Transperitoneal water transport before, during, and after episodes with infectious peritonitis in patients treated with CAPD.
ABSTRACT Peritonitis is considered to change peritoneal permeability and influences the long-term change in permeability during peritoneal dialysis. The objective of this study is to evaluate water transport across the peritoneum, expressed as drained ultrafiltration volume, before, during, and after episodes of peritonitis.
A retrospective analysis of data from a group of patients was performed in which drained ultrafiltration volume and glucose concentration in dialysis fluid were recorded for each dwell time every day during time on continuous ambulatory peritoneal dialysis treatment as a part of the clinical routine performed. Days with peritonitis and average of daily measurements 1 month before and after each peritonitis episode were evaluated separately for day and night exchanges. In all, 64 episodes of peritonitis in 30 patients were included in this study. Approximately 15,000 exchanges were recorded. Paired t-test and repeated-measures analysis of variance were performed.
Compared with the average for the previous month, there was a significant decrease in ultrafiltration volume for day exchanges occurring 2 days before the appearance of other clinical symptoms of peritonitis (P = 0.029). For night exchanges, the decrease in ultrafiltration volume occurred 24 hours before diagnosis (P < 0.001). Ultrafiltration volume was at its minimum the day of diagnosis for both the day (P < 0.001) and night (P < 0.001) exchanges compared with average volume for the previous month. Ultrafiltration volumes remained low for 2 days after diagnosis during both the day (P = 0.009) and night (P = 0.017) exchanges. Relative to the previous month, glucose concentration on the day of clinical diagnosis of peritonitis did not differ significantly (P = 0.328 and P = 0.963 for day and night shifts, respectively). Overall, no significant changes in ultrafiltration volumes or glucose concentrations from the month before to the month after the peritonitis episode were found (P = 0.99 and P = 0.27 for measurements during the day, respectively).
Osmotic forced ultrafiltration decreased during infectious peritonitis, most significantly for a long dwell time, consistent with an increase in both functional peritoneal surface area and hydraulic conductivity. This finding appeared 2 days before other clinical symptoms and remained significantly low 2 days after diagnosis.
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ABSTRACT: Acute infection in an animal model of chronic peritoneal dialysis (PD) induces structural changes in the peritoneum and altersfunctional characteristics of transport. These changes may compromise observations of the chronic effects of dialysis solutions. To test the hypothesis that antibiotics would prevent acute infection without affecting transport and structural properties, we characterized the frequency of infection in our rat model of PD and examined whether the inclusion of antibiotics in the dialysis solution altered the transport and structural properties of the peritoneum. Female Sprague-Dawley rats were aseptically injected daily under gas anesthesia with 30 - 40 mL of a sterile solution for 2 months via a peritoneal catheter tunneled to a subcutaneous port. Solutions used were Krebs-Ringer bicarbonate (KRB) alone, KRB with antibiotics (cefazolin 200 mg/L and gentamicin 2 mg/L), KRB with 4% glucose, and KRB with both glucose and antibiotics. After 2 months, osmotic filtration andsolute transport were assessed in each animal and peritoneal fluid was collected for bacterial culture. Angiogenesis was evaluated by quantitative image analysis of tissue sections stained with CD31. Tissue content of collagen, hyaluronic acid, and sulfated glycosaminoglycan was determined. Technique survival (successful PD for 2 months) and infection rate were comparable among all treated groups. There were no differences between the groups in transport properties. Structural changes were comparable between groups, with or without antibiotics. Addition of antibiotics to the dialysis solution did not affect thetransport characteristics of the peritoneum or the pathologic reaction of the tissue to the PD solution.Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis 26(2):249-58. · 2.21 Impact Factor
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ABSTRACT: In long-term peritoneal dialysis (PD) morphological and functional changes of the peritoneal membrane are common. Sub-mesothelial fibrosis, angiogenesis and vasculopathy are typical histomorphological alterations of the peritoneal membrane, which, to a certain degree, are induced by uremia and recurrent peritonitis. The most important causative factor, however, represents the chronic exposure to PD solutions. Glucose, glucose degradation products and advanced glycation end-products (AGEs) via different pathways induce inflammation, fibrosis and angiogenesis. As a functional consequence ultrafiltration failure due to peritoneal hyperpermeability and an increased effective peritoneal surface area represents a major clinical problem. An insufficient function of the water-selective aquaporin 1 (AQP-1) channel may also be causative for inadequate ultrafiltration. A rare but life-threatening complication of long-term PD is encapsulating peritoneal sclerosis (EPS). For both impaired AQP-1 function and EPS, the long-term effects of PD fluids are believed to be responsible, even though the mechanisms are not yet understood. The avoidance of glucose and modern PD fluids with fewer glucose degradation products, as well as first pharmacological attempts may help to preserve the peritoneal membrane in the long term.Pediatric Nephrology 02/2008; 23(1):19-25. · 2.94 Impact Factor
- Der Nephrologe 01/2007; 2(2):90-99.