Time course of peritoneal transport parameters in peritoneal dialysis patients who develop peritoneal sclerosis.
Peritoneal sclerosis (PS) is a severe complication of long-term peritoneal dialysis (PD). We therefore investigated whether longitudinal analysis of solute and fluid transport preceding a diagnosis of PS could predict its development. We reviewed all standard peritoneal permeability analyses (SPAs) performed with 3.86% glucose and completed before a diagnosis of PS in all patients (n = 11) in whom that diagnosis was made in our center between 1995 and 2006. Most patients had 4 SPAs available. A linear mixed-model procedure was used to analyze the trends. Transport of small-solutes showed significant inverse U-shaped trends before a diagnosis of PS. This trend held for the mass transport area coefficients of creatinine, urea, and urate (all p < 0.05) and for their dialysate-to-plasma ratios (all p < 0. 001). Net ultrafiltration and free water transport at 60 minutes showed significant downward linear trends (both p < or = 0. 01). This U-shaped trend in small-solute transport combined with an ongoing decrease in net ultrafiltration and free water transport might be a warning sign of the development of PS. It underlines the importance of regular assessment of peritoneal function with 3.86% peritoneal equilibration tests in every PD patient-not only those at risk for peritoneal membrane failure.
Sampimon
Denise E
DE
Department of Internal Medicine, Division of Nephrology, Academic Medical Center, University of Amsterdam, Netherlands.
Coester
Annemieke M
AM
Struijk
Dirk G
DG
Krediet
Raymond T
RT
D000293:Adolescent; D000328:Adult; D000368:Aged; D001692:Biological Transport; D003404:Creatinine / Q000378:metabolism; D005936:Glucans; D005947:Glucose / Q000493:pharmacokinetics; D015312:Hemodialysis Solutions; D006801:Humans; D000077607:Icodextrin; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism*; D010537:Peritoneum / Q000378:metabolism*; D010539:Permeability; D012598:Sclerosis; D014508:Urea / Q000378:metabolism; D014527:Uric Acid / Q000378:metabolism
D005936:Glucans; D015312:Hemodialysis Solutions; D014527:Uric Acid; D000077607:Icodextrin; D014508:Urea; D003404:Creatinine; D005947:Glucose