Korean Journal of Nephrology 2000;19(4):681-686.

복막 투석 환자에서 복막염 시 한외여과에 미치는 인자에 대한 분석 (An Analysis of the Factors which Influence UF during Peritonitis in PD Patients)

김영진(Young Jin Kim),정항재(Hang Jae Jung),조규향(Gyu Hyang Jo),박준범(Joon Bum Park),박종원(Jong Won Park),도준영(Joong Young Do),윤경우(Gyung Woo Yoon)

Abstract

Ultrafiltration failure is frequently observed during peritonitis in PD patients but the mechanism of UF failure is uncertain. To determine how important the aquaporin mediated water transport on ultrafiltration failure at the time of peritonitis is, we designed this study. PETs(peritoneal equilibration tests) were performed during peritonitis in 14 CAPD patients and dialysate-to-plasma ratios of sodium at 60 minutes with 3.86% glucose dialysate(D1/Pl Na) were measured. We compared the results of D4/P4 Cr, D4/DO glucose and UF volumes at the time of stable peritoneal function with the values of at the time of recovery from peritonitis. During the peritonitis, the value of D4/P4 Cr and Dl/Pl Na were significantly higher than before (mean 0.867 vs 0.65, p<0.001 and 0.897 vs 0.849, p= 0.002) but D4/DO glucose and ultrafiltration were significantly lower during peritonitis(mean 0.284 vs 0.381, p=0.008 and 150cc vs 310cc, p<0.001). After recovery from the peritonitis, the values of D4/P4 Cr were close to those of preperitonitis values(mean 0.740 vs 0.641, p=0.073). According to the linear regression analysis, UF volume change during peritonitis was significantly correlated with a change of Dl/Pl Na(coefficients=-0.630, p<0.05), but was not correlated with changes of D4/P4 Cr or D4/DO glucose. The levels of cytokines were significantly higher during peritonitis than preperitonitis period(TNF: mean 467 vs 10.34, p<0.05, IL-6: 236.8 vs 61.6, p<0.001, N=10). In conclusion, ultrafiltration failure during peritonitis seems to be associated with the impaired aqua-porin-mediated water transport mechanism rather than loss of osmotic gradients due to increased solute transport and glucose absorption. Peritoneal equalibrium test.