Relation between MicroRNA Expression in Peritoneal Dialysis Effluent and Peritoneal Transport Characteristics

Background:The role of microRNAs (miRNAs) in peritoneal transport is uncertain.Methods:We studied 82 new peritoneal dialysis (PD) patients, 22 prevalent patients without ultrafiltration problem, and 6 patients with documented ultrafiltration problem. Peritoneal transport was determined by standard peritoneal equilibration test (PET). RNA was extracted from the PD effluent after PET, and intra-peritoneal expression of miRNA targets were quantified.Results:There were significant difference in the PDE expressions of miR-15a and miR-21. There were modest inverse correlations between ultrafiltration volume and PDE expression of miR-17 (r= −0.198,p= 0.041) and miR-377 (r= −0.201,p= 0.041). There was an inverse correlations between dialysate-to-plasma creatinine concentration at 4 hours and PDE expression of miR-192 (r= −0.199,p= 0.040); while mass transfer area coefficient of creatinine correlated with PDE expression of miR-192 (r= −0.191,p= 0.049) and miR-377 (r= 0.201,p= 0.041). Amongst 7 randomly selected patients who had repeat PET after one year, there was a significant correlation between baseline PDE expression of miR-377 and change in ultrafiltration volume (r= −0.852,p= 0.015).Conclusion:The miRNA expression in PDE, including miR-15a, miR-17, miR-21, miR-30, miR-192, and miR-377, correlated with peritoneal transport characteristics. Our result suggests that miRNA may play a role in the regulation of peritoneal membrane function.

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Systemic Endotoxin in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00036 ◽

2018 ◽

Vol 38 (5) ◽

pp. 381-384 ◽

Cited By ~ 1

Author(s):

Ali M. Shendi ◽

Nathan Davies ◽

Andrew Davenport

Keyword(s):

Peritoneal Dialysis ◽

Extracellular Volume ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Fungal Cell ◽

Membrane Function ◽

Patient Demographics ◽

Markers Of Inflammation ◽

Systemic Endotoxemia

Previous reports linked systemic endotoxemia in dialysis patients to increased markers of inflammation, cardiovascular disease, and mortality. Many peritoneal dialysis (PD) patients use acidic, hypertonic dialysates, which could potentially increase gut permeability, resulting in systemic endotoxemia. However, the results from studies measuring endotoxin in PD patients are discordant. We therefore measured systemic endotoxin in 55 PD outpatients attending for routine assessment of peritoneal membrane function; mean age 58.7 ± 16.4 years, 32 (58.2%) male, 21 (38.2%) diabetic, median duration of PD treatment 19.5 (13 – 31) months, 32 (58.2%) using 22.7 g/L dextrose dialysates, and 47 (85.5%) icodextrin. The median systemic endotoxin concentration was 0.0485 (0.0043 – 0.103) Eu/mL. We found no association between endotoxin levels and patient demographics, markers of inflammation, serum albumin, N-terminal pro-brain natriuretic peptide, extracellular volume measured by bioimpedance, blood pressure, PD prescriptions or peritoneal membrane transporter status, or medications. The measurement of endotoxin can be lowered by failure to effectively release protein-bound endotoxin prior to analysis and increased by contamination when taking blood samples and processing and storing the samples. Additionally, contamination with β–glucan from fungal cell walls and the use of different assays to analyze endotoxin can also give differing results. These factors may help to explain the disparate results reported in different studies. Our study would suggest that exposure to standard peritoneal dialysates does not substantially increase systemic endotoxin. However, until endotoxin assays can measure free and bound endotoxin separately, the role of endotoxin causing inflammation in PD patients remains to be determined.

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

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00137 ◽

2012 ◽

Vol 32 (6) ◽

pp. 636-644 ◽

Cited By ~ 12

Author(s):

M. José Fernández-Reyes ◽

M. Auxiliadora Bajo ◽

Gloria Del Peso ◽

Marta Ossorio ◽

Raquel Díaz ◽

...

Keyword(s):

Mass Transfer ◽

Peritoneal Dialysis ◽

High Glucose ◽

Peritoneal Membrane ◽

Transfer Coefficients ◽

High Exposure ◽

Membrane Function ◽

Peritoneal Transport ◽

Fast Transport ◽

Glucose Exposure

♦ BackgroundFast 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.♦ ObjectiveWe 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.♦ MethodsThe 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.♦ ResultsMembrane 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.♦ ConclusionsPeritoneal 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.

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The Fast Peritoneal Equilibration Test First and Second Hour Results

BANTAO Journal ◽

10.2478/bj-2014-0008 ◽

2015 ◽

Vol 12 (1) ◽

pp. 36-39 ◽

Cited By ~ 1

Author(s):

Hakan Akdam ◽

Alper Alp ◽

Ozgul Ozbek ◽

Umut Cakiroglu ◽

Yavuz Yenicerioglu ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Standard Deviation ◽

Short Version ◽

Test Results ◽

Transport Function ◽

Peritoneal Membrane ◽

Peritoneal Equilibration Test ◽

Creatinine Concentration ◽

Time Points ◽

The Mean

Abstract Introduction. The Peritoneal Equilibration Test (PET) is employed to assess peritoneal membrane transport function. The purpose of the test is to determine the optimal peritoneal dialysis regimen. The performance of the test, which is conducted over 4 hours, is time consuming both for the nurses and the patient. There have been studies to validate an approved short version of the original PET protocol, and all have yielded different results. We evaluated the concordance between the 1-hour, 2-hour and 4-hour (classical) test results of the fast PET. Methods. The study included 32 patients (20 males and 12 females). The patients underwent the 4-hour fast PET test, and the dialysate-to-plasma ratio of creatinine concentration (D/Pcrea) was determined. The standard deviation was added to or subtracted from the mean D/Pcrea ratios at hours 1, 2, and 4 to determine transport groups. Results. The mean age of the patients was 51.4±16.7 years. Mean D/Pcrea ratios at hours 1, 2, and 4 were 0.41±0.07, 0.54±0.10, and 0.69+0.12, respectively. There was a strong correlation between the 4-hour D/Pcrea ratio and 1-hour (r=0.756, p<0.001) and 2-hour (r=0.867, p<0.001) D/Pcrea ratios. Seventeen patients (53%) were in the same transport group at hours 1, 2, and 4. Eighteen patients (56%) at 1 hour and 24 patients (75%) at 2 hours fell into the same transport group at 4 hours. The patients that fell into different transport groups at different time points showed a shift to a lower or higher transport group. Conclusions. Two-hour fast PET gives promising results for clinical assessment purposes.

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Does Prior Abdominal Surgery Influence Peritoneal Transport Characteristics or Technique Survival of Peritoneal Dialysis Patients?

Blood Purification ◽

10.1159/000510555 ◽

2020 ◽

Vol 50 (3) ◽

pp. 328-335

Author(s):

Andreia Dias da Silva ◽

Leticia García Gago ◽

Catuxa Rodríguez Magariños ◽

Daniela Astudillo Jarrín ◽

Ana Rodríguez-Carmona ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Abdominal Surgery ◽

Surgical Procedures ◽

First Year ◽

Peritoneal Membrane ◽

Membrane Function ◽

Technique Survival ◽

Peritoneal Transport ◽

Small Pore ◽

The Impact

Introduction: Prior abdominal surgery may result in peritoneal membrane adhesions and fibrosis, compromising the success of peritoneal dialysis (PD). The impact of this factor on peritoneal membrane function and PD technique survival has not been adequately investigated. Methods: Following an observational, retrospective design, we studied 171 incident PD patients, with the main objective of analyzing the influence of prior abdominal surgical procedures (main study variable) on baseline and evolutionary peritoneal transport characteristics (main outcome) and PD patient and technique survival (secondary outcomes). Abdominal surgeries were categorized according to the degree of presumed injury to the peritoneal membrane. We also considered the additive effect of aggressions to the membrane during the first year on PD therapy. Results: All patients had a baseline peritoneal equilibration test with complete drainage at 60′, and 113 patients had a second study at the end of the first year. Sixty-one patients (35.7%) had a record of prior abdominal surgery, including 29 patients with at least one major intraperitoneal surgery, 22 having undergone minor intraperitoneal procedures, and 21 with a background of major abdominopelvic extraperitoneal surgery. We did not observe differences, at baseline or after 1 year, among patients with or without previous abdominal procedures regarding small solute transport, overall capacity of ultrafiltration, free water transport, small pore ultrafiltration, or peritoneal protein excretion. Stratified analysis, considering prior and first-year-on-PD peritoneal aggressions, did not reveal any differences, although in this case our analysis was hampered by a limited statistical power. Abdominal surgical events did not influence patient or PD technique survival. Conclusion: Prior abdominal surgical procedures do not appear to compromise peritoneal membrane function or technique survival in patients successfully started on PD.

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The Relationship between Ultrafiltrate Volume with Icodextrin and Peritoneal Transport Pattern according to the Peritoneal Equilibration Test

Peritoneal Dialysis International ◽

10.1177/089686080202200210 ◽

2002 ◽

Vol 22 (2) ◽

pp. 229-233 ◽

Cited By ~ 18

Author(s):

Maria Regina Teixeira Araújo ◽

Roberto Flávio Silva Pecoits–Filho ◽

João Egidio Romão Junior ◽

Emil Sabbaga ◽

Marcello Machado Marcondes ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Negative Correlation ◽

Significant Negative Correlation ◽

Peritoneal Membrane ◽

Dialysis Patients ◽

Peritoneal Equilibration Test ◽

Peritoneal Transport ◽

The Mean ◽

The Difference ◽

The Relationship

♦ Objective To establish a relationship between peritoneal transport membrane pattern, analyzed by the peritoneal equilibration test (PET), and drained volume using icodextrin (7.5% Ico) and glucose (3.86% Glu) solutions. ♦ Design Thirty peritoneal dialysis patients were submitted to a standard 4-hour PET and divided into 4 transport categories based on dialysate-to-plasma ratio of creatinine (D/Pcr) and dialysate ratio of glucose at 4 and zero hours of the dwell (D4/D0). Patients were asked to perform exchanges for 2 consecutive nights in 10-hour dwells (2 L 3.86% Glu solution on the first night, and 2 L 7.5% Ico solution on the second night). The drained volume was measured and dialysate samples from the overnight exchanges were obtained for β2-microglobulin (B2M) levels. ♦ Results PET classification using D/Pcr showed that 46.6% of the patients were high and high-average transporters, or 23.3% when D4/D0 was used. In spite of this difference, both methods showed significant correlation ( p = 0.0001, r = 0.862). The mean drained volumes were similar for both solutions (for 3.86% Glu, 2696 ± 369 mL; for 7.5% Ico, 2654 ± 424 mL). The high and high-average transport patients classified by D4/D0 achieved a higher ultrafiltration with 7.5% Ico than with 3.86% Glu ( p = 0.0235). When classified by D/Pcr, the difference was not significant ( p = 0.2243). In the low and low-average transport patients classified by D/Pcr, we observed a significantly lower ultrafiltration when 7.5% Ico was used compared to 3.86% Glu solution ( p = 0.0197). Using D4/D0, we saw a tendency toward lower ultrafiltration ( p = 0.0719) in the same group. We then correlated the PET results and the difference between drained volume with 7.5% Ico and 3.86% Glu solution [ΔV (I–G)]. We found a significant negative correlation between D4/D0 and ΔV (I–G) ( p = 0.002, r = –0.5390), and a positive correlation between D/Pcr and ΔV (I–G) ( p = 0.005, r = 0.4932). The levels of B2M obtained with 7.5% Ico were higher than those obtained with 3.86% Glu solution (for 7.5% Ico, 9.47 ± 6.71 μg/vol; for 3.86% Glu, 7.29 ± 4.91 μg/vol; p = 0.004). Furthermore, we found significant correlation between the total amount of B2M obtained with 7.5% Ico solution and D4/D0 ( p < 0.0001, r = –0.4493), and D/Pcr ( p < 0.0001, r = 0.5431). ♦ Conclusion Mean drained volume was similar between the two solution groups. High transporters, as defined by D4/D0, achieved higher ultrafiltration with 7.5% Ico than with 3.86% Glu solution. This is most likely due to the higher number of small pores in the peritoneal membrane. Low transporters, as classified by D/Pcr, achieved lower ultrafiltration with 7.5% Ico than with 3.86% Glu solution. The ΔV (I–G) and the PET results showed significant correlation, confirming that high transporters have a higher ultrafiltration volume with 7.5% Ico. The total B2M mass obtained with 7.5% Ico was greater than with 3.86% Glu solution and significantly higher in the high transport patients, indicating a larger number of small pores. Thus, the ΔV (I–G) could give us an idea of the peritoneal transport pattern in peritoneal dialysis patients.

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Taking Peritoneal Dialysis beyond the Year 2000

Peritoneal Dialysis International ◽

10.1177/089686089901903s07 ◽

1999 ◽

Vol 19 (3_suppl) ◽

pp. 35-42 ◽

Cited By ~ 9

Author(s):

Ram Gokal

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Membrane ◽

Membrane Function ◽

Fluid Removal ◽

The Past ◽

First Choice ◽

Year 2000 ◽

Economic Considerations ◽

Appropriate Prescription ◽

Better Than

Over the past 25 years, peritoneal dialysis (PD) has steadily improved so that now its outcomes, in the form of patient survival, are equivalent to, and at times better than, those for hemodialysis. We now have a better understanding of the pathophysiology of peritoneal membrane function and damage and the importance of appropriate prescription to meet agreed-upon targets of solute and fluid removal. In the next millennium, greater emphasis will be put on prescription setting and subsequent monitoring. This will entail an increase in automated PD, especially for lifestyle reasons as well as for patients with a hyperpermeable peritoneal membrane. To improve outcomes, dialysis should be started earlier than is currently the case. It is easy to do this with PD, where an incremental approach is made easier by the introduction of icodextrin for long-dwell PD. In the future, solutions will be tailored to be more biocompatible and to provide improved nutrition and better cardiovascular outcomes. Finally, economic considerations favor PD, which is cheaper than in-centre hemodialysis. Thus, for many, PD has become a first-choice therapy, and with further improvements this trend will continue.

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A New Method to Increase Ultrafiltration in Peritoneal Dialysis: Steady Concentration Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00007 ◽

2016 ◽

Vol 36 (5) ◽

pp. 555-561 ◽

Cited By ~ 7

Author(s):

Vicente Pérez-Díaz ◽

Alfonso Pérez-Escudero ◽

Sandra Sanz-Ballesteros ◽

Guadalupe Rodríguez-Portela ◽

Susana Valenciano-Martínez ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Glucose Concentration ◽

Fluid Overload ◽

Glucose Solution ◽

Osmotic Gradient ◽

Single Session ◽

Peritoneal Equilibration Test ◽

Peritoneal Transport ◽

Constant Rate ◽

Limited Power

Background Peritoneal dialysis (PD) has limited power for liquid extraction (ultrafiltration), so fluid overload remains a major cause of treatment failure. Methods We present steady concentration peritonal dialysis (SCPD), which increases ultrafiltration of PD exchanges by maintaining a constant peritoneal glucose concentration. This is achieved by infusing 50% glucose solution at a constant rate (typically 40 mL/h) during the 4-hour dwell of a 2-L 1.36% glucose exchange. We treated 21 fluid overload episodes on 6 PD patients with high or average-high peritoneal transport characteristics who refused hemodialysis as an alternative. Each treatment consisted of a single session with 1 to 4 SCPD exchanges (as needed). Results Ultrafiltration averaged 653 ± 363 mL/4 h — twice the ultrafiltration of the peritoneal equilibration test (PET) (300 ± 251 mL/4 h, p < 0.001) and 6-fold the daily ultrafiltration (100 ± 123 mL/4 h, p < 0.001). Serum and peritoneal glucose stability and dialysis efficacy were excellent (glycemia 126 ± 25 mg/dL, peritoneal glucose 1,830 ± 365 mg/dL, D/P creatinine 0.77 ± 0.08). The treatment reversed all episodes of fluid overload, avoiding transfer to hemodialysis. Ultrafiltration was proportional to fluid overload ( p < 0.01) and inversely proportional to final peritoneal glucose concentration ( p < 0.05). Conclusion This preliminary clinical experience confirms the potential of SCPD to safely and effectively increase ultrafiltration of PD exchanges. It also shows peritoneal transport in a new dynamic context, enhancing the influence of factors unrelated to the osmotic gradient.

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MO710GALECTIN-3, IS IT A NEW PLAYER IN PERITONEAL INFLAMMATION AMONG PATIENTS UNDERGOING PERITONEAL DIALYSIS?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0032 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Yael Einbinder ◽

Keren Cohen-Hagai ◽

Sydney Benchetrit ◽

Tali Zitman-Gal

Keyword(s):

Cell Culture ◽

Peritoneal Dialysis ◽

Endothelial Cell ◽

Protein Expression ◽

Inflammatory Process ◽

Peritoneal Membrane ◽

Peritoneal Equilibration Test ◽

Endothelial Cell Culture ◽

Dialysis Vintage ◽

Mrna And Protein Expression

Abstract Background and Aims Peritoneal dialysis (PD) is a common used method for renal replacement therapy. Prolonged PD treatment causes structural and functional changes in the peritoneal membrane which are attributed to local inflammatory process in the peritoneal cavity. Galectin-3 (Gal-3) is a galactoside-binding lectin with pro-inflammatory and pro-fibrotic effects. The aim of this study was to assess correlation between Gal-3 serum and dialysate effluent levels with peritoneal membrane transport characteristics. Method Gal-3 levels in serum and dialysate effluent were measured simultaneously in prevalent PD patients in morning visit or during peritoneal equilibration test (PET). Gal-3 levels were correlated with clinical and laboratory parameters. Interlukin (IL) -6 levels were measured in dialysate effluent. Gal-3 mRNA and protein expression were evaluated after exposure of primary endothelial cell culture to several dialysate solutions. Results 37 PD patients were included in the study; mean age was 65.7±13.1 years, mean dialysis vintage was 17.5±13 months. Gal-3 levels in dialysate effluent correlated with peritoneal equilibration test (PET) results (0.663, p=0.005) and effluent IL-6 levels (0.674, p=0.002) but not with serum Gal-3 levels or dialysis vintage. Patients with high PET results had higher effluent Gal-3 levels as compared average low PET results. In multivariate regression analysis effluent IL-6 level was the most dominant predictor of effluent Gal-3 levels. Gal-3 mRNA and protein expression in primary endothelial cell culture were not affected by stimulation with dialysate solutions. Conclusion Our study demonstrated presence of Gal-3 within the dialysate effluent in PD patients. Gal-3 levels correlated with peritoneal membrane transport characteristics and effluent IL-6 levels suggesting a role in the inflammatory process within the peritoneal cavity.

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Pathophysiology of Ultrafiltration in Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089001000201 ◽

1990 ◽

Vol 10 (2) ◽

pp. 119-126 ◽

Cited By ~ 32

Author(s):

Claudio Ronco ◽

Mariano Feriani ◽

Stefano Chiaramonte ◽

Alessandra Brendolan ◽

Luisa Bragantini ◽

...

Keyword(s):

Blood Flow ◽

Peritoneal Dialysis ◽

Glucose Concentration ◽

Peritoneal Membrane ◽

Dialysis Membrane ◽

Ultrafiltration Rate ◽

Peritoneal Equilibration Test ◽

Common Causes ◽

Catheter Malposition ◽

Causes Of Failure

Pathophysiology of peritoneal ultrafiltration is analyzed in the present study. Peritoneal equilibration test is the easiest procedure to study in detail the possible causes of failure to control the ultrafiltration rate in patients undergoing peritoneal dialysis. Membrane failure, reduction in peritoneal blood flow, excessive lymphatic reabsorption catheter malposition, and fluid sequestration are the most common causes of ultrafiltration loss. Pharmacologic manipulation of peritoneal membrane, correction of mechanical inconvenients, reduction in peritonitis rate and in the level of immunostimulation of the mesotelial macrophages, together with a careful policy in terms of glucose concentration in the dialysate and dwell times may contribute not only to treat different forms of ultrafiltration loss but also to prevent their incidence.

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Monitoring of Long-Term Peritoneal Membrane Function

Peritoneal Dialysis International ◽

10.1177/089686080102100222 ◽

2001 ◽

Vol 21 (2) ◽

pp. 225-232 ◽

Cited By ~ 12

Author(s):

Simon J. Davies

Keyword(s):

Peritoneal Dialysis ◽

Solute Transport ◽

Water Transport ◽

Drop Out ◽

Published Data ◽

Peritoneal Membrane ◽

Membrane Function ◽

Technique Survival ◽

Ultrafiltration Failure

Objective Peritoneal membrane function influences dialysis prescription and clinical outcome and may change with time on treatment. Increasingly sophisticated tools, ranging from the peritoneal equilibration test (PET) to the standard permeability analysis (SPA) and personal dialysis capacity (PDC) test, are available to the clinician and clinical researcher. These tests allow assessment of a number of aspects of membrane function, including solute transport rates, ultrafiltration capacity, effective reabsorption, transcellular water transport, and permeability to macromolecules. In considering which tests are of greatest value in monitoring long-term membrane function, two criteria were set: those that result in clinically relevant interpatient differences in achieved ultrafiltration or solute clearances, and those that change with time in treatment. Study Selection Clinical validation studies of the PET, SPA, and PDC tests. Studies reporting membrane function using these methods in either long-term (5 years) peritoneal dialysis patients or longitudinal observations (> 2 years). Data Extraction Directly from published data. Additional, previously unpublished analysis of data from the Stoke PD Study. Results Solute transport is the most important parameter. In addition to predicting patient and technique survival at baseline, there is strong evidence that it can increase with time on treatment. Whereas patients with initially high solute transport drop out early from treatment, those with low transport remain longer on treatment, although, over 5 years, a proportion develop increasing transport rates. Ultrafiltration capacity, while being a composite measure of membrane function, is a useful guide for the clinician. Using the PET (2.27% glucose), a net ultrafiltration capacity of < 200 mL is associated with a 50% chance of achieving less than 1 L daily ultrafiltration at the expense of 1.8 hypertonic (3.86%) exchanges in anuric patients. Using a SPA (3.86% glucose), a net ultrafiltration capacity of < 400 mL indicates ultrafiltration failure. While there is circumstantial evidence that, with time on peritoneal dialysis, loss of transcellular water transport might contribute to ultrafiltration failure, none of the current tests is able to demonstrate this unequivocally. Of the other membrane parameters, evidence that interpatient differences are clinically relevant (permeability to macro-molecules), or that they change significantly with time on treatment (effective reabsorption), is lacking. Conclusion A strong case can be made for the regular assessment by clinicians of solute transport and ultrafiltration capacity, a task made simple to achieve using any of the three tools available.

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