Division of Nephrology, Department of Medicine, Amsterdam University Medical Center, The Netherlands.
Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands.
Perit Dial Int. 2022 Jul;42(4):335-343. doi: 10.1177/08968608221075102. Epub 2022 Feb 1.
Transport of serum proteins from the circulation to peritoneal dialysate in peritoneal dialysis patients mainly focused on total protein. Individual proteins have hardly been studied. We determined serum and effluent concentrations of four individual proteins with a wide molecular weight range routinely in the standardised peritoneal permeability analysis performed yearly in all participating patients. These include β-microglobulin, albumin, immunoglobulin G and α-macroglobulin. The dependency of transport of these proteins on their molecular weight and diffusion coefficient led to the development of the peritoneal protein restriction coefficient (PPRC), which is the slope of the relation between the peritoneal clearances of these proteins and their free diffusion coefficients in water, when plotted on a double logarithmic scale. The higher the PPRC, the more size restriction to transport. In this review, we discuss the results obtained on the PPRC under various conditions, such as effects of various osmotic agents, vasoactive drugs, peritonitis and the hydrostatic pressure gradient. Long-term follow-up of patients shows an increase of the PPRC, the possible causes of which are discussed. Venous vasculopathy of the peritoneal microcirculation is the most likely explanation.
在腹膜透析患者中，血清蛋白从循环系统向腹膜透析液中的转运主要集中在总蛋白上。个别蛋白几乎没有被研究过。我们在每年对所有参与患者进行的标准化腹膜通透性分析中，常规测定了四种具有广泛分子量范围的个体蛋白的血清和流出液浓度。这些包括β-微球蛋白、白蛋白、免疫球蛋白 G 和α-巨球蛋白。这些蛋白质的转运对其分子量和扩散系数的依赖性导致了腹膜蛋白限制系数（PPRC）的发展，即当这些蛋白质在腹膜中的清除率与其在水中的自由扩散系数在双对数标度上作图时，该系数是它们之间关系的斜率。PPRC 越高，对转运的尺寸限制越大。在这篇综述中，我们讨论了在各种条件下获得的 PPRC 结果，例如各种渗透剂、血管活性药物、腹膜炎和静水压力梯度的影响。对患者的长期随访显示 PPRC 增加，我们讨论了其可能的原因。腹膜微循环的静脉血管病变是最有可能的解释。
