NDT Advance Access originally published online on April 12, 2005
Nephrology Dialysis Transplantation 2005 20(6):1201-1206; doi:10.1093/ndt/gfh793
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Factors influencing peritoneal transport parameters during the first year on peritoneal dialysis: peritonitis is the main factor
1 Department of Nephrology, University Hospitals La Paz, 2 General Hospital, Segovia and 3 La Princesa, Madrid, Spain
Correspondence and offprint requests to: Gloria del Peso, MD, Servicio de Nefrología, Hospital Universitario La Paz, Po Castellana 261, E-28046-Madrid. Spain. Email: gpeso.hulp{at}salud.madrid.org
Background. Studies on the evolution of peritoneal transport during the first year of peritoneal dialysis (PD) are scarce and their results are contradictory. The aim of the present study was to analyse the evolution of peritoneal transport and residual renal function during the first year on PD, and to determine the factors that may influence them.
Methods. We studied 249 patients on continuous ambulatory PD with glucose exchange solutions (117 men, 132 women, mean age 51.9±16 years) 59 of whom had diabetes (25 type I). At baseline and after 1 year, we determined the mass transfer coefficients of urea (U-MTAC) and creatinine (Cr-MTAC), net ultrafiltration and residual renal function.
Results. Residual renal function decreased significantly during the first year (from 3.9±2.8 to 2.4±2.2 ml/min, P<0.001). Both U-MTAC and Cr-MTAC decreased after 1 year [U-MTAC from 22.7±7.8 to 20.7±6.6 ml/min (P<0.001), Cr-MTAC from 10.5±5.3 to 10.1±4.6 ml/min (NS)]. The ultrafiltration capacity increased significantly (from 923±359 to 987 U 341 ml/4 h, P<0.001). The evolution of MTAC values was independent of age, sex, diabetes and amount of hypertonic glucose used. When patients were grouped according to their initial Cr-MTAC, we observed a tendency toward normalization of the parameters of peritoneal function. Patients with peritonitis (n = 88) showed a first year increase in Cr-MTAC, which was significantly higher than in patients without peritonitis (11.1±5 vs 9.5±4.2, P<0.01). Ultrafiltration decreased in patients with more than four accumulated days of peritonitis (from 1062±447 to 1024±340 ml/4 h, NS); it increased in patients without peritonitis.
Conclusions. The peritoneal transport parameters tended toward normalization during the first year on PD, mainly with a decrease of small solute transport and an increase of ultrafiltration capacity. This evolution is independent of age, gender, diabetes and higher exposure to glucose in PD solutions. Peritonitis was the only independent factor that affected peritoneal function during the first year on peritoneal dialysis.
Keywords: peritoneal dialysis; peritoneal transport; peritonitis; ultrafiltration
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