title: Ultrafiltration failure in peritoneal dialysis: a pathophysiologic approach.
abstract: BACKGROUND
  Ultrafiltration failure is a significant cause of technique failure for peritoneal dialysis and subsequent transfer to hemodialysis.
  
  
  CONCLUSIONS
  Ultrafiltration failure is defined as failure to achieve at least 400 ml of net ultrafiltration during a 4 h dwell using 4.25% dextrose. Four major causes of ultrafiltration failure have been described. A highly effective peritoneal surface area is characterized by transition to a very rapid transport state with D/P creatinine >0.81. Low osmotic conductance to glucose is characterized by attenuation of sodium sieving and decreased peritoneal free water clearance to <26% of total ultrafiltration in the first hour of a dwell. Low effective peritoneal surface area manifests with decreases in the transport of both solute and water. A high total peritoneal fluid loss rate is the most difficult to diagnose clinically; failure to achieve ultrafiltration with an 8-10 h icodextrin dwell may provide a clue to diagnosis.
  
  
  CONCLUSIONS
  Knowledge of the specific pathophysiology of the various causes of ultrafiltration failure will aid in the diagnosis thereof.
authors: University of Colorado School of Medicine, Aurora, Colo., USA.
authors: Isaac
authors: I
authors: Teitelbaum
mesh_terms: D001692:Biological Transport; D001834:Body Water / Q000378:metabolism*; D003404:Creatinine / Q000378:metabolism; D015314:Dialysis Solutions / Q000737:chemistry; D005936:Glucans / Q000378:metabolism; D005947:Glucose / Q000378:metabolism; D006801:Humans; D000077607:Icodextrin; D010530:Peritoneal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D012964:Sodium / Q000378:metabolism; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure; D014462:Ultrafiltration
chemical_list: D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D012964:Sodium; D003404:Creatinine; D005947:Glucose