Are transient changes in capillary surface area required to explain peritoneal transport in renal failure patients?

Abstract

Background: Waniewski postulated a transient increase in peritoneal capillary surface area to fit their model predictions to experimental data of Heimburger measured in renal failure (RF) patients undergoing peritoneal dialysis (PD) but with only a 3.86% glucose dialysis fluid. The present aim is to propose a new mathematical model of the patient PD procedure that could closely fit the complete Heimburger measurement set without this postulate. Methods: The three-pore model of Rippe was used to describe transient changes in peritoneal volume and solute concentrations during a PD dwell. The predialysis, RF patient, plasma solute concentrations were assumed to remain constant during the dwell. The model was validated using the 3.86% glucose Heimburger measurements. Permeability surface area product parameters were chosen to match only the end-dwell peritoneal fluid glucose concentration and the end-dwell amounts of urea, creatinine, and Na+ removed from this simulated patient group. Then, this model was used to predict additional measurements by Heimburger on two other patient groups dialyzed with glucose concentrations of 2.27% and 1.36%, respectively. Parameters were unchanged when simulating these other patient groups. Results: To match the shape of the transient changes in drained volume and dialysis fluid glucose concentration for the 3.86% glucose group, it was necessary for only one parameter, the effective radius of glucose, to vary linearly in proportion to the dialysis fluid glucose concentration. This description was unchanged in the other two groups. Conclusion: Postulated transient increases in peritoneal capillary surface area were unnecessary to predict the entire Heimburger measurements.