Increased peritoneal permeability is associated with decreased fluid and small-solute removal and higher mortality in CAPD patients

Background: Recent studies suggest that increasedperitoneal membrane permeability is associated with higher morbidity andmortality in peritoneal dialysis patients. It is not known, however,whether the difference in clinical outcome among different peritonealtransport groups is due to differences in peritoneal fluid and soluteremoval. In the present study, we compared the peritoneal fluid and solutetransport and clinical outcome in CAPD patients with high (H), high-average(H-A), low-average (L-A) and low (L) peritoneal transport patterns.Design: A 6-h study was performed in 46 patients withfrequent dialysate and plasma samples using 21 of 3.86% glucose dialysatewith ¹³¹I albumin as an intraperitoneal volumemarker. The patients were divided into four transport groups according totheir D/P of creatinine at 240 min. Results: Theresults showed that high transporters had significantly lower peritonealfluid and small-solute removal but high glucose absorption and high proteinloss during a 6-h exchange. The serum albumin was lower and blood pressureand triglycerides were higher in high transporters compared with the othergroups. Two-year patient survival from the start of CAPD treatment wassignificantly lower for high transporters (64, 85, 90 and 100% for H, H-A,L-A and L respectively, P<0.01). The 1-year patient survival fromthe dwell study was also significantly lower in high transporters (16, 63,90 and 100% for each group, P<0.01).Conclusion: Our results suggest that high transportersremove less fluid and small solutes and have higher protein loss andincreased glucose absorption. These alterations may contribute to fluidoverload, malnutrition and lipid abnormalities that perhaps contribute tothe increased mortality among the high transporters. Keywords: CAPD, adequacy, peritoneal transport, mortality