Nephrology Dialysis Transplantation, Vol 13, Issue 1 146-153, Copyright © 1998 by Oxford University Press
A Imholz, G Koomen, W Voorn, D Struijk, L Arisz and R Krediet
Background: The effect of posture on peritoneal
transport characteristics during CAPD is unpredictable because (1) although
the capillary pressure is higher in the upright positions, the
intraperitoneal pressure is also elevated, and (2) the contact of dialysate
with the subdiaphragmatic lymphatics is probably more extensive during
recumbency. Methods: In eight CAPD patients, six
peritoneal permeability tests (4 h, glucose 2.27%, dextran 70 as volume
marker) were performed within 2 weeks, while the body posture was either
recumbent (3 tests) or upright (3 tests). In addition, intraperitoneal
pressure measurements were done in the recumbent and upright positions.
Results: The intraperitoneal pressure, not corrected
for the contribution of the hydrostatic column, was higher in upright
position (12.6±0.8 mmHg, mean±SEM) than during
recumbency (7.7±0.8; P <0.0005). Net ultrafiltration rate
was lower when upright; 0.96±0.09
ml/min/1.73m2, compared to 1.14±0.12 in
the supine position (P <0.05). This was achieved because the
effective lymphatic absorption rate was marginally higher and the
transcapillary ultrafiltration rate was slightly lower in the upright
position. The mass transfer area coefficient of creatinine, representing
effective peritoneal surface area, decreased from 107±1.3
ml/min/1.73 m2 (recumbent) to 9.9±1.4
(upright; P=0.08). The clearances of five serum proteins decreased more the
higher the molecular weight. As a consequence the restriction coefficient
was 2.07±0.09 (recumbent) vs
2.23±0.08 (upright; P=0.06). Hence the intrinsic permeability to
macromolecules was higher during recumbency. The intraperitoneal pressure
was correlated with the net ultrafiltration rate (r=-0.71, P=0.05) only
during recumbency. In upright position relations were found between the
effective lymphatic absorption rate and the mass transfer area coefficients
of low molecular solutes. The coefficients of variation of fluid and solute
parameters were not different between both positions.
Conclusions: It is concluded that the decrease in net
ultrafiltration rate in the upright position is only small and probably
caused by counteracting effects of a higher intra-abdominal pressure and
the effect of gravity. The upright position also led to only small
decreases in solute transport parameters. Key words:
CAPD; transport kinetics; body position; variability
ORIGINAL ARTICLES
Day-to-day variability of fluid and solute transport in upright and recumbent positions during CAPD
Departments of Medicine F4-215, Clinical Chemistry, and Clinical Epidemiology and Biostatistics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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