In order to measure in situ the kinetics of peritoneal ultrafiltration in peritoneal dialysis (PD) with long dialysate dwell, a colorimetric method using autologous hemoglobin as a marker added to the dialysis fluid was evaluated in 10 patients on PD for periods ranging from 2 weeks to 20 months. Four different dialysate formulae were successively tested in the same patient. The results expressed as normalised ultrafiltration coefficient (UFK, ml/min/1.73 m2 s.a.) showed a wide scatter among the patients. However, the dilution curves successively obtained with dialysis fluids of varying osmolar concentration in the same patient were very consistent with each other, indicating that UFK was a characteristic of the individual peritoneal membrane. The data presented suggest that UFK should be measured in each patient at initiation of PD in order to prescribe the dialysate formulae and the diffusion times fitting best his individual needs. On the other hand, repetitive measurements of UFK in the same subject would allow a useful analysis of the hydraulic permeability of the peritoneum by detecting any significant change in this parameter during long term PD.
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Kidney Med
January 2025
Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT.
Rationale & Objective: Peritoneal dialysis (PD) solutions provide both clearance of uremic toxins and sodium and water. An intraperitoneal (IP) solution of icodextrin and glucose designed without the requirement for uremic toxin clearance could provide substantially greater sodium and water removal than PD solutions.
Study Design: We examined varying concentrations of icodextrin and dextrose IP solutions in rats.
Front Immunol
January 2025
Department of Nephrology, Second Hospital of Jilin University, Changchun, China.
Long-term exposure of the peritoneum to peritoneal dialysate results in pathophysiological changes in the anatomical organization of the peritoneum and progressive development of peritoneal fibrosis. This leads to a decline in peritoneal function and ultrafiltration failure, ultimately necessitating the discontinuation of peritoneal dialysis, severely limiting the potential for long-term maintenance. Additionally, encapsulating peritoneal sclerosis, a serious consequence of peritoneal fibrosis, resulting in patients discontinuing PD and significant mortality.
View Article and Find Full Text PDFMar Drugs
November 2024
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
Peritoneal dialysis (PD) serves as a home-based kidney replacement therapy with increasing utilization across the globe. However, long-term use of high-glucose-based PD solution incites repeated peritoneal injury and inevitable peritoneal fibrosis, thus compromising treatment efficacy and resulting in ultrafiltration failure eventually. In the present study, we utilized human mesothelial MeT-5A cells for the in vitro experiments and a PD mouse model for in vivo validation to study the pathophysiological mechanisms underneath PD-associated peritoneal fibrosis.
View Article and Find Full Text PDFPediatr Nephrol
December 2024
Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China.
For patients undergoing long-term peritoneal dialysis (PD), exposure to biologically incompatible PD solutions and the consequent peritoneal structure change can lead to progressive angiogenesis and fibrosis, and ultimately result in ultrafiltration failure (UFF). Peritoneal transport studies in aquaporin 1 (AQP1) knockout mice indicate that water transport across the peritoneum is mediated by AQP1, which accounts for up to 50% of ultrafiltration. Another recent study on a large cohort of PD patients with kidney failure further substantiated the impact of AQP1 genotype variation on water channel expression in the peritoneal membrane, influencing water transport, ultrafiltration, and patient prognosis.
View Article and Find Full Text PDFiScience
December 2024
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong, China.
The microenvironmental changes in peritoneal dialysis effluent (PDE) after long-term vintage (LV) of PD in patients with ultrafiltration failure (LV_UF) are unclear. Single-cell sequencing revealed that peritoneal neutrophils were elevated in LV_UF patients, while MRC1-macrophage subcluster decreased compared with PD patients with short vintage (SV) and LV without ultrafiltration failure (LV_NOT_UF). Compared with the LV_NOT_UF group, the upregulated differentially expressed genes (DEGs) of monocytes/macrophages in the LV_UF group were involved in inflammatory response and EMT progress.
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