Abstract: FR-PO492
Peritoneal Transport of Small and Large Solutes During Long Dwells With Icodextrin
Session Information
- Peritoneal Dialysis: Current Topics
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Lindholm, Bengt, Karolinska Institutet, Stockholm, Stockholm, Sweden
- Stachowska-Pietka, Joanna, Instytut Biocybernetyki i Inzynierii Biomedycznej im Macieja Nalecza Polskiej Akademii Nauk, Warszaw, Poland
- Waniewski, Jacek, Instytut Biocybernetyki i Inzynierii Biomedycznej im Macieja Nalecza Polskiej Akademii Nauk, Warszaw, Poland
- Olszowska, Anna, Wojskowy Instytut Mediczny, Warszawa, Poland
- Garcia-lopez, Elvia, Karolinska Institutet, Stockholm, Stockholm, Sweden
- Wankowicz, Zofia, Instytut Biocybernetyki i Inzynierii Biomedycznej im Macieja Nalecza Polskiej Akademii Nauk, Warszaw, Poland
Background
Whereas icodextrin maintains effective ultrafiltration during long exchanges, data on solute removal and kinetics in long dwells with icodextrin are more scarce. We investigated impact of dwell duration up to 16h on the removal of small and large solutes.
Methods
Twenty patients underwent 16-h dwell with icodextrin. I-albumin was used as volume marker and frequent dialysate plasma samples were taken during the dwell. Clearances were evaluated at 4, 8, and 16-h of dwell for glucose, urea, creatinine, sodium, potassium, b2-microglobuline, total proteins, albumin, and IgG as the mass removed divided by the solute average plasma concentration and dwell duration.
Results
Ultrafiltration was increasing during the whole dwell to 0.7±0.3L after 16h. Lower small solutes clearances were found after 4h for glucose (on average from 5.7±1.2 at 4h to 3.0±0.7 at 16h), urea (5.2±0.9 to 3.0±0.5), creatinine (4.8±1.0 to 2.9±0.5), and potassium (4.6±0.9 to 2.5±0.5) mL/min and decreased only between 4 and 8h for sodium (1.2±0.8 to 0.8±0.4) mL/min with p<0.001. Moreover, although small solute concentrations in dialysate increases, they were not fully equilibrated with plasma (D/P being lower than 1 after 16h in case of urea, creatinine, potassium and sodium, p<0.001). Increase of urea and creatinine plasma concentration (by 6 and 4%, respectively) at 16 vs. 4h was found (p<0.001). In case of larger molecules, a decrease from 4 to 8h was found for b2-microglobuline (1.5±0.5 to 1.2±0.4) mL/min, total proteins (85.9±29.9 to 70.1±25.0), albumin (90.4±34.6 to 75.8±29.1), and IgG (74.1±28.0 to 60.5±23.5) µL/min with p<0.001, whereas after 8h it was significant only in case of IgG and total proteins with p<0.05, reaching at 16h 56.0±19.6 and 61.4±18.4 µL/min, respectively.
Conclusion
The rate coefficient (clearance) of small and large solute removal slows down with dwell time but is still maintained at 16-h dwell with icodextrin, especially for small solutes that are not fully equilibrated at the end of the dwell.
Funding
- Government Support – Non-U.S.