title: Peritoneal resting with heparinized lavage reverses peritoneal type I membrane failure. A comparative study of the resting effects on normal membranes.
abstract: BACKGROUND
  Ultrafiltration failure (UFF) is a serious complication of long-term peritoneal dialysis (PD). Peritoneal rest (PR) has been demonstrated as a valid treatment to reverse the functional changes that occur in UFF. The effects of PR on a normally functioning human peritoneum are unknown but are expected to be neutral. Our hypothesis was that PR positively modifies peritoneal function in patients with UFF, in contrast to the absence of effects when PR is applied under normal conditions.
  
  
  METHODS
  We studied 84 PR periods, comparing 35 patients with UFF and 49 controls (resting for abdominal surgery with temporary discontinuation of PD). We analyzed peritoneal transport pre-PR and post-PR by calculating the mass transfer coefficients of creatinine (Cr-MTAC), the dialysate/plasma creatinine ratio (D/P Cr) and the ultrafiltration (UF).
  
  
  RESULTS
  Baseline data was similar for the 2 groups, although the UFF group had a longer median time in PD (39 [18 - 60] vs 10 [5 - 23] months; p = 0.00001). Peritoneal rest induced a decrease in D/P Cr, Cr-MTAC and an increase in UF capacity in the UFF group (p = 0.0001, p = 0.004 and p = 0.001, respectively), without causing changes in the control group. Peritoneal rest in patients with more than 6 months of UFF was not able to reduce peritoneal solute transport or improve UF capacity. Response to PR did not differ among UFF patients with or without a previous history of peritonitis. Peritoneal rest enabled patients with UFF to continue on PD for a median time of 23 months (range, 13 - 46 months).
  
  
  CONCLUSIONS
  Peritoneal rest induces functional changes in patients with UFF but not in those with no functional abnormalities. This demonstrates that PR works only when abnormal but reversible functional conditions are present. However, the effect is highly dependent on how early PR is applied.
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Erika
authors.initials: E
authors.lastname: De Sousa
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Del Peso
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Alvarez
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Ros
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Mateus
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Aguilar
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Selgas
authors.affiliation: Department of Nephrology, University Hospital La Paz, IdiPAZ, Madrid, Spain; and Department of Nephrology, Hospital Carlos Haya, Malaga, Spain.
authors.forename: María-Auxiliadora
authors.initials: MA
authors.lastname: Bajo
mesh_terms: D000328:Adult; D001692:Biological Transport / Q000502:physiology; D016022:Case-Control Studies; D005260:Female; D006440:Hemofiltration / Q000009:adverse effects* / Q000379:methods; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D016014:Linear Models; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D011379:Prognosis; D012016:Reference Values; D019233:Retreatment / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000009:adverse effects / Q000379:methods; D028761:Withholding Treatment
chemical_list: D008567:Membranes, Artificial; D006493:Heparin
keywords: Peritoneal transport; heparin; peritoneal dialysis; peritoneal rest; ultrafiltration failure