Small and middle molecular weight solute clearance in nocturnal intermittent peritoneal dialysis.
OBJECTIVE
To determine the dialysate-to-plasma (D/P) concentration ratios and peritoneal dialytic clearance (CI(D)) of substances with a wide range of molecular weights in subjects receiving a simulated nocturnal intermittent peritoneal dialysis (NIPD) session.


METHODS
Open-label single-dose study.


METHODS
Six end-stage renal disease patients undergoing peritoneal dialysis (PD).


METHODS
Clinical research center of a university-affiliated hospital.


METHODS
Subjects received intravenous gentamicin and vancomycin on the first day of the study. Subjects received no PD until their return on the following day, when subjects underwent a simulated NIPD session utilizing four 2- to 2.5-L peritoneal dialysate dwells of 2 hours. Blood and dialysate samples were collected immediately before the session and after each dialysate dwell for determination of urea, creatinine, gentamicin, vancomycin, and beta2-microglobulin (beta2M) concentrations. Each solute's D/P concentration ratio and peritoneal CI(D) were calculated.


RESULTS
The (mean +/- SD) 2-hour D/P concentration ratios were 0.78 +/- 0.05 (urea), 0.49 +/- 0.11 (creatinine), 0.38 +/- 0.08 (gentamicin), 0.11 +/- 0.06 (vancomycin), and 0.07 +/- 0.03 (beta2M). Peritoneal CI(D) values (mL/min of dialysis) were 19.0 +/- 2.8 (urea), 12.1 +/- 3.5 (creatinine), 8.4 +/- 2.8 (gentamicin), 2.7 +/- 1.5 (vancomycin), and 1.7 +/- 0.8 (beta2M). The D/P concentration ratios and peritoneal CI(D) values for urea, creatinine, and gentamicin were significantly different from vancomycin and beta2M (repeated measures ANOVA, p < 0.05). Beta2-microglobulin peritoneal CI(D) was strongly related to gentamicin peritoneal CI(D) (r = 0.96, p < 0.05).


CONCLUSIONS
Small molecular weight solutes have significantly greater D/P and peritoneal CI(D) than middle molecular weight solutes in NIPD. In NIPD, daily peritoneal CI(D) of beta2M is lower than that reported in continuous ambulatory PD. NIPD also results in lower drug CI(D) than that reported in continuous ambulatory PD studies.
Brophy
D F
DF
Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia Campus, Richmond 23298-0533, USA.
Sowinski
K M
KM
Kraus
M A
MA
Moe
S M
SM
Klaunig
J E
JE
Mueller
B A
BA
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics; D003404:Creatinine / Q000097:blood / Q000493:pharmacokinetics; D015314:Dialysis Solutions / Q000032:analysis / Q000493:pharmacokinetics*; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics; D006801:Humans; D007275:Injections, Intravenous; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008970:Molecular Weight; D010530:Peritoneal Dialysis; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000378:metabolism; D014508:Urea / Q000097:blood / Q000493:pharmacokinetics; D014640:Vancomycin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics; D001613:beta 2-Microglobulin / Q000097:blood / Q000493:pharmacokinetics
D000900:Anti-Bacterial Agents; D015314:Dialysis Solutions; D005839:Gentamicins; D001613:beta 2-Microglobulin; D014640:Vancomycin; D014508:Urea; D003404:Creatinine