Document Detail


Two-in-one protocol: simultaneous small-pore and ultrasmall-pore peritoneal transport quantification.
MedLine Citation:
PMID:  22383631     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Reduced free water transport (FWT) through ultrasmall pores contributes to net ultrafiltration failure (UFF) and should be seen as a sign of more severe functional deterioration of the peritoneal membrane. The modified peritoneal equilibration test (PET), measuring the dip in dialysate Na concentration, estimates only FWT. Our aim was to simultaneously quantify small-solute transport, FWT, and small-pore ultrafiltration (SPUF) during a single PET procedure.
METHODS: We performed a 4-hour, 3.86% glucose PET, with additional measurement of ultrafiltration (UF) at 60 minutes, in 70 peritoneal dialysis patients (mean age: 50 ± 16 years; 61% women; PD vintage: 26 ± 23 months). We calculated the dialysate-to-plasma ratios (D/P) of creatinine and Na at 0 and 60 minutes, and the Na dip (Dip(D/PNa60')), the delta dialysate Na 0-60 (ΔDNa(0-60)), FWT, and SPUF.
RESULTS: Sodium sieving (as measured by ΔDNa(0-60)) correlated strongly with the corrected Dip(D/PNa60') (r = 0.85, p < 0.0001) and the corrected FWT (r = 0.41, p = 0.005). Total UF showed better correlation with FWT than with indirect measurements of Na sieving (r = 0.46, p < 0.0001 for FWT; r = 0.360, p < 0.0001 for Dip(D/PNa60')). Corrected FWT fraction was 0.45 ± 0.16. A negative correlation was found between time on PD and both total UF and FWT (r = -0.253, p = 0.035 and r = -0.272, p = 0.023 respectively). The 11 patients (15.7%) diagnosed with UFF had lower FWT (89 mL vs 164 mL, p < 0.05) and higher D/P creatinine (0.75 vs 0.70, p < 0.05) than did the group with normal UF. The SPUF correlated positively with FWT in the normal UF group, but negatively in UFF patients (r = -0.709, p = 0.015). Among UFF patients on PD for a longer period, 44.4% had a FWT percentage below 45%.
CONCLUSIONS: Measurement of FWT and SPUF is feasible by simultaneous quantification during a modified 3.86% glucose PET, and FWT is a decisive parameter for detecting causes of UFF in addition to increased effective capillary surface.
Authors:
Ana Paula Bernardo; M Auxiliadora Bajo; Olivia Santos; Gloria del Peso; Maria João Carvalho; António Cabrita; Rafael Selgas; Anabela Rodrigues
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-03-01
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  32     ISSN:  1718-4304     ISO Abbreviation:  Perit Dial Int     Publication Date:    2012 Sep-Oct
Date Detail:
Created Date:  2012-09-19     Completed Date:  2013-03-14     Revised Date:  2013-09-03    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  537-44     Citation Subset:  IM    
Affiliation:
Nephrology Department, Centro Hospitalar do Porto, Hospital de Santo António, and ICBAS/UP, Porto, Portugal. anabernardo@portugalmail.pt
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aquaporins
Biological Transport
Creatinine / analysis
Cross-Sectional Studies
Dialysis Solutions / metabolism*
Female
Glucose / analysis
Humans
Male
Middle Aged
Peritoneal Dialysis / methods*
Peritoneum / metabolism*
Sodium / analysis
Treatment Failure
Ultrafiltration
Water / metabolism
Chemical
Reg. No./Substance:
0/Aquaporins; 0/Dialysis Solutions; 50-99-7/Glucose; 60-27-5/Creatinine; 7440-23-5/Sodium; 7732-18-5/Water
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