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Related Experiment Videos

Ultrafiltration and solute kinetics using low sodium peritoneal dialysate

J K Leypoldt1, D I Charney, A K Cheung

  • 1Research Service, Veterans Affairs Medical Center, Salt Lake City, Utah, USA.

Kidney International
|December 1, 1995
PubMed
Summary

Low sodium peritoneal dialysate (LNaD) enhances fluid removal and sodium loss in patients undergoing continuous ambulatory peritoneal dialysis. This occurs due to higher glucose concentration, increasing net fluid removal and promoting sodium loss via diffusion and convection.

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Area of Science:

  • Nephrology
  • Renal Physiology
  • Dialysis Technology

Background:

  • Fluid overload is a common complication in patients with end-stage renal disease undergoing peritoneal dialysis.
  • Low sodium dialysate has shown potential in managing fluid overload and enhancing sodium removal.

Purpose of the Study:

  • To elucidate the mechanisms by which low sodium dialysate (LNaD) affects ultrafiltration and solute kinetics compared to conventional dialysates.
  • To compare the efficacy of LNaD with conventional dialysates of equal osmolality and equal glucose concentration in chronic peritoneal dialysis patients.

Main Methods:

  • A comparative study involving 10 chronic peritoneal dialysis patients.
  • Each patient underwent a 6-hour, 2-liter exchange with three different dialysates: LNaD, conventional dialysate with 1.5% glucose (CD1.5), and conventional dialysate with 2.5% glucose (CD2.5).

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  • Transperitoneal solute diffusion was assessed using the permeability-area product (PA) model.

    • Main Results:

    • Net fluid removal was significantly higher with LNaD (190 ml) and CD2.5 (250 ml) compared to CD1.5 (-200 ml).
    • Sodium loss was significantly greater with LNaD (72 mEq) and CD2.5 (41 mEq) than with CD1.5 (-18 mEq).
    • The permeability-area product (PA) for sodium was lower than for urea, creatinine, and glucose, and could only be accurately determined with LNaD.

    Conclusions:

    • LNaD enhances net fluid removal compared to CD1.5, primarily due to its higher glucose concentration acting as a more effective osmotic agent.
    • Sodium loss is augmented by both diffusion and convection when using LNaD.
    • Sodium transport across the peritoneal membrane is slower than that of urea, creatinine, and glucose, suggesting LNaD effectively manages fluid overload by increasing fluid removal and sodium excretion.