Correlation between peritoneal permeability and ultrafiltration volume with icodextrin-based peritoneal dialysis solution.
In the present study, we evaluated peritoneal transport characteristics during the use of icodextrin-based peritoneal dialysis (PD) solution, determining ultrafiltration (UF) and dialysate-to-plasma creatinine (D/P(Cr)) in a peritoneal equilibration test (PET). The subjects of the study were 8 anuric patients who, at the time of enrollment into the study, were receiving continuous ambulatory peritoneal dialysis (CAPD) and using a 2.5% glucose-based dialysis solution overnight. The mean age of the patients was 57.9 +/- 6.1 years (range: 45.2 - 64.1 years), and their mean duration of CAPD was 61.6 +/- 44.3 months (range: 5.6 - 140.1 months). We changed the 2.5% glucose solution that the patients were using for the 8-hour overnight dwell to icodextrin and measured the resulting UF. We also performed a PET before and 12 weeks after the start of icodextrin. After the start of icodextrin, PETs were carried out immediately after the icodextrin dwell; after rinsing twice with 2.5% glucose solution following an icodextrin dwell; and after an 8-hour dwell with glucose solution. The UF for 8-hour dwells increased significantly 12 weeks after the start of icodextrin (356.3 +/- 102.9 mL with 2.5% glucose at baseline vs. 517.5 +/- 102.8 mL with icodextrin, p < 0.001). However, the daily total UF was unchanged after the start of icodextrin (924.3 +/- 281.3 mL vs. 934.6 +/- 263.4 mL). As compared with the D/P(Cr) before the start of icodextrin, the D/P(Cr) after the start of icodextrin was significantly increased immediately after an icodextrin dwell (0.57 +/- 0.1 vs. 0.63 +/- 0.1, p < 0.01) and after twice rinsing with 2.5% glucose solution following an icodextrin dwell (0.57 +/- 0.1 vs. 0.66 +/- 0.2, p < 0.01). However, before or after the start of icodextrin, the D/P(Cr) after an 8-hour dwell with glucose solution did not change (0.57 +/- 0.1 vs. 0.57 +/- 0.1, p < 0.01). The D/P(Cr) measured in a PET was high immediately after a dwell with icodextrin. Those results may reflect an effect of icodextrin on the small pores. Before a PET, dialysis should be performed using a glucose solution.
Moriishi
Misaki
M
Department of Artificial Organs, Akane-Foundation Tsuchiya Hospital, Hiroshima, Japan. usagi@tsuchiya-hp.jp
Kawanishi
Hideki
H
Watanabe
Hiroshi
H
Tsuchiya
Sinichiro
S
D001002:Anuria / Q000628:therapy; D001692:Biological Transport; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005936:Glucans; D005947:Glucose / Q000378:metabolism; D015312:Hemodialysis Solutions; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000378:metabolism*; D010539:Permeability; D014462:Ultrafiltration
D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D003404:Creatinine; D005947:Glucose