[How to use the peritoneum as a dialysis membrane. Methods of surveillance, criteria of efficacy and longevity as a dialysis membrane, consequences with respect to techniques of peritoneal dialysis].
The structure of the peritoneum is well known. However, the real surface of the membrane which participates to solute transports during dialysis is purely putative, depending on numerous factors as cardiac output and consequently mesenteric blood flow, mesothelial cell junctions, interstitial thickness, number of functional peritoneal capillaries and so on. In addition lymphatic absorbtion of peritoneal fluid interacts with transcapillary water shifts. These various factors vary from one moment to another in a same patient and from patient to patient. Eventually, mechanical problems related to peritoneal catheter may alter fluid and solute transfer evaluation when estimated from analysis of drained dialysate. Notwithstanding, solute peritoneal equilibration curves may be used as a guide to prescribe dialysis, provided they are repeated several times. They appear more reliable to detect, and therefore prevent peritoneal structure alterations. The APEX (Accelerated Peritoneal Examination) test is more convenient than Peritoneal Equilibration Test (PET), as it summarizes in a single number the peritoneal permeability both to glucose and urea: hence, it represents the time at which glucose and urea equilibration curves (using percentages as units) cross; the shorter is the APEX time, the higher is the peritoneal permeability and, reversely, the longer is this time, the lower is the peritoneal permeability. The peritoneal membrane may be used at least five years without concern with lactate buffered solutions if peritonitis are efficiently prevented. Some patients have been followed for more than ten years without detectable adverse effects, but further evaluations still have to be performed to evaluate the longterm consequences of peritoneal dialysis. Peritoneal dialysis and haemodialysis must be considered as complementary technics which must be both available to patients.
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Hôpital René Dubos, Pontoise.
D006801:Humans; D008208:Lymphatic System / Q000502:physiology; D008566:Membranes / Q000502:physiology; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods; D010537:Peritoneum / Q000033:anatomy & histology / Q000098:blood supply / Q000502:physiology; D010539:Permeability; D013997:Time Factors