Ultrafiltration and Small Solute Transport at Initiation of PD: Questioning the Paradigm of Peritoneal Function

Author:

Selgas Rafael1,Bajo M. Auxiliadora1,Cirugeda Antonio1,Del Peso Gloria1,Valdés Jorge1,Castro M. José1,Sánchez Sonia1,Fernández–Reyes M. José1,Hevia Covadonga1,Gil Fernando1,Aguilera Abelardo1,Ortiz Javier1,Alegre Laura1,Álvarez Vicente1,Sánchez–Tomero J. Antonio1

Affiliation:

1. Hospital Universitario La Princesa and Hospital Universitario La Paz, “Grupo de Estudios Peritoneales de Madrid” del Instituto Reina Sofía de Investigación Nefrológica (FRIAT), Madrid, Spain

Abstract

Background Human peritoneal function on commencing peritoneal dialysis (PD) is not yet adequately understood. The objective of this study was to determine peritoneal functional patterns on commencing PD. Methods 367 end-stage renal disease (ESRD) patients on PD for the first time were studied between their initial second to sixth weeks on PD. Urea and creatinine mass transfer area coefficients (MTAC) and standardized ultrafiltration (UF) capacity were determined. Results Mean parametric values were MTAC urea 22.9 ± 7.04 mL/min, MTAC creatinine 10.31 ± 4.68 mL/min, and UF 896 ± 344 mL. Gender, patient size, and diabetes or kidney disease did not affect these parameters. The relationship between values of MTAC creatinine and UF reached statistical significance, although with a low value for Pearson's coefficient ( r=–0.30, p = 0.001). Age showed a significant inverse linear correlation with UF capacity ( r = –0.15, p = 0.003) and MTAC urea ( r = –0.11, p < 0.05). Logistic regression analysis demonstrated that UF below 400 mL was independently related to a high MTAC creatinine and older age. Diabetes was least frequent in patients with the lowest UF. However, in the analysis of MTAC creatinine quintiles, UF values did not follow the expected inverse pattern. The lack of differences in UF between the second and third to fourth MTAC creatinine quintiles is remarkable; MTAC creatinine ranged from 6.71 to 13.54. Conclusions The functional characteristics of human peritoneum varied markedly and there was a less intense than expected relationship between solute and water transports. This mild inverse relationship is intriguing and suggestive of the necessity of redefining some basic concepts. Age was associated with a lower peritoneal UF capacity, in part independently of small solute transport.

Publisher

SAGE Publications

Subject

Nephrology,General Medicine

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