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Jejunal dialysis in man using mannitol as the perfusate.
1Department of Nephrology, London Hospital (Whitechapel), UK.
Summary
Jejunal perfusion in normal subjects demonstrated significant clearance of urea and creatinine, suggesting potential for solute removal. However, efficacy in prolonged use for uremic patients requires further investigation.
Area of Science:
- Gastroenterology
- Nephrology
- Renal Physiology
Background:
- Enterohepatic circulation plays a role in waste product elimination.
- Limited data exists on segmental jejunal perfusion for solute clearance in healthy individuals.
Purpose of the Study:
- To evaluate the solute and water transport capabilities of a 50-cm jejunal segment in normal subjects.
- To assess the impact of perfusate tonicity and flow rate on clearance efficiency.
Main Methods:
- Segmental jejunal perfusion using a multilumen tube in four healthy volunteers.
- Perfusion with isotonic and hypertonic mannitol solutions at varying flow rates (18-70 ml/min).
- Measurement of solute (urea, creatinine, urate, electrolytes) and water clearance.
Main Results:
- Mean urea clearance was 23 ml/min and creatinine clearance was 8 ml/min, independent of perfusate tonicity.
- Significant free water clearance observed during hypertonic perfusion (22.4 ml/min) compared to isotonic (0.5 ml/min).
- Positive linear correlation between perfusate flow rate and solute clearance was noted.
Conclusions:
- Segmental jejunal perfusion can effectively clear urea and creatinine in healthy individuals.
- The method shows promise for solute removal, but clinical efficacy in prolonged use for uremic patients needs further study.
- Hypertonic perfusate significantly enhances free water clearance during jejunal perfusion.