Evaluation and Management of Ultrafiltration Problems in Peritoneal Dialysis

Mujais, Salim; Nolph, Karl D.; Gokal, Ram; Blake, Peter G.; Burkart, John M.; Coles, Gerald A.; Kawaguchi, Yoshindo; Kawanishi, Hideki; Korbet, Stephen M.; Krediet, Raymond T.; Lindholm, Bengt; Oreopoulos, Dimitrios G.; Rippe, Bengt; Selgas, Rafael

doi:10.1177/089686080002004s02

Cited by 219 publications

(36 citation statements)

References 79 publications

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“…A sub-analysis was performed in which patients with UF failure [ 17 ] were withdrawn from the analysis: 13 patients in the short-term, 4 in the medium-term and 9 in the long-term group had UF failure. Similar relationships prevailed (data not shown).…”

Section: Resultsmentioning

confidence: 99%

The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients

Coester¹,

Zweers²,

Waart³

et al. 2008

Clinical Kidney Journal

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Background. Recently, we found evidence of effluent potassium (K+) additional to diffusion and convection, suggesting cellular release (CR). Its relationship with free water transport (FWT) in stable peritoneal dialysis (PD) patients suggested an effect of hypertonicity of the dialysis solution leading to cell shrinkage. The aim of the present study was to reproduce these findings in groups according to PD duration and to further investigate the role of mesothelial cells in the observed phenomenon.Methods. Standard peritoneal permeability analyses done with 3.86% glucose were analysed cross-sectionally in three different groups: short-term (n = 53) 0–2 years PD treatment; medium-term (n = 24) 2–4 years PD and long-term (n = 26) > 4 years PD.Results. The time courses for FWT and cellular release of K+ (CR-K+) during the dwell were not significantly different among the groups. Cancer antigen (CA) 125 was highest in the short-term group (P ≤ 0.02) and had a strong positive correlation with mass transfer area coefficient of creatinine (MTAC-creatinine) only in the short-term group (r = 0.62, P ≤ 0.01). CA125 had no relationship with either CR-K+ or FWT, except for negative relationships in the short-term group (CR-K+, r = −0.41, P ≤ 0.05; FWT, r = −0.54, P ≤ 0.05).Conclusion. We conclude that the correlation of CA125 and MTAC-creatinine is dependent on PD duration and underlines the in vitro observation that mesothelial cells produce vasoactive substances that may increase the peritoneal surface area. However, CA125 is not directly related to CR-K+ or FWT. Therefore, the relationship between FWT and CR-K+ is likely to reflect hypertonic cell shrinkage, regardless of the duration of PD, and confirms our earlier findings.

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Section: Resultsmentioning

confidence: 99%

The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients

Coester¹,

Zweers²,

Waart³

et al. 2008

Clinical Kidney Journal

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“…Concerning the relationship between ultrafiltration (UF) volume and outcome, the European Automated Peritoneal dialysis Outcome Study (EAPOS) reported that the prognosis was poor when the daily UF volume was ≤750 mL in anuric patients (43); whilst in patients with residual renal function, the body fluid volume is affected by the net balance between water and salt intake and removal, and it is difficult to set a fixed UF volume. Achieving a particular level of UF volume is, however, not the primary target, but maintaining a clinical state without edema, hypertension and cardiac overload is most important (44).…”

Section: Chapter 2: Adequacy Of Peritoneal Dialysismentioning

confidence: 99%

2009 Japanese Society for Dialysis Therapy Guidelines for Peritoneal Dialysis

Nakayama¹

2010

Ther Apher Dial

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The guidelines for peritoneal dialysis (PD) of the Japanese Society for Dialysis Treatment were prepared at 2009. Upon presenting a concrete frame of PD practiced in Japan, it aims to promote PD as a standardized therapy in Japan. Notably, the guidelines recommended combination therapy of PD and hemodialysis as a part of integrated renal replacement therapy for end‐stage renal disease, as well as timely PD withdrawal by peritoneal degeneration in order to prevent progression of encapsulating peritoneal sclerosis.

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“…Assessment of the dialysate/plasma (D/P) ratio of Na + after 60 min of a dialysis exchange has been proposed as a semiquantitative method for AQP-1 function (Mujais et al, 2000). Calculation of FWT 0-60 min in patients is also possible using sodium transport in that period: the drained volume is divided in the volume that accompanies Na + transport from the circulation to the dialysate which is assumed to have occurred through the small pores, the remaining part of the drained volume is considered to represent FWT (Smit et al, 2004; La Milia et al, 2005).…”

Section: Pathways For Peritoneal Fluid Transportmentioning

confidence: 99%

“…The extremely large interindividual variability contrasts with an intraindividual variability of about 20% (Imholz et al, 1978) and points to large differences in transport characteristics of the “peritoneal membrane” between individual patients. The International Society for PD published a guideline on UF failure in 2000, containing a definition of UF failure, based on the results of the above mentioned studies: the 3 × 4 rule (Mujais et al, 2000). It states that UF failure is present when netUF is less than 400 mL after drainage of a 4% (3.86 or 4.25%, depending on the pharmacopeia) dialysis solution with an intraperitoneal stay of 4 h. Although patients with UF failure according to this definition are often hypervolemic, overhydration is not included in the definition of UF failure, because overhydration is not only dependent on fluid removal, but also on fluid intake.…”

Section: Introductionmentioning

confidence: 99%

Ultrafiltration Failure Is a Reflection of Peritoneal Alterations in Patients Treated With Peritoneal Dialysis

Krediet

2018

Front. Physiol.

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Ultrafiltration (UF) failure is a common and important complication of peritoneal dialysis (PD), especially in long-term patients without residual urine production, because it often causes overhydration, which is an important cause of death in this population. The current review provides an overview of the pathways of peritoneal fluid transport, followed by the mechanisms and causes of UF failure. The egression of circulating fluid to the tissue compartment and its subsequent re-uptake by the colloid osmotic pressure are markedly influenced by PD, because the dialysis solutions contain glucose as a low molecular weight agent causing removal of fluid from the circulation by crystalloid osmosis. Pores involved in transcapillary UF consist of inter-endothelial small pores and the intra-endothelial water channel aquaporin-1. The former allows transport of plasma fluid with dissolved low molecular weight solutes and accounts for 60% of the filtered volume, the latter transports 40% as pure water. This free water transport (FWT) is driven by the crystalloid pressure gradient, while small pore fluid transport (SPFT) is dependent on both hydrostatic and crystalloid osmotic pressure. The number of perfused peritoneal microvessels as assessed by small solute transport parameters, is differently associated with UF: a positive relationship is present with SPFT, but a negative one with FWT, because the effect of more vessels is counteracted by a faster disappearance rate of glucose. Ultrafiltration failure can be present shortly after the start of PD, for instance due to mesothelial-to-mesenchymal transition. Late UF failure develops in 21% of long-term patients. Both FWT and SPFT can be affected. Patients with encapsulating peritoneal sclerosis have severely impaired FWT, probably due to interference of interstitial collagen-1 with the crystalloid osmotic gradient. This mechanism may also apply to other patients with reduced FWT. Those with mainly impaired SPFT likely have a reduced hydrostatic filtration pressure due to vasculopathy. Deposition of advanced glycosylation end products is probably important in the development of this vasculopathy. It can be concluded that long-term UF failure may affect both SPFT and FWT. Vasculopathy is important in the former, interstitial fibrosis in the latter. Measurements of peritoneal transport function should include separate assessments of small pore-and FWT.

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Evaluation and Management of Ultrafiltration Problems in Peritoneal Dialysis

Cited by 219 publications

References 79 publications

The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients

The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients

2009 Japanese Society for Dialysis Therapy Guidelines for Peritoneal Dialysis

Ultrafiltration Failure Is a Reflection of Peritoneal Alterations in Patients Treated With Peritoneal Dialysis

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