Clinical Factors Affecting Peritoneal Membrane Function in Long-Term Continuous Ambulatory Peritoneal Dialysis Patients / 대한신장학회잡지

BACKGROUND: According to previous studies on peritoneal membrane function, solute transport significantly increased 3 years after the begining of peritoneal dialysis. However, there were only few reports regarding the change of peritoneal membrane function in long-term CAPD patients in Korea. METHODS: Clinical factors affecting peritoneal membrane function were analyzed, in patients who maintained CAPD more than 5 years. 124 patients performed peritoneal equilibration test(PET) 5 years after CAPD were included. Cross sectional study was performed to know the differences of clinical characteristics among 4 types of peritoneal membrane transport characteristics based on PET. Also, clinical factors affecting peritoneal memebrane function were analyzed in 31 patients who had undertaken PET initially and 5 years after the beginning of CAPD. RESULTS: D/P Cr was the highest(p<0.001) and ultrafiltration was the lowest(p=0.011) in high transport group. Also, the number of hypertonic glucose exchanges(more than 2.5%) per day was the highest (p=0.02), and serum albumin was the lowest(p<0.001) in this group. 17 patients were included in ultrafiltraion failure group. D/P Cr and the number of hypertonic glucose exchanges was significantly higher (p<0.001, p<0.001, respectively) and the duration of peritoneal dialysis was significantly longer(p=0.033) in ultrafiltration failure group compared with the others. D/P Cr of 124 patients was well correlated with the number of peritonitis(gamma=0.246, p=0.006), and the number of hypertonic glucose exchanges(gamma=0.33, p<0.001), but inversely correlated with serum albumin(gamma=-0.452, p<0.001) with the statistical significance. In 31 patients who undertook PET within 1 year after the begining of CAPD, although not significant, D/P Cr increased and ultrafiltration decreased after 5 years. A significant increase in D/P Cr(p=0.014) was seen in patients who experienced more than 2 episodes of peritonitis(n=14), compared with patients who experienced either peritonitis free or single episode of peritonitis(n=17). The linear regression analysis showed that the number of peritonitis and the number of hypertonic glucose exchanges per day were significantly correlated with the increased D/P Cr after 5 years(p=0.001, p=0.003, respectively). CONCLUSION: Clinical factors affecting peritoneal membrane function were the number of peritonitis, the use of hypertonic glucose exchanges and the duration of peritoneal dialysis. To preserve peritoneal membrane function, it is recommended to avoid hypertonic glucose exchanges and to reduce the number of peritonitis.

Significance of overnight D/P sodium test in continuous ambulatory peritoneal dialysis / 대한내과학회지

BACKGROUND: Standard PET (peritoneal equilibration test) is time consuming and it cannot reflect the water removal accurately because it measures solute transport by diffusion only. Thus, it is important to find parameters that can be used to predict both the diffusive permeability of peritoneal membrane and the peritoneal fluid removal. Sodium removal in CAPD is strongly related to the ultrafiltration and the recent study has suggested that dialysate sodium concentration at 240 minutes could reflect both peritoneal fluid removal and peritoneal transport characteristics. In this study, we investigated whether a single dialysate sodium test after overnight dwell could provide the same information as the standard PET and could reflect ultrafiltration failure. METHODS: A 9-hour overnight dwell study with 2L of 3.86% glucose dialysis solution was carried out in 48 clinically stable CAPD patients. All patients underwent a PET test with 2L of 2.27% glucose solution in the morning after an overnight dwell study. According to ultrafiltration (UF) failure (net UF<100 mL/4 hour on 2.27% glucose solution), patients were divided into two groups (group I, UF failure group; group II, non UF failure group). D/P(Na540) and D(Na540) at the end of the 9-hour dwell were compared between two groups RESULTS: D/P(Na540) was significantly correlated with D/Pcreatinine (r=0.551, p<0.001) and drained volume (r=-0.536, p<0.001) at 240 minutes on PET. There was also a significant correlation between D/P(Na540) and drained volume (r=-0.555, p<0.001) at 540 minutes after overnight dwell. D(Na540) was significantly correlated with D/Pcreatinine (r=0.448, p<0.01) at 240 minutes on PET and also weakly correlated with drain volume at 240 minutes (r=-0.37, p<0.01). There was a significant difference in D/P(Na540) between the group I and group II (p<0.05), but not in D(Na540). CONCLUSION: Overnight 9-hour dwell study with 3.86% glucose solution is a simple procedure and easy to perform on outpatient basis. D/P(Na540) is comparable with PET results and may discriminate the different transport groups. D/P(Na540) may also be used as an indicator of ultrafiltration failure.