title: The effect of amphotericin B on fluid kinetics and solute transport in CAPD patients.
abstract: Loss of net ultrafiltration capacity is an important complication in long-term continuous ambulatory peritoneal dialysis (CAPD). It has been reported in animal studies that the drained volumes after a dwell period were larger when amphotericin B had been given intraperitoneally. In this study the effect of intraperitoneally administered amphotericin B on fluid kinetics was evaluated in 3 CAPD patients. The first patient lost 2.5 kg body weight during the first 4 days of treatment, whereas the net ultrafiltration in the second patient was higher in the treatment period compared with the nontreatment period (750 +/- 38 mL/day vs 438 +/- 34 mL/day (mean +/- SEM), p < 0.0001). In the last patient it can be demonstrated that the increase in the net ultrafiltration was caused by an increase in the transcapillary ultrafiltration (570 vs 454 mL/4 hours), but that lymphatic absorption was not different (251 vs 265 mL/4 hours). The higher transcapillary ultrafiltration capacity is probably caused by an increase in the hydraulic permeability. It is likely that this phenomenon is governed by the interaction of amphotericin B with membrane-bound cholesterol leading to the formation of transcellular pores. However, the administration of amphotericin B caused a chemical peritonitis, probably due to its solvent, sodium desoxycholate. Therefore, before amphotericin B can be used for the treatment of CAPD patients with ultrafiltration failure, further investigations are necessary to obtain a solvent for amphotericin B that is nontoxic and causes no chemical peritonitis.
authors.affiliation: Department of Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A L
authors.initials: AL
authors.lastname: Imholz
authors.forename: G C
authors.initials: GC
authors.lastname: Koomen
authors.forename: D G
authors.initials: DG
authors.lastname: Struijk
authors.forename: L
authors.initials: L
authors.lastname: Arisz
authors.forename: R T
authors.initials: RT
authors.lastname: Krediet
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology*; D001692:Biological Transport / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000187:drug effects / Q000378:metabolism*; D010539:Permeability; D014462:Ultrafiltration
chemical_list: D000666:Amphotericin B