The Longitudinal Effect of a Single Peritonitis Episode on Peritoneal Membrane Transport in CAPD Patients

Abstract

Objective To evaluate the longitudinal effect of a single peritonitis episode on peritoneal membrane transport. Design A prospective longitudinal study. Setting Department of nephrology in a university hospital. Patients Eighteen continuous ambulatory peritoneal dialysis patients with peritonitis. Methods Peritoneal transport for low, middle, and high molecular weight (MW) solutes was evaluated by peritoneal equilibration test (PET). The first PET was performed on the day following the diagnosis of peritonitis. The test was repeated at weeks 1, 2, 4, 12, and 24 and the results were compared to baseline PET data obtained before peritonitis. In addition, dialysate CA125 concentration and leukocyte count were measured. Results During peritonitis there were significant increases in dialysate-to-plasma (D/P) ratios for all low, middle, and high MW solutes except potassium, and decreases in D4/D0 glucose ratio and ultrafiltration (UF) volume. Over the subsequent 2 weeks, solute transport gradually decreased to the baseline values then remained unchanged during follow-up. Although net UF volume demonstrated a similar course during the study, it did not completely return to the baseline value. No decrease in D/P sodium ratio was found at 60 minutes during the PET performed 24 weeks after peritonitis. The percent change in solute transport during peritonitis compared to baseline value was significantly correlated with a solute's MW ( r = 0.776, p = 0.014). The slope of the regression line for D/P ratios versus MW, in double logarithmic scale, before peritonitis (-0.73 ± 0.09) was steeper than the slope during peritonitis (-0.59 ± 0.08). Conclusions These findings indicate that a single peritonitis episode does not permanently affect peritoneal solute transport. However, the loss of net UF that accompanies peritonitis is not completely recovered, probably due to impairment of transcellular water transport. The transport changes associated with peritonitis may be due to the combined effect of increased effective peritoneal surface area and intrinsic permeability. Our findings suggest that the latter mechanism seems to be more important.

Peritoneal Dialysis Vintage and Glucose Exposure but Not Peritonitis Episodes Drive Peritoneal Membrane Transformation During the First Years of PD

“…Experimental in vivo studies have previously demonstrated major peritoneal inflammatory and fibrotic changes with bacterial and LPS induced peritonitis (Hautem et al, 2017). Repeated peritoneal equilibration tests suggest rapid recovery of peritoneal solute transport in most patients after a single episode of peritonitis (Davies et al, 1996; Ates et al, 2000), but persistent changes with repeated peritonitis episodes (Davies et al, 1996), ultimately associating with worse technique and patient outcome (Boudville et al, 2012; Ye et al, 2017). Most of these data were obtained in patients treated with acidic, high GDP PD fluids.…”

“…Functional changes correlated with the severity of infection as assessed by the cumulative dialysate leukocyte count (Davies et al, 1996). A more recent study with the same fluid type and close monitoring of transport function after the first peritonitis episode suggested recovery of peritoneal small solute transport within 2 weeks post peritonitis, but only subtotal recovery of UF (Ates et al, 2000). In a cohort of 137 patients treated with both low and high GDP fluids and 92 patients with a history of a single episode of peritonitis, the latter exhibited significantly and persistently increased small solute transport, and decreased large molecule transport and UF rates (van Diepen et al, 2015); subgroup analyses with regard to the PD fluid type were not performed.…”

Inflammatory Cytokines, Angiogenesis, and Fibrosis in the Rat Peritoneum

“…7 In the first month after peritonitis, patients develop an acute dysfunction of the peritoneum as a dialysis membrane. 8 This is characteristically associated with increased transport of small molecular weight solutes and ultrafiltration failure. The mechanism for this is not well established, but vascular effects of nitric oxide 9 or prostaglandins 10 have been hypothesized to play a role.…”

Peritoneal Dialysis Fluid Bioincompatibility and New Vessel Formation Promote Leukocyte-Endothelium Interactions in a Chronic Rat Model for Peritoneal Dialysis

“…Despite many beneficial developments, peritonitis remains a common complication of peritoneal dialysis (PD) [6,12]. During peritonitis, PD patients develop an acute dysfunction of the peritoneum, associated with increased transport of small molecular weight solutes and ultrafiltration failure [2].…”