Waniewski J, Heimbürger O, Werynski A, Park M S, Lindholm B
Institute of Biocybernetics and Biomedical Engineering, Warsaw, Poland.
Artif Organs. 1995 Apr;19(4):295-306. doi: 10.1111/j.1525-1594.1995.tb02332.x.
To investigate possible effects of glucose concentration, dwell time, and peritoneal reabsorption on the combined diffusive and convective peritoneal solute transport, dialysate to plasma concentration ratios (D/P) and solute clearances were evaluated for 6-h peritoneal dwell studies with 1.36, 2.27, and 3.86% glucose solutions. The diffusive mass transport coefficient, KBD, and sieving coefficient, S, were estimated using the Babb-Randerson-Farrell model of peritoneal transport. Dialysate volumes over time and peritoneal reabsorption rates, KE, were assessed using radiolabeled iodinated serum albumin (RISA). The transport parameters were estimated with and without peritoneal reabsorption of solutes taken into account. To test the stability of the transport parameters throughout a single peritoneal dwell, KBD and S values were estimated for the initial 3-120 min, the final 120-360 min, and the entire 3-360 min dwell period for dialysis with 3.86% glucose solution. The transport parameters did not differ between the three dialysis fluids although clearances of small solutes were higher with the 3.86% solution. Values of KBD, but not S, were dependent on the correction for peritoneal reabsorption of solutes. Computer simulations showed that S could be estimated even with the 1.36% glucose solution. A significant change of the transport parameters, with increased values of KBD during the initial period of the dwell, was found for urea, potassium, sodium, and total protein during dialysis with the 3.86% solution. S values for urea and potassium were close to 1 during the initial period whereas unphysical (higher than 1) S values were found for the whole dwell period. The transient increase of KBD during the initial part of the dwell may reflect changes in the peritoneal barrier possibly induced by fresh dialysis fluid. In conclusion, the transport parameters KBD and S are not influenced by the concentration of glucose in the dialysis fluid. Moreover, the estimation of KBD but not of S is dependent on the assumed rate of peritoneal reabsorption. Finally, the current results challenge the assumption that KBD and S are constant throughout a peritoneal dialysis exchange.
为研究葡萄糖浓度、驻留时间和腹膜重吸收对腹膜溶质扩散和对流联合转运的可能影响，对使用1.36%、2.27%和3.86%葡萄糖溶液进行的6小时腹膜驻留研究的透析液与血浆浓度比（D/P）和溶质清除率进行了评估。使用腹膜转运的Babb-Randerson-Farrell模型估算扩散质量传输系数KBD和筛分系数S。使用放射性标记的碘化血清白蛋白（RISA）评估随时间变化的透析液体积和腹膜重吸收率KE。在考虑和不考虑溶质腹膜重吸收的情况下估算转运参数。为测试整个单次腹膜驻留期间转运参数的稳定性，对使用3.86%葡萄糖溶液进行透析的初始3 - 120分钟、最后120 - 360分钟以及整个3 - 360分钟驻留期估算KBD和S值。尽管3.86%溶液中小溶质的清除率较高，但三种透析液之间的转运参数并无差异。KBD值而非S值取决于溶质腹膜重吸收的校正。计算机模拟表明，即使使用1.36%葡萄糖溶液也可估算S。在使用3.86%溶液进行透析期间，发现尿素、钾、钠和总蛋白的转运参数有显著变化，驻留初期KBD值增加。尿素和钾的S值在初期接近1，而在整个驻留期发现不符合实际（高于1）的S值。驻留初期KBD的短暂增加可能反映了新鲜透析液可能引起的腹膜屏障变化。总之，转运参数KBD和S不受透析液中葡萄糖浓度的影响。此外，KBD而非S的估算取决于假定的腹膜重吸收率。最后，当前结果对KBD和S在整个腹膜透析交换过程中保持恒定这一假设提出了挑战。
