Adverse effect of peritonitis on peritoneal membrane function in children on dialysis

The effect of peritonitis on peritoneal membrane solute transport character istics was determined as part of a multicenter study in children on continu ous ambulatory/cycling peritoneal dialysis. Ninety-three children each unde rwent a 4-h peritoneal equilibration test (PET) with 1,100 ml/m(2) 2.5% Dia neal for determination of mass transfer area coefficients (MTAC), dialysate to plasma ratios (DIP) for creatinine and urea at 0, 30, 60, 120, 180, and 240 min and dialysate glucose levels at 0, 30, 60, 120, 180, and 240 min f or calculation of D/Do. The mean age of the study cohort was 10.1+/-5.6 yea rs (range 0.1-19 years). There were 162 historical episodes of peritonitis; at the time of the PET tests, 36 children had never had an episode of peri tonitis (group I) while 57 children had a history of one or more episodes o f peritonitis (group II). In group II children, the 4-h glucose D/Do was si gnificantly lower and the 4-h D/P creatinine ratio, the creatinine MTAC, an d the glucose MTAC were significantly higher (each P<0.05) than in group I. In children with a history of peritonitis caused by Gramnegative organisms , the 4-h glucose D/Do (P<0.05) and the creatinine MTAC (P<0.05) were signi ficantly lower and the glucose MTAC (P=0.07) nearly significantly lower tha n in children without a history of peritonitis. Linear regression analysis did not demonstrate a correlation between any of the variables and duration of peritoneal dialysis, while the rate of peritonitis was weakly correlate d with glucose MTAC (r=0.34, P<0.05) and with 4-h glucose D/Do (r=-0.222, P <0.01). We conclude that children with a history of peritonitis have perito neal membranes that are more permeable to glucose and creatinine than child ren without a history of peritonitis, and that the peritoneal membranes of children who have had peritonitis caused by Gram-negative organisms are als o more permeable to creatinine and glucose. Such changes are likely to have an adverse effect on membrane function and could eventually contribute to ultrafiltration failure.