Nephrology Dialysis Transplantation, Vol 13, Issue 5 1242-1249, Copyright © 1998 by Oxford University Press
T Wang, O Heimbuger, J Waniewski, J Bergstrom and B Lindholm
Background: Recent studies suggest that increased
peritoneal membrane permeability is associated with higher morbidity and
mortality in peritoneal dialysis patients. It is not known, however,
whether the difference in clinical outcome among different peritoneal
transport groups is due to differences in peritoneal fluid and solute
removal. In the present study, we compared the peritoneal fluid and solute
transport and clinical outcome in CAPD patients with high (H), high-average
(H-A), low-average (L-A) and low (L) peritoneal transport patterns.
Design: A 6-h study was performed in 46 patients with
frequent dialysate and plasma samples using 21 of 3.86% glucose dialysate
with 131I albumin as an intraperitoneal volume
marker. The patients were divided into four transport groups according to
their D/P of creatinine at 240 min. Results: The
results showed that high transporters had significantly lower peritoneal
fluid and small-solute removal but high glucose absorption and high protein
loss during a 6-h exchange. The serum albumin was lower and blood pressure
and triglycerides were higher in high transporters compared with the other
groups. Two-year patient survival from the start of CAPD treatment was
significantly lower for high transporters (64, 85, 90 and 100% for H, H-A,
L-A and L respectively, P<0.01). The 1-year patient survival from
the dwell study was also significantly lower in high transporters (16, 63,
90 and 100% for each group, P<0.01).
Conclusion: Our results suggest that high transporters
remove less fluid and small solutes and have higher protein loss and
increased glucose absorption. These alterations may contribute to fluid
overload, malnutrition and lipid abnormalities that perhaps contribute to
the increased mortality among the high transporters. Key
words: CAPD, adequacy, peritoneal transport, mortality
ORIGINAL ARTICLES
Increased peritoneal permeability is associated with decreased fluid and small-solute removal and higher mortality in CAPD patients
Divisions of Baxter Novum and Renal Medicine K-56, Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, S-141 86 Huddinge, Sweden; Corresponding author
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