INCREASED PERITONEAL PERMEABILITY IS ASSOCIATED WITH DECREASED FLUID AND SMALL-SOLUTE REMOVAL AND HIGHER MORTALITY IN CAPD PATIENTS

Background. Recent studies suggest that increased peritoneal membrane permeability is associated with higher morbidity and mortality in peri toneal dialysis patients. It is not known, however, whether the differ ence in clinical outcome among different peritoneal transport groups i s due to differences in peritoneal fluid and solute removal. In the pr esent study, we compared the peritoneal fluid and solute transport and clinical outcome in CAPD patients with high (H), high-average (H-A), low-average (L-A) and low (L) peritoneal transport patterns. Design. A 6-h dwell study was performed in 46 patients with frequent dialysate and plasma samples using 21 of 3.86% glucose dialysate with I-131 albu min as an intraperitoneal volume marker. The patients were divided int o four transport groups according to their D/P of creatinine at 240 mi n. Results. The results showed that high transporters had significantl y lower peritoneal fluid and small-solute removal but high glucose abs orption and high protein loss during a 6-h exchange. The serum albumin was lower and blood pressure and triglycerides were higher in high tr ansporters compared with the other groups. Two-year patient survival f rom the start of CAPD treatment was significantly lower for high trans porters (64, 85, 90 and 100% for H, H-A, L-A and L respectively, P<0.0 1). The 1-year patient survival from the dwell study was also signific antly lower in high transporters (16, 63, 90 and 100% for each group, P<0.01). Conclusion. Our results suggest that high transporters remove less fluid and small solutes and have higher protein loss and increas ed glucose absorption. These alterations may contribute to fluid overl oad, malnutrition and lipid abnormalities that perhaps contribute to t he increased mortality among the high transporters.