[Monitoring of the peritoneal permeability in peritoneal dialysis]. / Surveillance de la perméabilité du péritoine en dialyse péritonéale.

Monitoring peritoneal permeability is indispensable to adjust the dialysis procedure to the characteristics of each individual patient and to detect and prevent the complications of peritoneal dialysis. Several monitoring techniques can be used, the simplest one being the most inaccurate. The authors consider that in routine practice the first alterations can be detected merely by measuring ultrafiltration. The next step is a single glucose assay after a 4-hour long contact. Evaluating the speed of diffusion of glucose and urea by means of four assays in two hours is an excellent compromise: the equilibration curves thus obtained can be summarized as the time required for the percentage of glucose absorption to be identical with the percentage of dialysate saturation in urea (APEX time).

The need for using an enzymatic colorimetric assay in creatinine determination of peritoneal dialysis solutions.

The fate of the peritoneal membrane on continuous ambulatory peritoneal dialysis (CAPD) is usually evaluated through the modification of its permeability to various solutes as glucose, creatinine, and urea. Therefore, the accuracy of the methods used for measurements of creatinine is of great importance. A particular problem does exist for creatinine determination as it may be influenced by the presence of glucose. We studied a new enzymatic colorimetric method for creatinine determination in peritoneal dialysis solutions which contain high dextrose concentrations. Creatinine was measured in plasma, urine, and dialysate from 18 patients on CAPD and in pure dextrose solutions, with an enzymatic test (Boehringer Mannheim) and with Jaffe's reaction on two different analyzers: Astra (Beckman) and Eris (Merck). Creatinine results were similar with both assays (Jaffe's reaction and enzymatic test) when measured in blood and urine. However the Jaffe's reaction gave higher creatinine results than the enzymatic test (p less than 0.001), when assays were performed in peritoneal dialysis solutions and in pure glucose solutions. In addition, it appeared that other components of dialysis solutions, mainly calcium chloride, influenced unpredictably the results of creatinine with the Jaffe's reaction. We conclude that specific enzymatic test is a more accurate and reliable method to evaluate creatinine kinetics through the peritoneal membrane when determined in CAPD solutions.

[The decrease in thyroid hormones in CAPD is not explained either by iodine saturation or by dialysate loss]. / La diminution des hormones thyroïdiennes en DPCA ne s'explique ni par la saturation iodée ni par la perte dans le dialysat.

Total T4, total T3 and TSH were measured in blood, urine and dialysate of 13 patients on CAPD. Iodine was measured in blood and urine. Free T4 and T3 were measured in blood only. Serum measurements revealed one true hypothyroidism, normal total T4, T3 and TSH for 12 patients, low free T4 and T3 with normal TSH for 9 patients. Iodine was slightly elevated for 3 patients. Urinary T4 and T3 were low. Dialysate T4 and T3 were low (T4 = 13, 6 nmol/24 H). Low free thyroid hormones are not relevant to iodine excess, nor to dialysate losses. Low free thyroid hormones may be considered as an endocrine dysfunction of chronic illnesses.

[Hypertensive type I diabetics have a higher level of microalbuminuria than normotensives irrespective of blood glucose equilibrium]. / Les diabétiques type I hypertendus ont une microalbuminurie plus élevée que les normotendus indépendamment de l'équilibre glycémique.

Micro-albuminuria, glycosylated haemoglobin and creatinine clearance were measured in 28 insulin dependent and 8 insulin requiring diabetic patients (17 males aged 45 +/- 14.4 and 19 females aged 40 +/- 17 years). Twelve had retinopathy and six had high blood pressure. There was no statistical difference of duration of diabetes, creatinine clearance and glycosylated haemoglobin between patients with normal microalbuminuria and patients with hyper microalbuminuria. There was no correlation between glycosylated haemoglobin and micro-albuminuria, between creatinine clearance and micro-albuminuria, and between creatinine clearance and glycosylated haemoglobin. Patients with retinopathy did not have significantly higher levels of micro-albuminuria. Hypertensive patients had a significantly higher micro-albuminuria (p = 0.03, m = 45.10 +/- 56) compared with normotensive patients (m = 15.49 +/- 17.54). Glycosylated haemoglobin did not differ whether patients were normo or hypertensive. Hypertensive patients were significantly older (p = 0.01) than normotensive. The lack of difference in glycemic control between normo and hypertensive diabetics suggests that diabetes and hypertension are two independent cumulative risk factors of micro-albuminuria. Hypermicro-albuminuria may be secondary to microangiopathy in young diabetics and secondary to hypertension in old diabetics.

[Encapsulating peritonitis during continuous ambulatory peritoneal dialysis. A physiopathologic hypothesis]. / Péritonite encapsulante au cours de dialyse péritonéale continue ambulatoire. Hypothèse physiopathologique.

A case of sclerosing encapsulating peritonitis was observed in a patient who had been treated by continuous ambulatory peritoneal dialysis for 4 years. During that period the patient had always used a lactate buffered dialysate (Dianeal solution, supplied by Travenol) and no disinfectant. Nine episodes of peritonitis occurred during the first two years of dialysis. At the end of the first year the patient had decreased ultrafiltration associated with high glucose absorption. A peritoneal biopsy performed at that time showed mesothelial alterations and desquamation. Sclerosing encapsulating peritonitis was suspected at the end of the fourth year, on the basis of changes in the glucose equilibration curve which showed that poor ultrafiltration was now associated with very slow glucose absorption. The diagnosis was confirmed at laparotomy. The authors suggest that the first stage of encapsulating peritonitis might be prolonged and severe alteration of the mesothelial layer. Dialysis should be discontinued immediately in the presence of a loss of filtration with hypermeability (type I) in order to permit normal recovery. If this is not done, loss of filtration with severe hypopermeability (type II) may develop due to multiple adhesions or to the encapsulating process.