Nocturnal ultrafiltration profiles in patients on APD: impact on fluid and solute transport.
In order to prevent morbidity and mortality in peritoneal dialysis (PD), sodium and water balance as well as a minimal level of small-solute clearances are needed. The impact of three nocturnal peritoneal ultrafiltration (UF) profiles on UF and small solute clearance in patients on automated PD (APD) was studied: constant glucose concentration of 1.36% (flat) or modifying the glucose concentration of the heater bag (descendant: 3.86-1.36%; ascendant: 1.36-3.86%). Sixty-two patients were enrolled in the study and received each profile within a four-month period, thus serving as their own controls. UF was lower with the flat profile (367+/-420ml; P<0.01), but no difference was seen between the two higher glucose concentration profiles. Peritoneal Kt/V (pKt/V) and peritoneal creatinine clearance (CrpC) showed statistically higher values from the descendant vs ascendant vs flat profiles (pKt/V: 1.54+/-0.30 vs 1.45+/-0.30 vs 1.38+/-0.27, and CrpC: 36.9+/-7.9 vs 33.5+/-7.48 vs 29.92+/-7.5 mlmin(-1)). Multivariate analysis showed statistical significance for the following: in the intrasubject comparisons, the profile for pKt/V (F=9.109, P<0.001) and CrpC (F=11.697, P<0.001), and in the intersubjects comparisons, the effects of both gender (F=14.334, P<0.01) for pKt/V and peritoneal permeability for both parameters (pKt/V: F=4.37, P<0.05; CrpC: F=11.697, P<0.001). In conclusion, the application of ascendant and descendant UF profiles in automated PD is feasible and results in better UF and small solute clearances, thus preventing inadequate dialysis and volume overload..
Vega
N D
ND
Division of Nephrology, Hospital, Universitario de Gran Canaria Dr Negrín, Canary Islands, Spain. nvegdia@gobiernodecanarias.org
Gallego
R
R
Oliva
E
E
Henriquez
F
F
Palop
L
L
Divino Filho
J C
JC
Lindholm
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism*; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology*; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D016896:Treatment Outcome; D014462:Ultrafiltration
D001786:Blood Glucose; D003404:Creatinine