Should sodium removal in peritoneal dialysis be estimated from the ultrafiltration volume?

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• 作者：Michel Fischbach ; Ariane Zaloszyc ; Betti Schaefer…
• 关键词：Free water ; Coupled water ; Aquaporin ; Small pore ; Ultrafiltration ; Sodium
• 刊名：Pediatric Nephrology
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：32
• 期：3
• 页码：419-424
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Pediatrics; Nephrology; Urology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1432-198X
• 卷排序：32

文摘

In peritoneal dialysis (PD), ultrafiltration (UF) volume is the sum of solute-free- and solute-coupled-water removal, a dynamic process throughout the entire dwell exerted via aquaporin-1 (AQP1) and small pores, respectively. Determination of sodium sieving is used as a parameter for AQP1 function analysis, while coupled water removal is essential for adequate sodium and water balance and thus blood pressure control. The diffusive capacity of glucose via the small pores determines the dynamic crystalloid osmotic gradient. The osmotic conductance, i.e., milliliter of UF per gram of glucose absorbed, quantifies cooperation between small-pores and AQP1 channels. In continuous ambulatory peritoneal dialysis, with dwell times beyond glucose-induced sodium-sieving effects, approximate dialytic sodium removal (DSR) may be estimated from the UF volume (in average 100 mmol Na/L UF), while DSR is lower, with shorter cycle times, in automated PD (APD); therefore, effluent sodium concentrations should be measured. Applying dialysis mechanics, i.e., varying dwell time and dwell volume—as proposed in adapted APD to the PD prescription—may provide unmatched high DSR relative to UF volume, findings which are not sufficiently explained by the three-pore model of PD. Overall DSR should therefore be measured rather than estimated from UF volume.