Maher J F, Bennett R R, Hirszel P, Chakrabarti E
Kidney Int. 1985 Jul;28(1):16-20. doi: 10.1038/ki.1985.112.
The mechanism whereby hypertonic dextrose affects peritoneal transport was investigated in a short-term model of peritoneal dialysis using alert intact rabbits. During control (1.5% dextrose) dialyses osmotic ultrafiltration was 0.28 mg/kg/min, the clearance of potassium was 0.98, urea 0.54, phosphate 0.32, and dextrose (reverse) 0.21 ml/kg/min. With 4.25% dextrose, the ultrafiltration rate increased to 0.73 ml/kg/min (P less than 0.02), but solute transport did not increase despite the added convective flux. The posthypertonic exchanges did not differ from control despite the effect of residual dialysate contaminating this peritoneal lavage. By indicator dilution residual volume averaged 12% of total dialysate volume. Acute volume expansion by intravenous dextrose after desoxycorticosterone acetate (DOCA) pretreatment increased the ultrafiltration coefficient, potassium and urea clearances significantly, and DOCA alone was ineffective. It is suggested that in uremic humans hypertonic dextrose dialysis increases peritoneal mass transport rates because the absorbed dextrose causes extracellular volume expansion that cannot be eliminated promptly. No evidence of a direct effect of dextrose augmenting peritoneal permeability was detected.
在清醒的完整家兔短期腹膜透析模型中，研究了高渗葡萄糖影响腹膜转运的机制。在对照（1.5%葡萄糖）透析期间，渗透超滤率为0.28mg/kg/min，钾清除率为0.98，尿素为0.54，磷酸盐为0.32，葡萄糖（反向）为0.21ml/kg/min。使用4.25%葡萄糖时，超滤率增加至0.73ml/kg/min（P<0.02），但尽管对流通量增加，溶质转运并未增加。尽管残留透析液污染了此次腹膜灌洗，但高渗后交换与对照无差异。通过指示剂稀释法测得残留体积平均占总透析液体积的12%。在醋酸脱氧皮质酮（DOCA）预处理后静脉注射葡萄糖引起的急性容量扩张显著增加了超滤系数、钾和尿素清除率，单独使用DOCA则无效。提示在尿毒症患者中，高渗葡萄糖透析增加了腹膜物质转运率，因为吸收的葡萄糖导致细胞外液容量扩张且不能迅速消除。未检测到葡萄糖对增加腹膜通透性有直接作用的证据。
