Follow-up of Peritoneal Mass Transfer Properties in Long-term CAPD Patients

Selgas, Rafael; R-Carmona, A.; Martı́nez, M.E.; Conesa, J.; P-Fontan, M.; Huarte, Emma; Ortega, Olimpia; S-Sicilia, L.

doi:10.1007/978-3-662-11784-2_9

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…In most studies on the long-term effect of CAPD on the peritoneal membrane no significant trend in the transport of solutes was observed, although in some individuals a decrease or increase has been demon strated [1, [4][5][6][16][17][18][19][20][21][22][23][24]. Pollock et al [25] reported an increase in the 24-hour peritoneal clearance of creatinine in time.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, in the majority of the published series the transport characteristics for low-molecular weight so lutes and fluid removal were reported, but few data are available on middle-molecular solutes (molecular weight 500-5,500) and macromolecules. Probably due to the small number of patients in most studies the data on the change in transport properties of the peritoneal mem brane in CAPD are conflicting [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Functional Characteristics of the Peritoneal Membrane in Long-Term Continuous Ambulatory Peritoneal Dialysis

Struijk

Krediet

Koomen

et al. 1991

Nephron

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Peritoneal transport characteristics of 20 long-term (LT) patients with a mean duration on continuous ambulatory peritoneal dialysis (CAPD) of 60 months were compared with those of 20 matched patients who recently started (RS) CAPD (mean 39 days, range 11–63). Mass transfer area coefficients (MTC) of creatinine, glucose and inulin were higher in the LT group than in the RS group (12.1 versus 9.2 ml/min, p < 0.01; 9.9 versus 8.3 ml/min, p < 0.05; 4.1 versus 3.5 ml/min, p < 0.05). The MTC of α₂-macroglobulin were lower in the LT group (13 versus 25 μl/min; p < 0.01). The size selectivity of the membrane for the transport of macromolecules, determined as protein MTC ratios, showed a more restricted passage for macromolecules in the LT group. Net fluid removal using glucose 3.86% was lower in the LT patients (487 versus 826 ml/4 h; p < 0.001). The results indicate the development of a larger effective peritoneal surface area combined with a less permeable peritoneal membrane after many years of CAPD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Functional Characteristics of the Peritoneal Membrane in Long-Term Continuous Ambulatory Peritoneal Dialysis

Struijk

Krediet

Koomen

et al. 1991

Nephron

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“…In the majority of patients treated with CAPD for up to 3 years, the peritoneal ultrafiltration capacity (UFC) and small-solute transport characteristics seem to be relatively stable (16,(19)(20)(21)(22)(23). However, several studies demonstrate a tendency towards increasing diffusive transport for urea, creatinine, and glucose (as assessed by increased diffusive mass transport coefficients: KBD or PET D/P), as well as a tendency towards decreasing net UF (15)(16)(17)(23)(24)(25)(26)(27)(28)(29)(30). However, individual patients may exhibit markedly different characteristics: some patients demonstrate increased diffusive solute transport and decreased ultrafiltra tion, whereas other patients show opposite patterns (16,18,(31)(32)(33).…”

Section: Changes In Peritoneal Transport With Long-term Peritoneal Dialysismentioning

confidence: 99%

Alterations in Water and Solute Transport with Time on Peritoneal Dialysis

1999

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Peritoneal ultrafiltration capacity and small -solute transport characteristics seem to be relatively stable in most patients treated with PD for up to 3 years. However, in patients treated with PD for 4 years or more, there is a tendency towards increasing diffusive transport for small solutes as well as a tendency towards decreasing net UF, whereas the peritoneal protein clearances seem to be reduced or stable. Loss of UFC is a well-known complication during long-term PD treatment, and the risk for loss of UFC may be as high as 50% after 6 years on PD. Several different mechanisms of UFC loss have been reported. In particular, the most common mechanism for loss of UFC is increased diffusive transport resulting in rapid glucose absorption and thus rapid loss of the osmotic driving force. Also reported as causes of UFC loss have been: reduced efficiency of the osmotic agent (perhaps owing to decreased transcellular water transport); loss of peritoneal surface area with slow solute transport owing to fibrosis and the formation of adhesions (during the late stage of sclerosing peritonitis); and increased peritoneal fluid absorption. In individual patients, a combination of several mechanisms may be involved in the apparent UFC failure.

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“…These studies have provided elaborate mathematical methods, but simple tests for clinical management are not avail able except the determination of plasma sol ute concentrations. Some of these mathemat ical models have only been tested in a limited or unknown number of patients [2,3], Only one longitudinal study on changes in perito- neal permeability using mass transfer area coefficients and with observation periods of more than 1 year has been published [12].…”

Section: Discussionmentioning

confidence: 99%

Simple Assessment of the Efficacy of Peritoneal Transport in Continuous Ambulatory Peritoneal Dialysis Patients

et al. 1986

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The efficacy of peritoneal transport was assessed in 13 permeability studies in 11 continuous ambulatory peritoneal dialysis (CAPD) patients. During each study the in situ intraperitoneal volume was measured as well as the dialysate and plasma concentrations of various solutes with a molecular weight range from 60 to 5,500. As clearance estimations are unsuitable for the purpose of permeability studies, mass transfer area coefficients were used. By applying a simple mathematical model assuming first-order kinetics, these coefficients were calculated for urea, lactate, creatinine, glucose, kanamycin, and inulin. The accuracy of the calculations is indicated by their r values. After pooling these correlation coefficients, the mean approached 1.00 for all solutes with high confidence limits, indicating the usefulness of the model. A further simplification was tested using only an initial- and end-dialysate sample and two blood samples, without the measurement of the in situ intraperitoneal volume. Except for inulin the results of this simplification correlated well with the results described above. The reproducibility of the simplified mass transfer area coefficient calculations was investigated on 15 occasions in 3 other CAPD patients. The coefficients of variation of low molecular weight solutes varied between 15 and 20%. It is concluded that mass transfer area coefficient estimations using the latter method can be performed in any CAPD patient and probably yield sufficient information to establish the efficacy of the membrane transport mechanism during clinical follow-up.

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Follow-up of Peritoneal Mass Transfer Properties in Long-term CAPD Patients

Cited by 7 publications

References 3 publications

Functional Characteristics of the Peritoneal Membrane in Long-Term Continuous Ambulatory Peritoneal Dialysis

Functional Characteristics of the Peritoneal Membrane in Long-Term Continuous Ambulatory Peritoneal Dialysis

Alterations in Water and Solute Transport with Time on Peritoneal Dialysis

Simple Assessment of the Efficacy of Peritoneal Transport in Continuous Ambulatory Peritoneal Dialysis Patients

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