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Peritoneal transport characteristics with glucose polymer based dialysate
M M Ho-dac-Pannekeet1, N Schouten, M J Langendijk
1Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.
Kidney International
|September 1, 1996
Summary
Glucose polymer dialysate (icodextrin) provides sustained ultrafiltration in CAPD patients, enhancing beta-2 microglobulin clearance without altering peritoneal membrane characteristics. This osmotic agent may improve fluid removal in patients with larger peritoneal surface areas.
Area of Science:
- Nephrology
- Peritoneal Dialysis
- Biomedical Engineering
Background:
- Conventional peritoneal dialysis (PD) solutions use glucose as an osmotic agent, leading to rapid ultrafiltration and potential glucose absorption.
- Glucose polymers offer an alternative osmotic agent, iso-osmotic to plasma, potentially providing sustained ultrafiltration via colloid osmosis.
Purpose of the Study:
- To compare the fluid and solute kinetics of a glucose polymer-based dialysate (icodextrin) with conventional glucose-based dialysates in stable CAPD patients.
- To investigate the impact of icodextrin on transcapillary ultrafiltration (TCUF) rate, lymphatic absorption, and solute transport.
Main Methods:
- Standard peritoneal permeability analysis (SPA) performed in 10 CAPD patients using 7.5% icodextrin, 1.36% glucose, and 3.86% glucose dialysates.
- Dextran 70 added to calculate fluid kinetics; fluid profiles analyzed for TCUF rate and ultrafiltration patterns.
- Mass transfer area coefficients (MTAC) and solute/solute ratios (e.g., D/P creatinine, D/PNa+) measured.
Main Results:
- Icodextrin demonstrated sustained ultrafiltration, with TCUF increasing linearly over time, unlike the hyperbolic pattern seen with glucose.
- Clearances of beta-2 microglobulin (β2m) were significantly higher with icodextrin compared to glucose solutions.
- A positive correlation between MTAC creatinine and TCUF rate was observed with icodextrin, suggesting enhanced ultrafiltration in patients with larger peritoneal surface areas.
Conclusions:
- Glucose polymer solutions (icodextrin) induce sustained ultrafiltration and enhance clearance of low molecular weight proteins like β2m.
- Icodextrin exerts osmotic pressure across intercellular pores, facilitating β2m transport without significant sodium sieving.
- The duration of CAPD treatment inversely correlated with the total ultrafiltration coefficient, primarily due to reduced transcellular pore function in long-term patients.