Diffusive and Convective Solute Transport in Peritoneal Dialysis with Glucose as an Osmotic Agent

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Abstract
To investigate possible effects of glucose concentration, dwell time, and peritoneal reabsorption on the combined diffusive and convective peritoneal solute transport, dialysate to plasma concentration ratios (D/P) and solute clearances were evaluated for 6-h peritoneal dwell studies with 1.36, 2.27, and 3.86% glucose solutions. The diffusive mass transport coefficient, KBD, and sieving coefficient, S, were estimated using the Babb-Randerson-Farrell model of peritoneal transport. Dialysate volumes over time and peritoneal reabsorption rates, KE, were assessed using radiolabeled iodinated serum albumin (RISA). The transport parameters were estimated with and without peritoneal reabsorption of solutes taken into account. To test the stability of the transport parameters throughout a single peritoneal dwell, KBD and S values were estimated for the initial 3-120 min, the final 120-360 min, and the entire 3-360 min dwell period for dialysis with 3.86% glucose solution. The transport parameters did not differ between the three dialysis fluids although clearances of small solutes were higher with the 3.86% solution. Values of KBD, but not S, were dependent on the correction for peritoneal reabsorption of solutes. Computer simulations showed that S could be estimated even with the 1.36% glucose solution. A significant change of the transport parameters, with increased values of KBD during the initial period of the dwell, was found for urea, potassium, sodium, and total protein during dialysis with the 3.86% solution. S values for urea and potassium were close to 1 during the initial period whereas unphysical (higher than 1) S values were found for the whole dwell period. The transient increase of KBD during the initial part of the dwell may reflect changes in the peritoneal barrier possibly induced by fresh dialysis fluid. In conclusion, the transport parameters KBD and S are not influenced by the concentration of glucose in the dialysis fluid. Moreover, the estimation of KBD but not of S is dependent on the assumed rate of peritoneal reabsorption. Finally, the current results challenge the assumption that KBD and S are constant throughout a peritoneal dialysis exchange.