Standard Peritoneal Permeability Analysis in Children

Abstract

Abstract. Peritoneal transport characteristics in children on peritoneal dialysis (PD) has been reported to be different compared to adults. However, various test methods can influence this difference. Thirty-one standard peritoneal permeability analyses (SPA) were performed in 18 PD children with a median (range) age of 9.8 yr (2 to 19) and a median duration of PD of 2.6 yr (0.19 to 6.8). The median mass transfer area coefficient (MTAC) for creatinine was 9.6 ml/min per 1.73 m2 (4.4 to 18.0), and for urea 17.3 ml/min per 1.73 m2 (12.2 to 22.8). The median dialysate to plasma creatinine ratio (D/PCr) was 0.69 (0.44 to 0.92), the glucose absorption 59% (23 to 75), and the D/D0 for glucose 0.38 (0.23 to 0.62). The median clearance of β2-microglobulin was 923 μl/min per 1.73 m2 (366 to 1828), of albumin 103 μl/min per 1.73 m2 (55 to 211), of IgG 48 μl/min per 1.73 m2 (20 to 105), and of α2-macroglobulin 12 μl/min per 1.73 m2 (5 to 49). No correlation was found between these results and age or PD time. The restriction coefficient for macromolecules indeed increased with duration of PD treatment (r = 0.38, P = 0.03). The median transcapillary ultrafiltration rate was 1.2 ml/min per 1.73 m2 (-0.01 to 2.8), the net ultrafiltration rate 0.2 ml/min per 1.73 m2 (-1.97 to 1.82), and the effective lymphatic absorption rate 1.04 ml/min per 1.73 m2 (-0.06 to 2.91). When corrected for body surface area, no differences were found in peritoneal fluid and solute transport characteristics between children and adults. No effect of time on PD on the transport parameters was found in a cross-sectional analysis, except for an increase of the restriction coefficient to macromolecules. This finding is similar to observations in adults. Therefore, the present study showed no evidence for the common belief that the peritoneal membrane in children is different from that in adult patients.

Effects of sulodexide in the prevention of peritoneal membrane changes in continuous ambulatory peritoneal dialysis patients

“…Measurement of dialysate CA125 can indicate the exfoliation of peritoneal mesothelial cells, which is the early event of membrane structural change. Previous studies found that the longer the duration of PD, the lower the CA125 concentration [49,50,52]. This finding is in accordance with our study that there was a significantly lower CA125 concentration from baseline in the placebo group after a 3-month intervention, but in the sulodexide group, there was no significant difference change from baseline.…”

“…The peritoneal membrane structure can change over time when exposed to long-term PD, and peritoneal biopsy data showed a loss of mesothelial integrity after 5 years on PD [21]. This finding is in accordance with the results of subsequent studies that showed that the longer the duration of PD, the lower the CA125 concentration [49,50,52].…”

The Factors Affectıng The Effıcıency Of Contınuous Ambulatory Perıtoneal Dıalysıs In Chıldren

“…Ultrafiltration is one of the important determinants of dialysis adequacy. 21,29 In addition to studies showing that ultrafiltration increases with increasing peritoneal dialysis fill volume, [30][31][32] there are also studies reporting ultrafiltration was caused by increased lymphatic reflux and therefore decreasing dialysis adequacy. Some of them have reported an increase in mortality and morbidity rates by triggering peritoneal fibrosis in the long term associated with an increase fill volume.…”