Functional Deterioration of the Peritoneum: Does It Occur in the Absence of Peritonitis?

Peritoneal function in relation to the occurrence of peritonitisand the osmolarity of the dialysate was studied in 72 CAPD patientswith a mean duration of treatment of 16.5±9.0 months(group 1). Data from 24 of these patients, who were on CAPDfor longer than 2 years (average 28.6±4.9), were subjectedto further detailed analysis (group 2). Each group consistedof two subgroups, one of patients who had experienced peritonitisand one of patients who had had no episodes of peritonitis. Results from group 1 revealed that the use of hyperosmolar bagsincreased in parallel with the duration of CAPD treatment evenin the non-peritonitis subgroup, and that peritonitis enhancedthe tendency to use hyper osmolar dialysate solutions. Thisphenomenon was also observed in the peritonitis subgroup ofgroup 2, but was not apparent in the non-peritonitis subgroupof group 2 when examined as a whole: however, individual analysisrevealed that some of them had a similar tendency to use hyperosmolardialysate, as was seen in the peritonitis subgroup. These results comfirm that the peritonitis impairs the ultrafiltrationcapability of the peritoneum. The results also suggest thatthe long-term use of hyperosmolar dialysate may be associatedwith decreased ultrafiltration, hence emphasis should be placedupon the use of hyposmolar dialysate solutions for long-termCAPD.