The Influence of Initial Peritoneal Transport Characteristics, Inflammation, and High Glucose Exposure on Prognosis for Peritoneal Membrane Function

Abstract

<jats:sec><jats:title>♦ Background</jats:title><jats:p>Fast transport status, acquired with time on peritoneal dialysis (PD), is a pathology induced by peritoneal exposure to bioincompatible solutions. Fast transport has important clinical consequences and should be prevented.</jats:p></jats:sec><jats:sec><jats:title>♦ Objective</jats:title><jats:p>We analyzed the repercussions of initial peritoneal transport characteristics on the prognosis for peritoneal membrane function, and also whether the influence of peritonitis and high exposure to glucose are different according to the initial peritoneal transport characteristics or the moment when such events occur.</jats:p></jats:sec><jats:sec><jats:title>♦ Methods</jats:title><jats:p>The study included 275 peritoneal dialysis patients with at least 2 peritoneal function studies (at baseline and 1 year). Peritoneal kinetic studies were performed at baseline and annually. Those studies consist of a 4-hour dwell with glucose (1.5% during 1981 – 1990, and 2.27% during 1991 – 2002) to calculate the peritoneal mass transfer coefficients of urea and creatinine (milliliters per minute) using a previously described mathematical model.</jats:p></jats:sec><jats:sec><jats:title>♦ Results</jats:title><jats:p>Membrane prognosis and technique survival were independent of baseline transport characteristics. Fast transport and ultrafiltration (UF) failure are reversible conditions, provided that peritonitis and high glucose exposure are avoided during the early dialysis period. The first year on PD is a main determining factor for the membrane's future, and the mass transfer coefficient of creatinine at year 1 is the best functional predictor of future PD history. After 5 years on dialysis, permeability frequently increases, and UF decreases. Icodextrin is associated with peritoneal protection.</jats:p></jats:sec><jats:sec><jats:title>♦ Conclusions</jats:title><jats:p>Peritoneal membrane prognosis is independent of baseline transport characteristics. Intrinsic fast transport and low UF are reversible conditions when peritonitis and high glucose exposure are avoided during the early dialysis period. Icodextrin helps in glucose avoidance and is associated with peritoneal protection.</jats:p></jats:sec>

Analysis of Ultrafiltration Failure Diagnosed at the Initiation of Peritoneal Dialysis with the Help of Peritoneal Equilibration Tests with Complete Drainage at Sixty Minutes. A Longitudinal Study

“…Small solute transport rates showed a simultaneous regression to mean values, increasing in slower transporters and decreasing in fast transporters. Similar findings were reported by Fernandez-Reyes et al (13), with nonsignificant trends to an increase in UF during the first year, and a later progressive decay. A more recent in-depth study (14), based on SPA tests, partially confirmed the results of previous investigations, by reporting an overall stability of the capacity of UF during the first years, followed by a later decline, particularly after the fourth year on PD.…”

Characterization of the Brazpd ii Cohort and Description of Trends in Peritoneal Dialysis Outcome across Time Periods

“…Last, APD is usually the modality of choice for the treatment of high transporters in PD. It is known that these patients are at high risk for ultrafiltration failure and present significantly more comorbidities that may influence outcomes, particularly when glucose-sparing solutions are not available, as was our case at the time (21,22).…”

Peritoneal Water Transport Characteristics of Diabetic Patients Undergoing Peritoneal Dialysis. A Longitudinal Study

“…It has long been recognized that there is a large variability in the characteristics of water and solute transport across the peritoneal membrane and that in some individuals, these conditions change over time [16][17][18][19]. This variability may have important clinical consequences, and monitoring these parameters is essential, to guide prescription and improve patient outcomes [20].…”