Document Detail


Restriction coefficients of low molecular weight solutes and macromolecules during peritoneal dialysis.
MedLine Citation:
PMID:  9360654     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The intrinsic permeability of the peritoneal membrane can be functionally represented by the restriction coefficient (RC). The RC can be calculated as the exponent of the power relation between the mass transfer area coefficients (MTACs) of various solutes and their free diffusion coefficients in water. When the RC = 1.0, transport is determined by free diffusion only, as is expected for low molecular weight (LMW) solutes. A RC > 1.0 suggests that transport is restricted by the peritoneal membrane in a size-selective way, as has been found previously for macromolecules (MM). RCLMW can be calculated using the MTACs of urea, creatinine, urate, and beta 2-microglobulin, whereas RCMM can be calculated from clearances of beta 2-microglobulin, albumin, IgG, and alpha 2-macroglobulin. RCLMW and RCMM were determined in 108 peritoneal dialysis (PD) patients. In 36 patients, 3 or more (range 3-13) observations for RCLMW during a period of at least 2 years were available. RCMM were analyzed when present in the same patients. The median cross sectional values (n = 108) were: RCLMW: 1.22 (range 0.75-2.18) and RCMM: 2.30 (range 1.86-3.27). RCLMW was not correlated with time on PD, neither cross sectionally (r = -0.07, NS) nor after analysis of trend (mean regression coefficient t = 0.26, SD = 0.07). For RCMM a positive correlation with duration of PD was demonstrated (cross sectionally r = -0.18, p = 0.02, analysis of trend: t = 2.27, SD = 0.11, n = 27). Both RCs were not interrelated (r = -0.18, NS). The absence of a relation between both RCs suggests that LMW solutes and MM are transported by different pathways. The mean value of 1.22 for the RCLMW illustrates that the transport of LMW solutes is mainly by free diffusion, through the small-pore system. MM, which have to pass through the large-pore system, are restricted by the peritoneal membrane in a size-selective way, as shown by the high value of the RCMM. The lack of a correlation between the RCLMW and duration of PD indicates that no systematic changes occur in the small pores of the peritoneal vessels. In contrast, the increase of RCMM with duration of PD suggests restrictive changes at the level of the large-pore system.
Authors:
M M Ho-dac-Pannekeet; J G Koopmans; D G Struijk; R T Krediet
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis     Volume:  13     ISSN:  1197-8554     ISO Abbreviation:  Adv Perit Dial     Publication Date:  1997  
Date Detail:
Created Date:  1998-01-21     Completed Date:  1998-01-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9104803     Medline TA:  Adv Perit Dial     Country:  CANADA    
Other Details:
Languages:  eng     Pagination:  72-6     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Biological Transport
Creatinine / metabolism
Humans
Immunoglobulin G / metabolism
Macromolecular Substances
Molecular Weight
Peritoneal Dialysis*
Peritoneum / metabolism*
Permeability
Serum Albumin / metabolism
Urea / metabolism
Uric Acid / metabolism
alpha-Macroglobulins / metabolism
beta 2-Microglobulin / metabolism
Chemical
Reg. No./Substance:
0/Immunoglobulin G; 0/Macromolecular Substances; 0/Serum Albumin; 0/alpha-Macroglobulins; 0/beta 2-Microglobulin; 57-13-6/Urea; 60-27-5/Creatinine; 69-93-2/Uric Acid

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