title: The Natural Time Course of Membrane Alterations During Peritoneal Dialysis Is Partly Altered by Peritonitis.
abstract: ♦
  
  
  
  The quality of the peritoneal membrane can deteriorate over time. Exposure to glucose-based dialysis solutions is the most likely culprit. Because peritonitis is a common complication of peritoneal dialysis (PD), distinguishing between the effect of glucose exposure and a possible additive effect of peritonitis is difficult. The aim of the present study was to compare the time-course of peritoneal transport characteristics in patients without a single episode of peritonitis-representing the natural course-and in patients who experienced 1 or more episodes of peritonitis during long-term follow-up. ♦
  
  
  
  This prospective, single-center cohort study enrolled incident adult PD patients who started PD during 1990-2010. A standard peritoneal permeability analysis was performed in the first year of PD treatment and was repeated every year. The results in patients without a single episode of peritonitis ("no-peritonitis group") were compared with the results obtained in patients who experienced 1 or more peritonitis episodes ("peritonitis group") during a follow-up of 4 years. ♦
  
  
  
  The 124 patients analyzed included 54 in the no-peritonitis group and 70 in the peritonitis group. The time-course of small-solute transport was different in the groups, with the peritonitis group showing an earlier and more pronounced increase in the mass transfer area coefficient for creatinine (p = 0.07) and in glucose absorption (p = 0.048). In the no-peritonitis group, the net ultrafiltration rate (NUFR) and the transcapillary ultrafiltration rate (TCUFR) both showed a steep increase from the 1st to the 2nd year of PD that was absent in the peritonitis group. Both groups showed a decrease in the NUFR after year 3. A decrease in the TCUFR occurred only in the peritonitis group. That decrease was already present after the year 1 in patients with severe peritonitis. The time-course of free water transport showed a continuous increase in the patients without peritonitis, but a decrease in the patients who experienced peritonitis (p < 0.01). No difference was observed in the time-course of the effective lymphatic absorption rate. The time-courses of immunoglobulin G and α2-macroglobulin clearances showed a decrease in both patient groups, with a concomitant increase of the restriction coefficient. Those changes were not evidently influenced by peritonitis. The two groups showed a similar decrease in the mesothelial cell mass marker cancer antigen 125 during follow-up. ♦
  
  
  
  On top of the natural course of peritoneal function, peritonitis episodes to some extent influence the time-course of small-solute and fluid transport-especially the transport of solute-free water. Those modifications increase the risk for overhydration.
authors.affiliation: Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam Nephrology Department and Internal Medicine, St. Elisabeth Hospital, Tilburg sadievanesch@gmail.com.
authors.forename: Sadie
authors.initials: S
authors.lastname: van Esch
authors.affiliation: Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam Dianet, Amsterdam-Utrecht, Netherlands.
authors.forename: Dirk G
authors.initials: DG
authors.lastname: Struijk
authors.affiliation: Division of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Krediet
mesh_terms: D000328:Adult; D000368:Aged; D001692:Biological Transport; D015314:Dialysis Solutions / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010538:Peritonitis / Q000209:etiology / Q000378:metabolism*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D015314:Dialysis Solutions
keywords: Peritonitis; peritoneal transport; standard peritoneal permeability analysis