How Accurate is the Description of Transport Kinetics in Peritoneal Dialysis According to Different Versions of the Three-Pore Model?

2008 ◽  
Vol 28 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Jacek Waniewski ◽  
Malgorzata Debowska ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Peritoneal Fluid ◽  
Dwell Time ◽  
Transport Kinetics ◽  
Transport Parameters ◽  
Pore Model ◽  
Peritoneal Transport ◽  
Endogenous Protein ◽  
Dialysate Volume

Objective The three-pore model of peritoneal transport is used extensively for modeling peritoneal fluid and solute transport, but the currently used versions include certain modifications of the transport parameters that have not been validated quantitatively versus detailed data on fluid and solute kinetics. The aim of this study was to evaluate different versions of the three-pore model. Method Detailed clinical peritoneal fluid and solute transport data were obtained from 40 peritoneal dwell studies in clinically stable continuous ambulatory peritoneal dialysis patients in whom the dialysate volume was measured using a macromolecular volume marker (RISA). Results Using a new version of the three-pore model with several adjusted transport parameters, good agreement between the measured and the simulated values of dialysate volume and concentrations of small solutes and RISA (but not of endogenous protein) versus dwell time was obtained; however, the predicted peritoneal absorption for longer than the investigated dwell time would be too high. Conclusion The three-pore model, with some adjustments proposed in this study, may be used for detailed description of peritoneal transport kinetics, but it should be pointed out that, even after these adjustments, it still does not provide the correct description of peritoneal fluid absorption and transport of macromolecules.

On the change of transport parameters with dwell time during peritoneal dialysis

2020 ◽  
pp. 089686082097151
Author(s):  
Jacek Waniewski ◽  
Joanna Stachowska-Pietka ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Data ◽  
Dwell Time ◽  
Dialysis Fluid ◽  
Transport Parameters ◽  
Satisfactory Description ◽  
Pore Model ◽  
Vasodilatory Effect ◽  
Peritoneal Transport ◽  
Molecular Radius

The transitory change of fluid and solute transport parameters occurring during the initial phase of a peritoneal dialysis dwell is a well-documented phenomenon; however, its physiological interpretation is rather hypothetical and has been disputed. Two different explanations were proposed: (1) the prevailing view—supported by several experimental and clinical studies—is that a vasodilatory effect of dialysis fluid affects the capillary surface area available for dialysis, and (2) a recently presented alternative explanation is that the molecular radius of glucose increases due to the high glucose concentration in fresh dialysis fluid and that this change affects peritoneal transport parameters. The experimental bases for both phenomena are discussed as well as the problem of the accuracy necessary for a satisfactory description of clinical data when the three-pore model of peritoneal transport is applied. We show that the correction for the change of transport parameters with dwell time provides a better fit with clinical data when applying the three-pore model. Our conclusion is in favor of the traditional interpretation namely that the transitory change of transport parameters with dwell time during peritoneal dialysis is primarily due to the vasodilatory effect of dialysis fluids.

scholarly journals Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Jacek Waniewski ◽  
Stefan Antosiewicz ◽  
Daniel Baczynski ◽  
Jan Poleszczuk ◽  
Mauro Pietribiasi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Fluid Transport ◽  
Peritoneal Membrane ◽  
Transport Parameters ◽  
Patient Age ◽  
Pore Model ◽  
Peritoneal Transport ◽  
Patient Âgé ◽  
Dialysis Vintage

During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (αu), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage,αuwas higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane.

Changes of Peritoneal Transport Parameters with Time on Dialysis: Assessment with Sequential Peritoneal Equilibration Test

2017 ◽  
Vol 40 (11) ◽  
pp. 595-601 ◽  
Author(s):  
Jacek Waniewski ◽  
Stefan Antosiewicz ◽  
Daniel Baczynski ◽  
Jan Poleszczuk ◽  
Mauro Pietribiasi ◽  
...  
Keyword(s):  
Solute Transport ◽  
Fluid Transport ◽  
Transport Processes ◽  
Model Parameters ◽  
Hydraulic Permeability ◽  
Transport Parameters ◽  
Peritoneal Equilibration Test ◽  
Transport Barrier ◽  
Pore Model ◽  
Peritoneal Transport

Background Sequential peritoneal equilibration test (sPET) is based on the consecutive performance of the peritoneal equilibration test (PET, 4-hour, glucose 2.27%) and the mini-PET (1-hour, glucose 3.86%), and the estimation of peritoneal transport parameters with the 2-pore model. It enables the assessment of the functional transport barrier for fluid and small solutes. The objective of this study was to check whether the estimated model parameters can serve as better and earlier indicators of the changes in the peritoneal transport characteristics than directly measured transport indices that depend on several transport processes. Methods 17 patients were examined using sPET twice with the interval of about 8 months (230 ± 60 days). Results There was no difference between the observational parameters measured in the 2 examinations. The indices for solute transport, but not net UF, were well correlated between the examinations. Among the estimated parameters, a significant decrease between the 2 examinations was found only for hydraulic permeability LpS, and osmotic conductance for glucose, whereas the other parameters remained unchanged. These fluid transport parameters did not correlate with D/P for creatinine, although the decrease in LpS values between the examinations was observed mostly for patients with low D/P for creatinine. Conclusions We conclude that changes in fluid transport parameters, hydraulic permeability and osmotic conductance for glucose, as assessed by the pore model, may precede the changes in small solute transport. The systematic assessment of fluid transport status needs specific clinical and mathematical tools beside the standard PET tests.

scholarly journals Threefold Peritoneal Test of Osmotic Conductance, Ultrafiltration Efficiency, and Fluid Absorption

2013 ◽  
Vol 33 (4) ◽  
pp. 419-425 ◽  
Author(s):  
Jacek Waniewski ◽  
Ramón Paniagua ◽  
Joanna Stachowska–Pietka ◽  
María-de-Jesús Ventura ◽  
Marcela Ávila–Díaz ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Peritoneal Fluid ◽  
Absorption Rate ◽  
Transport Parameter ◽  
Fluid Absorption ◽  
Transport Parameters ◽  
Fluid Removal ◽  
Modifiable Factors ◽  
Small Solute

BackgroundFluid removal during peritoneal dialysis depends on modifiable factors such as tonicity of dialysis fluids and intrinsic characteristics of the peritoneal transport barrier and the osmotic agent—for example, osmotic conductance, ultrafiltration efficiency, and peritoneal fluid absorption. The latter parameters cannot be derived from tests of the small-solute transport rate. We here propose a simple test that may provide information about those parameters.MethodsVolumes and glucose concentrations of drained dialysate obtained with 3 different combinations of glucose-based dialysis fluid (3 exchanges of 1.36% glucose during the day and 1 overnight exchange of either 1.36%, 2.27%, or 3.86% glucose) were measured in 83 continuous ambulatory peritoneal dialysis (CAPD) patients. Linear regression analyses of daily net ultrafiltration in relation to the average dialysate-to-plasma concentration gradient of glucose allowed for an estimation of the osmotic conductance of glucose and the peritoneal fluid absorption rate, and net ultrafiltration in relation to glucose absorption allowed for an estimation of the ultrafiltration effectiveness of glucose.ResultsThe osmotic conductance of glucose was 0.067 ± 0.042 (milliliters per minute divided by millimoles per milliliter), the ultrafiltration effectiveness of glucose was 16.77 ± 7.97 mL/g of absorbed glucose, and the peritoneal fluid absorption rate was 0.94 ± 0.97 mL/min (if estimated concomitantly with osmotic conductance) or 0.93 ± 0.75 mL/min (if estimated concomitantly with ultrafiltration effectiveness). These fluid transport parameters were independent of small-solute transport characteristics, but proportional to total body water estimated by bioimpedance.ConclusionsBy varying the glucose concentration in 1 of 4 daily exchanges, osmotic conductance, ultrafiltration efficiency, and peritoneal fluid absorption could be estimated in CAPD patients, yielding transport parameter values that were similar to those obtained by other, more sophisticated, methods.

Urea Peritoneal Transfer Evaluated Using Plasma Water Urea Concentrations

1994 ◽  
Vol 14 (3) ◽  
pp. 243-247 ◽  
Author(s):  
Alicja E. Grzegorzewska
Keyword(s):  
Peritoneal Dialysis ◽  
Dwell Time ◽  
Transport Coefficients ◽  
Urea Concentration ◽  
Transport Parameters ◽  
Dialysis Unit ◽  
Blood Samples ◽  
Peritoneal Transport ◽  
Transfer Parameters ◽  
Water Values

Objective To quantify differences in evaluation of urea peritoneal transport parameters according to the expression of urea concentration in whole plasma and plasma water. Design Prospective study in which the dialysate samples for urea determinations were taken at short dwell times (2.5 45 minutes) during three consecutive exchanges of intermittent peritoneal dialysis (IPD). Blood samples were drawn at the beginning and at the end of the study period. Urea peritoneal transport parameters were calculated using urea concentration in whole plasma and plasma water. The results were then compared. Setting Peritoneal dialysis unit of a nephrology de partment. Patients Ten stable patients on IPD. Interventions Dialysateand blood sample collections.. Main Outcome Measures: Dialysate-to-plasma ratios (DIP), peritoneal clearances (Cp)’ and diffusive mass transport coefficients (KBD) of urea. Results At short dwell times, uncorrected (whole plasma) DIP and Cp of urea values were higher than the corrected (plasma water) values by 5.7% -5.9%. Uncorrected urea KBD’ calculated using the simplified two sample model of Garred et al., yielded an overestimation that significantly increased with prolongation of dwell (8.5±0.5% at 2.5 minutes vs 13.0±0.8% at 45 minutes). Urea KBD’ assessed by the linear regression model of Garred and Spencer, was 9.4±0.3% higher for uncorrected values. Conclusions The expression of urea concentration in whole plasma instead of plasma water overestimates urea peritoneal transfer parameters. The percent overestimation (y) of urea KBD’ calculated using the simplified model of Garred et al., can be predicted with the equation y = 0.131x+ 7.563, wherex is the dwell time (in minutes).

#58: Improving the Peritoneal Dialysis Program in a Pediatric hospital in Honduras Using Six Sigma Methodology

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Sara Eloisa Rivera Molina ◽  
Claudia Romero Quiroz ◽  
Dilcia Sauceda Acosta
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Six Sigma ◽  
Peritoneal Fluid ◽  
Dwell Time ◽  
Clinical Signs ◽  
Pediatric Hospital ◽  
Gram Negative ◽  
Six Sigma Methodology ◽  
Fluid Cell

Abstract Background Peritoneal dialysis (PD) is the most common method of renal replacement therapy (RRT) in pediatric patients in Honduras. It has improved survival and quality of life. Unfortunately, there are complications associated with the use of PD catheters, 85% of which, are of infectious origin. These infections carry a high burden of morbidity and mortality, lengthen hospital stays, and increase costs and are a motive for transfer to hemodialysis. Hospital María Especialidades Pediátricas (HMEP) is a pediatric hospital caring for patients with chronic kidney disease in Honduras, PD has been offered as a method for RRT since September 2014. Methods In HMEP, monitoring of PD infection rates through active surveillance began December 1, 2017, as the first step (define and measure) toward the improvement of the PD Program based on Six Sigma methodology. A case of peritonitis was diagnosed when at least 2 of the following 3 criteria were met: (1) Clinical signs or symptoms of peritonitis (cloudy effluent or abdominal pain with fever or vomiting); (2) Altered peritoneal fluid cell count (after a dwell time of 2 hours: a WBC above 100 cells/mm3 in an uncentrifuged sample, with at least 50% neutrophils; or any WBC count with at least 50% neutrophils if the dwell time was less than 2 hours); (3) Positive peritoneal fluid culture. Patient data, risk factors for infection, causative organisms, and event outcomes were recorded. We present the main results of the analysis phase of all peritonitis cases using descriptive statistics. Results From December 1, 2017, through November 30, 2019, 79 patients required PD, representing 8931 catheter-days; and 30 peritonitis episodes occurred among 28 individuals (35%). The peritonitis rate during the 2-year surveillance period was 1.2 infections per patient-years (ideally: <0.67). Twenty-seven (90%) of cases were classified as healthcare associated since these patients underwent PD 3 times a week in the hospital and the catheter was only manipulated by medical staff; the other patients received dialysis at home. The median time from catheter placement to the event was 27 days (5–383 days). All patients had clinical signs or symptoms of peritonitis. Peritoneal fluid cell count results were available for 29 infections, all of which reported altered results. Peritoneal fluid cultures were positive in only 12 events (40%); 6 (50%) reported Gram-negative organisms, 5 (41%) reported Gram-positive and 1 reported Aspergillus spp. Nonfermentative Gram-negative bacteria (Pseudomonas aeruginosa and Acinetobacter lwoffii) were the most common organisms identified; Staphylococcus epidermidis was the most common Gram-positive. Ten events (33%) required removal and replacement of the catheter due to the infection, 6 (20%) required permanent transfer to hemodialysis; 2 (7.1%) patients experienced a relapse. Two (7.1%) died due to infection. Conclusions Implementing Six Sigma methodology allowed us to improve our PD Program by objectively quantifying the magnitude of the problem and identifying risk factors. This supported the infection prevention and control team with the implementation and improvement of preventive measures: change in hand hygiene products (from triclosan to chlorhexidine), increasing hand hygiene compliance, improving connection/disconnection procedure, PD catheter insertion, and maintenance, empowerment of caregivers.

Fluid and Solute Transport in CAPD Patients before and after Permanent Loss of Ultrafiltration Capacity

2005 ◽  
Vol 28 (10) ◽  
pp. 976-984 ◽  
Author(s):  
J. Waniewski ◽  
D. Sobiecka ◽  
M. DĘbowska ◽  
O. Heimbürger ◽  
A. Werynski ◽  
...  
Keyword(s):  
Solute Transport ◽  
Absorption Rate ◽  
Fluid Absorption ◽  
Transport Parameters ◽  
Normal Range ◽  
Peritoneal Transport ◽  
High K ◽  
Before And After ◽  
Permanent Loss ◽  
High Fluid

Background Two major types of permanent loss of ultrafiltration capacity (UFC) were previously distinguished among patients treated with CAPD: 1) type HDR with high diffusive peritoneal transport rate of small solutes and low osmotic conductance, but with normal fluid absorption rate, and 2) type HAR with high fluid absorption rate, but with normal diffusive peritoneal transport rate of small solutes and normal osmotic conductance. However, the detailed pattern of changes in peritoneal transport parameters in patients developing loss of ultrafiltration capacity is not known. Objective Analysis of solute and fluid transport parameters in the same patient before and after UFC loss. Patients Seven CAPD patients who had undergone repeated dwell studies, which were carried out before and/or after the onset of UFC loss. Methods Dialysis fluids (2 L) with glucose or a mixture of amino acids as osmotic agent at three basic tonicities were applied during 6 hour dwell studies. Fluid and solute transport parameters were previously shown not to be affected by these dialysis solutions (except by hypertonic amino acid-based solution). Intraperitoneal dialysate volume and fluid absorption rate were assessed using radiolabeled human serum albumin (RISA). Osmotic conductance (aOS) was estimated by a mathematical model as ultrafiltration rate induced by unit osmolality gradient. Diffusive mass transport coefficients, KBD, for glucose, urea, and creatinine were estimated using the modified Babb-Randerson-Farrell model. Results Five patients had increased KBD for small solutes after the onset of UFC loss, and three of them had decreased aOS, whereas two patients had normal aOS. In one of them, aOS decreased with time after the onset of UFC loss with concomitant normalization of glucose absorption. In all studies of these five patients the fluid absorption rate was within the normal range. Two other patients had increased fluid absorption rate (about 5 ml/min), and one of them also had increased KBD for small solutes, in two consecutive dwell studies in each patient with the second study being carried out at 1 and 7 months respectively after the first one. In all four studies in these two patients, the aOS was within the normal range. The sodium dip during dialysis with 3.86% glucose-based solution was lost, not only among most patients with UFC loss related to reduced osmotic conductance, but also in patients with increased KBD. Conclusions The occurrence of two major types of UFC loss was confirmed. However, a case of a mixed type of UFC loss with high fluid absorption rate and high KBD for small solutes, but normal osmotic conductance, and with normalization of initially high KBD for small solutes, linked with decreasing initially normal osmotic conductance, was also found. As a reduced sodium dip with hypertonic glucose solution is not only seen in patients with reduced osmotic conductance, it cannot reliably be used as a single measure of decreased aquaporin function. Permanent ultrafiltration capacity loss may be a dynamic phenomenon with a variety of alterations in peritoneal transport characteristics.

Efficacy of Peritoneal Dialysis during Infusion and Drainage Procedures

2010 ◽  
Vol 30 (6) ◽  
pp. 633-637 ◽  
Author(s):  
Daniel Baczyński ◽  
Stefan Antosiewicz ◽  
Jacek Waniewski ◽  
Zbigniew Nowak ◽  
Zofia Wańkowicz
Keyword(s):  
Peritoneal Dialysis ◽  
Kinetic Modeling ◽  
Dwell Time ◽  
Uremic Toxin ◽  
Dialysis Fluid ◽  
Fluid Exchange ◽  
Peritoneal Transport ◽  
Toxin Removal ◽  
Technique Failure ◽  
Precise Assessment

BackgroundInadequate dialysis is still a major cause of technique failure in peritoneal dialysis (PD). Mathematical models provide the possibility of direct and precise assessment of peritoneal transport of urea and creatinine throughout the dwell and allow calculation of optimal schedules, dwell times, and predicted adequacy of a prescribed regimen. Kinetic modeling is particularly important for automated PD. If the effectiveness of uremic toxin removal that takes place during infusion and drainage of dialysis fluid is not taken into account, the predicted adequacy of the whole PD session may be underestimated.AimsTo estimate the efficacy of urea and creatinine removal during the dialysis fluid exchange procedure.Material and Methods17 patients treated with PD were included in the study. PD effectiveness during dialysate exchange was defined as the quotient k of removed amount of creatinine/BUN during the infusion and drainage of dialysate and during a dwell of the same duration as the dialysate exchange.ResultsThe effectiveness of creatinine and urea removal was reduced during the exchange procedure ( kcreat= 0.68 ± 0.43 and kBUN= 0.87 ± 0.44) and differed between these 2 solutes ( p = 0.0009). The k coefficients for urea and creatinine were well correlated ( R2= 0.83).ConclusionsThe effectiveness of peritoneal transport of creatinine and BUN during the inflow/outflow phase was relatively high compared to that during the same dwell time (68% and 87% respectively). This real effectiveness of the dialysate exchange procedure should be taken into account in the process of planning automated PD sessions, otherwise the predicted overall efficacy of creatinine and urea removal throughout the session may be underestimated. This underestimation is proportional to the number of dwells per day.

Peritoneal Fluid Transport in CAPD Patients with Different Transport Rates of Small Solutes

2004 ◽  
Vol 24 (3) ◽  
pp. 240-251 ◽  
Author(s):  
Danuta Sobiecka ◽  
Jacek Waniewski ◽  
Andrzej Weryński ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Osmotic Pressure ◽  
Absorption Rate ◽  
Fluid Transport ◽  
Transport Coefficients ◽  
Dialysis Fluid ◽  
Transport Parameters ◽  
Ultrafiltration Rate ◽  
Small Solute

Background Continuous ambulatory peritoneal dialysis (CAPD) patients with high peritoneal solute transport rate often have inadequate peritoneal fluid transport. It is not known whether this inadequate fluid transport is due solely to a too rapid fall of osmotic pressure, or if the decreased effectiveness of fluid transport is also a contributing factor. Objective To analyze fluid transport parameters and the effectiveness of dialysis fluid osmotic pressure in the induction of fluid flow in CAPD patients with different small solute transport rates. Patients 44 CAPD patients were placed in low ( n = 6), low-average ( n = 13), high-average ( n = 19), and high ( n = 6) transport groups according to a modified peritoneal equilibration test (PET). Methods The study involved a 6-hour peritoneal dialysis dwell with 2 L 3.86% glucose dialysis fluid for each patient. Radioisotopically labeled serum albumin was added as a volume marker. The fluid transport parameters (osmotic conductance and fluid absorption rate) were estimated using three mathematical models of fluid transport: ( 1 ) Pyle model (model P), which describes ultrafiltration rate as an exponential function of time; ( 2 ) model OS, which is based on the linear relationship of ultrafiltration rate and overall osmolality gradient between dialysis fluid and blood; and ( 3 ) model G, which is based on the linear relationship between ultrafiltration rate and glucose concentration gradient between dialysis fluid and blood. Diffusive mass transport coefficients (KBD) for glucose, urea, creatinine, potassium, and sodium were estimated using the modified Babb–Randerson–Farrell model. Results The high transport group had significantly lower dialysate volume and glucose and osmolality gradients between dialysate and blood, but significantly higher KBD for small solutes compared with the other transport groups. Osmotic conductance, fluid absorption rate, and initial ultrafiltration rate did not differ among the transport groups for model OS and model P. Model G yielded unrealistic values of fluid transport parameters that differed from those estimated by models OS and P. The KBD values for small solutes were significantly different among the groups, and did not correlate with fluid transport parameters for model OS. Conclusion The difference in fluid transport between the different transport groups was due only to the differences in the rate of disappearance of the overall osmotic pressure of the dialysate, which was a combined result of the transport rate of glucose and other small solutes. Although the glucose gradient is the major factor influencing ultrafiltration rate, other solutes, such as urea, are also of importance. The counteractive effect of plasma small solutes on transcapillary ultrafiltration was found to be especially notable in low transport patients. Thus, glucose gradient alone should not be considered the only force that shapes the ultrafiltration profile during peritoneal dialysis. We did not find any correlations between diffusive mass transport coefficients for small solutes and fluid transport parameters such as osmotic conductance or fluid and volume marker absorption. We may thus conclude that the pathway(s) for fluid transport appears to be partly independent from the pathway(s) for small solute transport, which supports the hypothesis of different pore types for fluid and solute transport.

Effect of Oral Administration of Losartan, Prazosin, and Verapamil on Peritoneal Solute Transport in Continuous Ambulatory Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (6) ◽  
pp. 576-582 ◽  
Author(s):  
Enrique Rojas-Campos ◽  
Laura Cortés-Sanabria ◽  
Héctor R. Martínez-Ramírez ◽  
Liliana González ◽  
Fabiola Martín-del-Campo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Oral Administration ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Convective Transport ◽  
Dialysis Dose ◽  
Dialysis Adequacy ◽  
Peritoneal Transport ◽  
Adequacy Assessment ◽  
To Receive ◽  
Dialysate Volume

Background Several intraperitoneally administered drugs have been shown to modify transport of peritoneal solute and fluid. Fewer studies, however, have evaluated the effect of orally administered drugs. The present study was performed to evaluate the effects of oral losartan, prazosin, and verapamil on peritoneal membrane transport during a peritoneal equilibration test (PET), as well as the effects on creatinine clearance (CrCl), Kt/V urea, 24-hour protein in drained dialysate, and drained volume. Methods This was an open, controlled, crossover clinical trial performed in 20 patients on continuous ambulatory peritoneal dialysis. All subjects used four 2-L 1.5% glucose dialysis exchanges per day. After a 7-day washout period (without antihypertensives), they had a baseline standard PET and dialysis adequacy assessment performed. Subsequently, they were randomly allocated to receive the first of three study drugs (losartan, prazosin, and verapamil), which were administered orally for a 7-day period. Immediately after each drug period, patients had a new 3-day washout and subsequently started the next drug, until they had received each of the three drugs. On the last day of administration of each drug, patients were subjected to a new PET and adequacy of dialysis evaluation. Results None of the studied drugs significantly modified the peritoneal transport of creatinine, glucose, urea, sodium, potassium, or total protein as evaluated by PET. Verapamil significantly increased peritoneal CrCl [51.3 (44.3 – 53.3) vs baseline 45.8 (41.4 – 50.5) L/week/1.73 m2, p < 0.05], weekly Kt/V urea [1.75 (1.60 – 1.78) vs baseline 1.59 (1.54 – 1.73), p < 0.05], and drained dialysate volume [8.80 (8.30 – 8.96) vs baseline 8.44 (8.20 – 8.50) L/day, p < 0.05]. Conclusions Oral administration of losartan, prazosin, and verapamil did not modify the peritoneal transport of solutes during a 4-hour PET. Oral verapamil significantly increased CrCl, Kt/V urea, and 24-hour drained dialysate volume. It is most likely that verapamil increases peritoneal (hydraulic) conductivity, and then net ultrafiltration volume and convective transport of urea, creatinine, and protein. Verapamil could be considered as an alternative in patients requiring increased dialysis dose and/or ultrafiltration.

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