely that the transitory change of transport parameters with dwell time during peritoneal dialysis is primarily due to the vasodilatory effect of dialysis fluids.

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Time Course of Peritoneal Function in Automated and Continuous Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00166 ◽

2012 ◽

Vol 32 (6) ◽

pp. 605-611 ◽

Cited By ~ 6

Author(s):

Wieneke M. Michels ◽

Marion Verduijn ◽

Alena Parikova ◽

Elisabeth W. Boeschoten ◽

Dirk G. Struijk ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Repeated Measures ◽

Time Course ◽

Fluid Transport ◽

Free Water ◽

Transport Parameters ◽

Lymphatic Absorption ◽

Small Pore ◽

Year 2000 ◽

Over Time

♦ Background and ObjectivesIn automated peritoneal dialysis (APD), a patient's peritoneal membrane is more intensively exposed to fresh dialysate than it is in continuous ambulatory peritoneal dialysis (CAPD). Our aim was to study, in incident peritoneal dialysis (PD) patients, the influence of APD—compared with that of CAPD—on peritoneal transport over 4 years.♦ Design, Setting, Participants, and MeasurementsPatients were included if at least 2 annual standard permeability analyses (SPAs) performed with 3.86% glucose were available while the patient was using the same modality with which they had started PD (APD or CAPD). Patients were followed until their first modality switch. Differences in the pattern of SPA outcomes over time were tested using repeated-measures models adjusted for age, sex, comorbidity, primary kidney disease, and year of PD start.♦ ResultsThe 59 CAPD patients enrolled were older than the 47 APD patients enrolled (mean age: 58 ± 14 years vs 49 ± 14 years; p < 0.01), and they had started PD earlier (mean start year: 2000 vs 2002). Over time, no differences in solute ( p > 0.19) or fluid transport ( p > 0.13) were observed. Similarly, free water transport ( p = 0.43) and small-pore transport ( p = 0.31) were not different between the modalities. Over time, patients on APD showed a faster decline in effective lymphatic absorption rate (ELAR: p = 0.02) and in transcapillary ultrafiltration (TCUF: p = 0.07, adjusted p = 0.05). Further adjustment did not change the results.♦ ConclusionsCompared with patients starting on CAPD, those starting on APD experienced a faster decline in ELAR and TCUF. Other transport parameters were not different over time between the groups.

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Insulin Resistance in Nondiabetic Peritoneal Dialysis Patients: Associations with Body Composition, Peritoneal Transport, and Peritoneal Glucose Absorption

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.03170315 ◽

2015 ◽

Vol 10 (12) ◽

pp. 2205-2212 ◽

Cited By ~ 11

Author(s):

Ana Paula Bernardo ◽

Jose C. Oliveira ◽

Olivia Santos ◽

Maria J. Carvalho ◽

Antonio Cabrita ◽

...

Keyword(s):

Insulin Resistance ◽

Body Composition ◽

Peritoneal Dialysis ◽

Glucose Absorption ◽

Dialysis Patients ◽

Peritoneal Transport

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Peritoneal transport rate, systemic inflammation, and residual renal function determine peritoneal protein clearance in continuous ambulatory peritoneal dialysis patients

International Urology and Nephrology ◽

10.1007/s11255-014-0744-8 ◽

2014 ◽

Vol 46 (11) ◽

pp. 2215-2219 ◽

Cited By ~ 4

Author(s):

Yi Tang ◽

Hui Zhong ◽

Yongshu Diao ◽

Min Qin ◽

Xueli Zhou

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Systemic Inflammation ◽

Residual Renal Function ◽

Transport Rate ◽

Dialysis Patients ◽

Protein Clearance ◽

Peritoneal Transport ◽

Peritoneal Protein Clearance

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Changes in Peritoneal Transport during the First Month of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089501500103 ◽

1995 ◽

Vol 15 (1) ◽

pp. 12-17 ◽

Cited By ~ 30

Author(s):

Michael V. Rocco ◽

Jean R. Jordan ◽

John M. Burkart

Keyword(s):

Peritoneal Dialysis ◽

Medical Center ◽

Group Versus ◽

Dialysis Patients ◽

Dialysis Unit ◽

Peritoneal Transport ◽

Time Period ◽

Initiation Of Dialysis ◽

Calculated Mass

Objective To determine if peritoneal transport characteristics change during the initial month of peritoneal dialysis. Design Retrospective review of peritoneal equilibration test (PET) results in patients who received their first PET during the first two weeks of peritoneal dialysis (early PET group) versus patients who received their first PET between four and 28 weeks after the initiation of dialysis (late PET group). The initial PET values were compared to subsequent PET results obtained approximately seven months after the initial PET. Setting Peritoneal dialysis unit of a tertiary medical center. Outcome Measures PET results and calculated mass transfer area coefficient (MT AC) values. Patients Thirty-four peritoneal dialysis patients in the early PET group and 17 peritoneal dialysis patients in the late PET group. Results In the early PET group, there was a statistically significant increase from the initial to follow-up values for both dialysate-to-plasma (DIP) creatinine and MTAC creatinine (p < 0.01) as well as a significant decrease for four-hour dialysate to initial dialysate ratios (DID) glucose (p = 0.08) and MTAC glucose (p < 0.05). In the late PET group, there was no significant change in any of these parameters with time. However, in the late PET group, there was a significant decrease in DIP urea values with time (p < 0.01), but not with MTAC urea. In addition, there were no differences over time in either group for serum albumin or hematocrit values. Conclusion During the first two weeks of peritoneal dialysis, there tends to be a change in peritoneal transport characteristics in some patients. PET data obtained during this time period should be interpreted as preliminary.

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