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Adverse effect of peritonitis on peritoneal membrane function in children on dialysis
S P Andreoli1, J Leiser, B A Warady
1James Whitcomb Riley Hospital for Children, Indianapolis, IN 46202, USA. SAndreol@iupui.edu
Insights
Children with peritonitis history show increased peritoneal membrane permeability to glucose and creatinine. This suggests peritonitis adversely affects membrane function, potentially leading to ultrafiltration failure in continuous ambulatory/cycling peritoneal dialysis.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Peritoneal Dialysis
Background:
- Peritonitis is a common complication in children undergoing continuous ambulatory/cycling peritoneal dialysis (CAPD/CCPD).
- The impact of peritonitis on peritoneal membrane transport characteristics is not fully understood in pediatric populations.
Purpose of the Study:
- To determine the effect of peritonitis on peritoneal membrane solute transport characteristics in children on CAPD/CCPD.
- To compare membrane function between children with and without a history of peritonitis.
Main Methods:
- A multicenter study involving 93 children undergoing CAPD/CCPD.
- Each child performed a 4-hour peritoneal equilibration test (PET) using 2.5% Dianeal.
- Measurements included mass transfer area coefficients (MTAC) for creatinine and glucose, dialysate to plasma ratios (D/P) for creatinine, and dialysate glucose levels (D/Do).
Main Results:
- Children with a history of peritonitis (Group II) exhibited significantly lower 4-hour glucose D/Do and higher 4-hour D/P creatinine, creatinine MTAC, and glucose MTAC compared to those without peritonitis history (Group I).
- Peritonitis caused by Gram-negative organisms was associated with lower 4-hour glucose D/Do and higher creatinine MTAC.
- Peritonitis rate showed a weak correlation with glucose MTAC and 4-hour glucose D/Do.
Conclusions:
- Children with a history of peritonitis have more permeable peritoneal membranes to glucose and creatinine.
- Peritonitis, particularly caused by Gram-negative organisms, alters peritoneal membrane function, increasing permeability.
- These changes may adversely impact membrane function and contribute to ultrafiltration failure in pediatric CAPD/CCPD patients.
Abstract:
The effect of peritonitis on peritoneal membrane solute transport characteristics was determined as part of a multicenter study in children on continuous ambulatory/cycling peritoneal dialysis. Ninety-three children each underwent a 4-h peritoneal equilibration test (PET) with 1,100 ml/m2 2.5% Dianeal for determination of mass transfer area coefficients (MTAC), dialysate to plasma ratios (D/P) for creatinine and urea at 0, 30, 60, 120, 180, and 240 min and dialysate glucose levels at 0, 30, 60, 120, 180, and 240 min for calculation of D/Do. The mean age of the study cohort was 10.1 +/- 5.6 years (range 0.1-19 years). There were 162 historical episodes of peritonitis; at the time of the PET tests, 36 children had never had an episode of peritonitis (group I) while 57 children had a history of one or more episodes of peritonitis (group II). In group II children, the 4-h glucose D/Do was significantly lower and the 4-h D/P creatinine ratio, the creatinine MTAC, and the glucose MTAC were significantly higher (each P < 0.05) than in group I. In children with a history of peritonitis caused by Gram-negative organisms, the 4-h glucose D/Do (P < 0.05) and the creatinine MTAC (P < 0.05) were significantly lower and the glucose MTAC (P = 0.07) nearly significantly lower than in children without a history of peritonitis. Linear regression analysis did not demonstrate a correlation between any of the variables and duration of peritoneal dialysis, while the rate of peritonitis was weakly correlated with glucose MTAC (r = 0.34, P < 0.05) and with 4-h glucose D/Do (r = -0.222, P < 0.01). We conclude that children with a history of peritonitis have peritoneal membranes that are more permeable to glucose and creatinine than children without a history of peritonitis, and that the peritoneal membranes of children who have had peritonitis caused by Gram-negative organisms are also more permeable to creatinine and glucose. Such changes are likely to have an adverse effect on membrane function and could eventually contribute to ultrafiltration failure.