scholarly journals Solute Transport Across the Peritoneal Membrane

2002 ◽  
Vol 13 (suppl 1) ◽  
pp. S84-S91
Author(s):  
John K. Leypoldt
Keyword(s):  
Peritoneal Dialysis ◽  
Solute Transport ◽  
Peritoneal Cavity ◽  
Molecular Size ◽  
Fluid Absorption ◽  
Peritoneal Membrane ◽  
Dialysis Dose ◽  
Transport Pathways ◽  
Stage Renal Disease ◽  
End Stage

ABSTRACT. The current understanding of the transport pathways that govern solute removal during peritoneal dialysis is reviewed. Diffusive transport rates across the peritoneal membrane for small solutes are slow. Even though the rate of diffusive solute transport decreases with increasing molecular size, large molecules (e.g., albumin) are nevertheless removed from the patient during routine peritoneal dialysis. Recent work has confirmed a previous suggestion that diffusive solute transport is limited by the small area of the peritoneal membrane that participates in the transport process. This small functional area is due to either poor contact of the peritoneal membrane with dialysis solution bathing the peritoneal cavity or to the limited surface area of capillaries that perfuse peritoneal tissues. Convective solute transport during peritoneal dialysis is proportional to the transperitoneal ultrafiltration rate but is less than that expected, because of low solute sieving by the peritoneal membrane and fluid absorption from the peritoneal cavity. Low solute sieving across the peritoneal membrane was first identified in 1966, a phenomenon that is now attributed to the presence of water-only transport pathways mediated by aquaporin-1. Fluid absorption from the peritoneal cavity occurs at the same time as transperitoneal ultrafiltration, but the pathways by which these two processes occur simultaneously remain speculative. This review proposes a novel hypothesis, whereby fluid absorption occurs in areas of the peritoneal membrane that are governed by different physical forces than those governing transperitoneal ultrafiltration. Further understanding of the pathways for fluid and solute transport during peritoneal dialysis will permit improvements in the adequacy of the dialysis dose and the more efficacious use of peritoneal dialysis to treat patients with end-stage renal disease.

scholarly journals A disposable, ultra-fine endoscope for non-invasive, close examination of the intraluminal surface of the peritoneal dialysis catheter and peritoneal cavity

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Masaaki Nakayama ◽  
Chieko Hamada ◽  
Keitaro Yokoyama ◽  
Yudo Tanno ◽  
Nanae Matsuo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Study ◽  
Peritoneal Cavity ◽  
Abdominal Cavity ◽  
Peritoneal Dialysis Catheter ◽  
Peritoneal Membrane ◽  
Non Invasive ◽  
Luminal Side ◽  
Stage Renal Disease ◽  
End Stage

Abstract The ability to visualize intraluminal surface of peritoneal dialysis (PD) catheter and peritoneal cavity could allow elucidation of the cases of outflow problems, and provide information on changes to the peritoneal membrane leading to encapsulating peritoneal sclerosis. A non-invasive examination that allows those monitoring in need is desirable. We have developed a disposable ultra-fine endoscope that can be inserted into the lumen of the existing PD catheter, allowing observation of the luminal side of the catheter and peritoneal cavity from the tip of the PD catheter, with minimum invasion in practice. In a pre-clinical study in pigs and a clinical study in 10 PD patients, the device provided detailed images, enabling safe, easy observation of the intraluminal side of the entire catheter, and of the morphology and status of the peritoneal surface in the abdominal cavity under dwelling PD solution. Since this device can be used repeatedly during PD therapy, clinical application of this device could contribute to improved management of clinical issues in current PD therapy, positioning PD as a safer, more reliable treatment modality for end-stage renal disease.

Peritoneal Dialysis

2019 ◽  
Author(s):  
Karlien François ◽  
Joanne M. Bargman
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Dialysis Fluid ◽  
Keywords Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos,  8 figures, 4 tables, and 73 references.  Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Peritoneal Dialysis

2019 ◽  
Author(s):  
Karlien François ◽  
Joanne M. Bargman
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Dialysis Fluid ◽  
Keywords Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos,  8 figures, 4 tables, and 73 references.  Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Sleep Related Respiratory Disorders in End-Stage Renal Disease Patients on Peritoneal Dialysis

1992 ◽  
Vol 12 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Nand K. Wadhwa ◽  
M. Seliger ◽  
Harly E. Greenberg ◽  
Edward Bergofsky ◽  
Wallace B. Mendelson
Keyword(s):  
Peritoneal Dialysis ◽  
Sleep Apnea ◽  
Renal Disease ◽  
Sleep Disturbance ◽  
Peritoneal Cavity ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Chronic Sleep

Study Objective To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep. Design Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD. Setting Tertiary-referral university hospital. Patients and Methods Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63±4 (SEM) years were studied. Results Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paC02 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, Pa02 was significantly lower (p<0.05) during the night with (Pa02=78±7 mmHg) than during the night without PD fluid (Pa02=92±4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r=-0.94; p<0.005). Conclusions This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.

Association between Redox Status of Serum Albumin and Peritoneal Membrane Transport Properties in Patients on Peritoneal Dialysis

2015 ◽  
Vol 40 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Paik Seong Lim ◽  
Hung-Ping Chen ◽  
Chang-Hsu Chen ◽  
Ming Yin Wu ◽  
Chuen Yuh Wu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Serum Albumin ◽  
Membrane Transport ◽  
End Stage Renal Disease ◽  
Redox Status ◽  
Peritoneal Membrane ◽  
Transport Characteristic ◽  
Stage Renal Disease ◽  
End Stage

Background: Albumin, the most abundant protein in the extracellular fluid, displays an important antioxidant activity. Increased levels of oxidized albumin levels (high human non-mercaptoalbumin (HNA) level) have been reported in the serum of patients with end-stage renal disease. In this study, we attempted to identify the albumin redox status in the serum of patients on peritoneal dialysis (PD) and examined the relationship between these proteins and the transport type of the peritoneal membrane and other clinical and laboratory variables. Methods: We performed a cross-sectional study of a cohort of 80 patients with end-stage renal disease receiving PD. Peritoneal transport characteristics were identified and after peritoneal equilibration test patients were grouped as high (high(H)/high-average (HA) group, n = 31) or low (low (L)/low-average (LA) group, n = 49) transporters. The redox state of human serum albumin was measured using high-performance liquid chromatography. Results: The fraction of human mercaptoalbumin (HMA) showed significantly higher values in patients with high transport status than those with low transport status (f(HMA) 64.0 ± 5.4 and 52.7 ± 10.4%, respectively). Our data showed that the H/HA transport characteristic was associated with lower albumin (3.76 ± 0.48 vs. 4.00 ± 0.35, p < 0.05), and lower levels of advanced oxidized protein product (p = 0.008) when compared with the L/LA type. A correlation analysis showed that there was a positive correlation between dialysate/plasma (D/P) creatinine and f(HMA) levels (r = 0.511, p < 0.0001), as well as hemoglobin levels r = 0.231, p = 0.044 and a negative correlation between D/P creatinine and serum albumin, cholesterol and LDL levels (r = -0.236, p = 0.039; r = -0.237, p = 0.038; r = -0.272, p = 0.018, respectively). Conclusions: This study showed that higher serum levels of reduced albumin f(HMA) appear to be associated with high/high average peritoneal membrane transport characteristics in the incident PD patients.

Peritoneal Dialysis: Better than, Equal to, or Worse than Hemodialysis? Data Worth Knowing before Choosing a Dialysis Modality

2001 ◽  
Vol 21 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Elias Thodis ◽  
Ploumis Passadakis ◽  
Vassilis Vargemezis ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Membrane Damage ◽  
Integrated Approach ◽  
Dialysis Dose ◽  
Significant Saving ◽  
Technological Advances ◽  
Data Worth ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Technological advances such as those that allow the delivery of an adequate dialysis dose to a larger percentage of patients, minimization of peritoneal membrane damage with more biocompatible solutions, and lower peritonitis rates will undoubtedly improve retention of patients on peritoneal dialysis (PD) for longer periods. Currently, only 15% of the world dialysis population is managed by PD. Peritoneal dialysis has many advantages over hemodialysis, and if end-stage renal disease (ESRD) patients are fully informed about them, the proportion of patients who would prefer this treatment would rise to 25% – 30%. An integrated approach to the treatment of ESRD could start with PD in a large percentage of patients, especially those who will receive a kidney transplant within 2 – 3 years. With the present epidemic of ESRD, this approach could lead to a significant saving, relieve the pressure on dialysis units, and allow a larger number of ESRD patients to be treated.

Peritoneal Dialysis

2019 ◽  
Author(s):  
Karlien François ◽  
Joanne M. Bargman
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Dialysis Fluid ◽  
Keywords Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos,  8 figures, 4 tables, and 73 references.  Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

Pharmacokinetics of Aztreonam Administered loP o in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

1989 ◽  
Vol 9 (1) ◽  
pp. 57-59 ◽  
Author(s):  
Paul Nikolaidis ◽  
Nicholas Dombros ◽  
Panagiotis Alexiou ◽  
Elias Balaskas ◽  
Achilles Tourkantonis
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Elimination Rate ◽  
Normal Subjects ◽  
Serum Levels ◽  
High Rate ◽  
Pharmacokinetic Parameters ◽  
Stage Renal Disease ◽  
End Stage

The pharmacokinetics of Aztreonam (AZT) administered i.p. in six stable patients undergoing continuous ambulatory peritoneal dialysis (CAPD) for end-stage renal disease (ESRD) were studied. One gram of AZT was added into a 2 L bag of dialysate (Medital-Bieffe®) just prior to infusion into the peritoneal cavity. The dwell time was 8 h. The serum maximum concentration of AZT was 42.5 ± 12.4 mg/L (x ± SD), achieved in 4.6 ± 1.0 h. The elimination half-life was 2.4 ± 0.8 h, almost equal to that found in normal subjects (1.7–2 h). The pharmacokinetic parameters of elimination, as elimination rate constant and clearance of AZT from peritoneal cavity were found 0.305 ± 0.101 h-1 and 10.05 ± 3.7 mL/min, respectively, while the bioavailability via the peritoneal mem brane was 90.8 ± 3.05% of administered dose. It is concluded that AZT is eliminated from dialysate at a high rate after i.p. administration and its dialysate and serum levels exceed the MIC for the majority of sensitive organisms including Pseudomonas species. Aztreonam appears to be a potentially useful antibiotic for CAPD peritonitis.

Impact of Glucose in Peritoneal Dialysis: Saint or Sinner?

2005 ◽  
Vol 25 (5) ◽  
pp. 415-425 ◽  
Author(s):  
Thomas Sitter ◽  
Matthias Sauter
Keyword(s):  
Peritoneal Dialysis ◽  
Degradation Products ◽  
Therapeutic Interventions ◽  
Buffer System ◽  
Peritoneal Membrane ◽  
Functional Changes ◽  
Osmotic Agent ◽  
Stage Renal Disease ◽  
End Stage ◽  
Osmotic Agents

Peritoneal dialysis (PD) solutions using glucose as osmotic agent have been used for more than two decades as effective treatment for patients with end-stage renal disease. Although alternative osmotic agents such as amino acids and macromolecular solutions, including polypeptides and glucose polymers, are now available, glucose is still the most widely used osmotic agent in PD. It has been shown to be safe, effective, readily metabolized, and inexpensive. On the other hand, it is widely assumed that exposure of the peritoneal membrane to high glucose concentrations contributes to both structural and functional changes in the dialyzed peritoneal membrane. As in diabetes, glucose, either directly or indirectly through the generation of glucose degradation products or the formation of advanced glycation end products, may contribute to peritoneal membrane failure. Although efforts to reduce glucose toxicity have been made for years, only a few suggestions, such as dual-bag systems with bicarbonate as buffer system, have found broader acceptance. Recently, some interesting new approaches to the problem of glucose-related toxicity have been made, but further investigations will be necessary before they can be used clinically. This review will focus on adverse effects of glucose in PD solutions and summarize different aspects of glucotoxicity and potential therapeutic interventions.

Are Three Exchanges Suitable for Asian Patients on Peritoneal Dialysis?

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 45-47 ◽  
Author(s):  
Georgi Abraham ◽  
Milly Mathew ◽  
Padma Gopalakrishnan ◽  
Suresh Sankarasubbaiyan ◽  
Sunil Shroff
Keyword(s):  
Developing Countries ◽  
Peritoneal Dialysis ◽  
Indian Subcontinent ◽  
Residual Renal Function ◽  
Insurance Companies ◽  
Dialysis Dose ◽  
Asian Patients ◽  
Lower Protein ◽  
Stage Renal Disease ◽  
End Stage

Phenomenal growth in continuous ambulatory peritoneal dialysis (CAPD) has occurred in the developing countries of Asia. In many regions in Asia, neither governments nor insurance companies fully cover treatment expenses for dialysis. Hence, patients in developing countries such as India, Bangladesh, Pakistan, and Nepal use just three 2-L exchanges daily. Typical practice in many centers is to do daytime CAPD with a dry night. Most of our Indian patients who are on three exchanges per day showed a Kt/V of 1.67 and 2-year survival rate of 60% with a normalized protein equivalent of nitrogen appearance of 0.73 – 0.80 g/kg daily. Vegetarians had a lower protein consumption rate and lower serum albumin levels. Peritoneal membrane characteristics vary among high, high average, and low average in various regions of Asia. The prevalence of diabetic nephropathy, with its associated comorbid conditions, as a major cause of end-stage renal disease in the Indian subcontinent explains the differences in the CAPD mortality rates between India and various Asian countries. Given the financial constraints in countries in Asia, small-volume dialysis of 6 L daily may be an acceptable compromise in some patient populations with a smaller body size and significant residual renal function; however, dialysis dose should be individualized according to the needs of each patient.

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