Continuous ambulatory peritoneal dialysis with a high flux membrane

The standard peritoneal equilibration test (PET) was performed in 66 patients on CAPD. Patients were classified as low (n = 5), low average (n = 22), high average (n = 27), and high (n = 12) transporters based on the dialysate/plasma creatinine (D/P Cr) after 4 hour dwells. After an average time interval of 14 months on CAPD, indices of dialysis adequacy and nutrition were assessed. Based on monitoring of patient chemistries and drain volumes, peritoneal transport was considered stable during the interval. Instilled volumes and exchange tonicity were individualized in each patient to achieve combined renal and dialysis weekly creatinine clearance and KT/V urea that were not significantly different between groups. Overall, there were significant positive correlations of PET D/P Cr with dialysate albumin concentrations (r = 0.30, p < 0.02) and dialysate albumin losses (g/wk, r = 0.27, p < 0.04). There were significant inverse correlations with lean body mass (r = -0.26, p < 0.03), drain volumes (r = -0.025, p < 0.04), and KT urea by dialysis (L/wk, r = -0.24, p < 0.05). High transporters had significantly (p < 0.05) lower mean serum albumin, net protein catabolic rate (nPCR), lean body mass calculated from creatinine kinetics, and daily creatinine production (and presumably lower muscle mass) compared with one or more lower transport groups. In conclusion, we hypothesize that, in high transporters, use of more hypertonic exchanges with greater glucose absorption may inhibit appetite and nPCR; also, protein losses in drain volumes are increased. High transporters may require increased clearance and protein intake targets compared with other groups to maintain nutrition.(ABSTRACT TRUNCATED AT 250 WORDS)