Peritoneal Dialysis with Amino Acid Solutions: Fluid and Solute Transport Kinetics

Lindholm, Bengt; Weryński, Andrzej; Bergström, Jonas

doi:10.1111/j.1525-1594.1988.tb01516.x

Cited by 47 publications

(5 citation statements)

References 12 publications

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“…Peritoneal dialysis (PD) is very unique in this respect because its “membrane” is composed only of natural transport barriers (5). This gives us an opportunity to apply the methods developed for the description of transport processes in artificial organs for blood cleaning mechanisms during PD (6,7).…”

mentioning

confidence: 99%

Membrane Transport of Several Ions During Peritoneal Dialysis: Mathematical Modeling

Galach

Waniewski

2012

Artificial Organs

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Peritoneal dialysis utilizes a complex mass exchange device created by natural permselective membranes of the visceral and abdominal muscle tissues. In mathematical modeling of solute transport during peritoneal dialysis, each solute is typically considered as a neutral, independent particle. However, such mathematical models cannot predict transport parameters for small ions. Therefore, the impact of the electrostatic interactions between ions on the estimated transport parameters needs to be investigated. In this study, transport of sodium, chloride, and a third ion through a permselective membrane with characteristics of the peritoneal transport barrier was described using two models: a model with the Nernst-Planck (NP) equations for a set of interacting ions and a model with combined diffusive and convective transport of each ion separately (DC). Transport parameters for the NP model were calculated using the pore theory, while the parameters for the DC model were estimated by fitting the model to the predictions from the NP model. Solute concentration profiles in the membrane obtained by computer simulations based on these two models were similar, whereas the transport parameters (diffusive mass transport parameters and sieving coefficients) were generally different. The presence of the third ion could substantially modify the values of diffusive mass parameter for sodium and chloride ions estimated using the DC model compared with those predicted by NP. The extent of this modification depended on the molecular mass and concentration of the third ion, and the rate of volumetric flow. Closed formulas for the transport parameters of the DC model in terms of the NP model parameters, ion concentration profiles in the membrane, and volumetric flow across the membrane were derived. Their reliable approximations, which include only boundary ion concentrations instead of spatial intramembrane concentration profiles, were formulated. The precision of this approximation was demonstrated by numerical simulations of the investigated three-ion system. Our modeling demonstrated that the fitted transport parameters depend not only on ion molecular weight but also on the characteristics and concentration of all other ions in the fluid as well as on the fluid flow rate through the membrane. Therefore, theoretical predictions of ion transport parameters need to take into account multi-ionic character of dialysis and body fluids. The transport parameters estimated using the DC model for one ion may vary with the ionic composition, ion concentrations in the fluids, and volumetric flow and may not reflect the theoretical description of diffusive and convective characteristics of single ion.

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mentioning

confidence: 99%

Membrane Transport of Several Ions During Peritoneal Dialysis: Mathematical Modeling

Galach

Waniewski

2012

Artificial Organs

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“…Nonetheless, this has been less clear in the context of a stable, noninfected peritoneal cavity [11]. Lindholm et al stated that albumin, the predominant plasma and dialysate protein, is able to pass through small pores (predominantly by convection) as well as large pores [14]. As for longitudinal analysis, previous studies have stated that inflammation arises with time on PD [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, D/P creatinine, a major driver of PPL, was unchanged during long-term follow-up. The dip of sodium (11 mEq/L [5][6][7][8][9][10][11][12][13][14][15][16][17] vs. 12 mEq/L [9][10][11][12][13][14], p = 0.563) or the percentage of free water transport did not change significantly (0.42 [0.31-0.53] vs. 0.53 [0.49-0.56], p = 0.424).…”

Section: Repeated Measures Analysismentioning

confidence: 99%

Peritoneal Protein Loss With Time in Peritoneal Dialysis

Malho Guedes,

Marques,

Domingos

et al. 2024

Seminars in Dialysis

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Longitudinal evolution of peritoneal protein loss (PPL), a reflection of hydrostatic pressure–driven leak of plasma proteins through the large‐pore pathway, is not clear. Time on PD causes loss of mesothelial cells, vasculopathy, and increased thickness of the submesothelial fibrous layer. Are these structural changes associated with progressive increase of PPL, in a parallel with the rise in the D/P creatinine? The aim of the present study was to identify longitudinal changes of PPL over time. This single‐center, longitudinal study included 52 peritoneal dialysis (PD) patients with a median follow‐up of 26.5 months, evaluated at two different time points with a minimum interval of 6 months. Repeated measures analysis was performed using paired sample t‐test or the nonparametric Wilcoxon signed‐rank test, depending on the distribution. After a median interval of 15.5 months, lower levels of residual renal function and urine volume, lower Kt/V, and creatinine clearance were found. D/P creatinine and PPL were stable, but a decrease in ultrafiltration was present. Systemic inflammation, nutrition, and volume overload showed no significant change with time on PD. Analysis of a subpopulation with over 48 months between initial and subsequential assessment (n = 11) showed again no difference in inflammation, nutritional and hydration parameters from baseline, but importantly PPL decreased after more than 4 years on PD (mean difference 1.2 g/24, p = 0.033). D/P creatinine and dip of sodium remained unchanged. The absence of deleterious effects of time on PD is reassuring, pointing to the benefit of updated PD prescription, including the standard use of more biocompatible solutions towards membrane preservation and adjusted prescription avoiding overhydration and inflammation while maintaining nutritional status. After controlling for confounders, PPL may act as a biomarker of acquired venous vasculopathy, even if small pore fluid transport rates and free water transport are preserved.

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“…Several investigators have examined the nutritional benefit of substituting AA for glucose in PD solutions. [50][51][52][53][54][55][56][57] Some studies have reported a significant improvement in some nutritional parameters, while others have shown no significant improvement in the same parameters.…”

Section: Amino-acid-based Solutionsmentioning

confidence: 99%

Use of new peritoneal dialysis solutions in children

Canepa

Verrina

Perfumo

2008

Kidney International

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Standard peritoneal dialysis (PD) solutions with low pH and containing high concentrations of lactate and glucose have been demonstrated to negatively affect the peritoneal membrane, mesothelial cell viability, residential peritoneal cells, and also to inhibit phagocytic functions. An increasing body of experimental evidence supports the idea that the peritoneal hypervascularization and fibrosis observed in long-term PD are causally related to the acute and chronic toxicity of conventional PD solutions. A Physioneal (lactate/bicarbonate mixed buffer pH 7-7.4), Physioneal, Extraneal (7.5% icodextrin), Nutrineal (1.1% amino-acid-containing solution) regimen, for example, offers a significant reduction in carbohydrate load (approximately 40-50%), lower exposure to and absorption of glucose degradation products, reduced oxidative stress, and improved volume control when compared with a first-generation DDDD (4 x Dianeal) regimen. The positive aspects of each solution that we have observed in our patients allow a recommendation on the potential benefit of using these solutions in children treated with PD. In fact, data from the literature as well as the results of the studies reported in this paper show that in children the application of neutral pH bicarbonate/lactate-buffered solution for the standard nighttime APD prescription, icodextrin solution for a long daytime dwell, and AA-based solution in malnourished patients is safe and effective. Extended clinical trials should be encouraged to better define the PD schedules for the combined use of these solutions that may be associated with the best clinical efficacy and the highest level of biocompatibility.

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Peritoneal Dialysis with Amino Acid Solutions: Fluid and Solute Transport Kinetics

Cited by 47 publications

References 12 publications

Membrane Transport of Several Ions During Peritoneal Dialysis: Mathematical Modeling

Membrane Transport of Several Ions During Peritoneal Dialysis: Mathematical Modeling

Peritoneal Protein Loss With Time in Peritoneal Dialysis

Use of new peritoneal dialysis solutions in children

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