Factors Affecting Ul Trafil Tration in Continuous Ambulatory Peritoneal Dialysis First Report of an International Cooperative Study

Abstract

In 20 participating centers in Canada, France and the USA, 210 patients on continuous ambulatory peritoneal dialysis for one to 66 months underwent drainage measurements with a hypertonic (3.86 to 4.5 gm % dextrose), 2L, four-hour-dwell exchange. Patients had used lactate solutions only (n = 73), acetate solutions only (n = 21), or acetate before a change to lactate (n = 16). Mean net ultrafiltration (± SEM) (UF, ml) values were 701 ± 22, 489 ± 61, and 390 ± 56 respectively; mean dialysate glucose concentrations (mg/dl) were 1053 ± 23, 722 ± 107, and 701 ± 24. Mean values in groups exposed to acetate were significantly (p < 0.01) below those in the lactate-only group. There was no significant correlation of UF with the peritonitis rate; in the lactate-only group, there was no significant correlation between UF and time on CAPD. In summary, the chronic use of acetate solutions appeared to be associated with more rapid decreases in dialysate glucose and low UF Slingeneyer et al reported that 10 and 30% of patients treated with continuous ambulatory peritoneal dialysis (CAPD) at their center in France lose ultrafiltration capacity at one and two years respectively (I). Eventually 24% of patients with decreasing ultrafiltration had to be transferred to hemodialysis.