Fluid Tonicity Affects Peritoneal Characteristics Derived by 3-PORE Model

Abstract

Background It is typically assumed that within short time-frames, patient-specific peritoneal membrane characteristics are constant and do not depend on the initial fluid tonicity and dwell duration. The aim of this study was to check whether this assumption holds when membrane properties are estimated using the 3-pore model (3PM). Methods Thirty-two stable peritoneal dialysis (PD) patients underwent 3 8-hour peritoneal equilibration tests (PETs) with different glucose-based solutions (1.36%, 2.27%, and 3.86%). Temporary drainage was performed at 1 and 4 hours. Glucose, urea, creatinine, sodium, and phosphate concentrations were measured in dialysate and blood samples. Three-pore model parameters were estimated for each patient and each 8-hour PET separately. In addition, model parameters were estimated using data truncated to the initial 4 hours of peritoneal dwell. Results In all cases, model-estimated parameter values were within previously reported ranges. The peritoneal absorption (PA) and diffusive permeability for all solutes except sodium increased with fluid tonicity, with about 18% increase when switching from glucose 2.27% to 3.86%. Glucose peritoneal reflection coefficient and osmotic conductance (OsmCond), and fraction of hydraulic conductance for ultrasmall pores decreased with fluid tonicity (over 40% when switching from glucose 1.36%). Model fitting to the truncated 4-hour data resulted in little change in the parameters, except for PA, peritoneal hydraulic conductance, and OsmCond, for which higher values for the 4-hour dwell were found. Conclusion Initial fluid tonicity has a substantial impact on the 3PM-estimated characteristics of the peritoneal membrane, whereas the impact of dwell duration was relatively small and possibly influenced by the change in the patient's activity.