This review focuses on the physiologic and clinical consequences of rapid solute transport in the peritoneum. The concept, the current understanding of related factors, and the possible causes implicated in rapid solute transport are discussed first. Then, the consequences, with particular emphasis on mortality, are highlighted. Finally, based on recent advances and clinical studies, some strategies for the treatment of fast peritoneal transport are reviewed.
Correa–RotterR., Cueto–ManzanoA.The problem of the high transporter: is survival decreased?Perit Dial Int2001; 21(Suppl 3): S75–9.
4.
DaviesS.J.Mitigating peritoneal membrane characteristics in modern peritoneal dialysis therapy.Kidney Int Suppl2006; (103): S76–83.
5.
Cueto–ManzanoA.M., Correa–RotterR.Is high peritoneal transport rate an independent risk factor for CAPD mortality?Kidney Int2000; 57: 314–20.
6.
DaviesS.J., BryanJ., PhillipsL., RussellG.I.Longitudinal changes in peritoneal kinetics: the effects of peritoneal dialysis and peritonitis.Nephrol Dial Transplant1996; 11: 498–506.
7.
Fernández–ReyesM.J.H., BajoM.A., HevíaC., del PesoG., RosS., García de MiguelA.Inherent high peritoneal transport and ultrafiltration deficiency: their mid-term clinical relevance.Nephrol Dial Transplant2007; 22: 218–23.
8.
ChungS.H., HeimbürgerO., LindholmB.Poor outcomes for fast transporters on PD: the rise and fall of a clinical concern.Semin Dial2008; 21: 7–10.
9.
ter WeeP.M., van IttersumF.J.The new peritoneal dialysis solutions: friends only, or foes in part?Nat Clin Pract Nephrol2007; 3: 604–12.
10.
WilliamsJ.D., CraigK.J., TopleyN., von RuhlandC., FallonM., NewmanG.R.Morphologic changes in the peritoneal membrane of patients with renal disease.J Am Soc Nephrol2002; 13: 470–9.
11.
NumataM., NakayamaM., NimuraS., KawakamiM., LindholmB., KawaguchiY.Association between an increased surface area of peritoneal microvessels and a high peritoneal solute transport rate.Perit Dial Int2003; 23: 116–22.
12.
Yáñez–MóM., Lara–PezziE., SelgasR., Ramírez–HuescaM., Domínguez–JiménezC., Jiménez–HeffernanJ.A.Peritoneal dialysis induces an epithelial–mesenchymal transition of mesothelial cells.N Engl J Med2003; 348: 403–13.
13.
del PesoG., Jiménez–HeffernanJ.A., BajoM.A., AroeiraL.S., AguileraA., Fernández–PerpénA.Epithelial-to-mesenchymal transition of mesothelial cells is an early event during peritoneal dialysis and is associated with high peritoneal transport.Kidney Int Suppl2008; (108): S26–33.
14.
AxelssonJ., DevuystO., NordforsL., HeimbürgerO., StenvinkelP., LindholmB.Place of genotyping and phenotyping in understanding and potentially modifying outcomes in peritoneal dialysis patients.Kidney Int Suppl2006; (103): S138–45.
15.
BrimbleK.S., WalkerM., MargettsP.J., KundhalK.K., RabbatC.G.Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis.J Am Soc Nephrol2006; 17: 2591–8.
16.
HolmesC., MujaisS.Glucose sparing in peritoneal dialysis: implications and metrics.Kidney Int Suppl2006; (103): S104–9.
17.
KoningsC.J., KoomanJ.P., SchonckM., StruijkD.G., GladziwaU., HoorntjeS.J.Fluid status in CAPD patients is related to peritoneal transport and residual renal function: evidence from a longitudinal study.Nephrol Dial Transplant2003; 18: 797–803.
18.
TonbulZ., AltintepeL., SözlüC., YeksanM., YildizA., TürkS.The association of peritoneal transport properties with 24-hour blood pressure levels in CAPD patients.Perit Dial Int2003; 23: 46–52.
19.
KaganA., Bar-KhayimY., SchaferZ., FainaruM.Kinetics of peritoneal protein loss during CAPD: II. Lipoprotein leakage and its impact on plasma lipid levels.Kidney Int1990; 37: 980–90.
20.
Cueto–ManzanoA.M., GambaG., Correa–RotterR.Quantification and characterization of protein loss in continuous ambulatory peritoneal dialysis.Rev Invest Clin2000; 52: 611–17.
21.
YangW.S., MinW.K., ParkJ.S., KimS.B.Effect of increasing serum albumin on serum lipoprotein(a) concentration in patients receiving CAPD.Am J Kidney Dis1997; 30: 507–13.
22.
HimmelfarbJ., McMonagleE.Albumin is the major plasma protein target of oxidant stress in uremia.Kidney Int2001; 60: 358–63.
23.
Cueto–ManzanoA.M., Quintana–PiñaE., Correa–RotterR.Long-term CAPD survival and analysis of mortality risk factors: 12-year experience of a single center.Perit Dial Int2001; 21: 148–53.
24.
Cueto–ManzanoA.M.Hypoalbuminemia in dialysis. Is it a marker for malnutrition or inflammation? [Spanish].Rev Invest Clin2001; 53: 152–8.
25.
Cueto–ManzanoA.M., EspinosaA., HernándezA., Correa–RotterR.Peritoneal transport kinetics correlate with serum albumin but not with the overall nutritional status in CAPD patients.Am J Kidney Dis1997; 30: 229–36.
26.
KangD.H., YoonK.I., ChoiK.B., LeeR., LeeH.Y., HanD.S.Relationship of peritoneal membrane transport characteristics to the nutritional status in CAPD patients.Nephrol Dial Transplant1999; 14: 1715–22.
TisdaleM.J.Biology of cachexia.J Natl Cancer Inst1999; 89: 1763–73.
29.
StenvinkelP., HeimbürgerO., LindholmB., KaysenG.A., BergströmJ.Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, inflammation, and atherosclerosis (MIA syndrome).Nephrol Dial Transplant2000; 15: 953–60.
30.
StenvinkelP., ChungS.H., HeimbürgerO., LindholmB.Malnutrition, inflammation, and atherosclerosis in peritoneal dialysis patients.Perit Dial Int2001; 21(Suppl 3): 26–9.
31.
Cueto–ManzanoA.M., SalazarM., Valera–GonzalezI., Rojas–CamposE., Martinez–RamirezH.R., Cortes–SanabriaL.Association between the peritoneal transport rate and systemic inflammation marker in continuous ambulatory peritoneal dialysis [Abstract].J Am Soc Nephrol2002; 13: 201A.
32.
Pecoits–FilhoR., AraújoM.R., LindholmB., StenvinkelP., AbensurH., RomãoJ.E.Jr.Plasma and dialysate IL-6 and VEGF concentrations are associated with high peritoneal solute transport rate.Nephrol Dial Transplant2002; 17: 1480–6.
33.
RodriguesA.S., AlmeidaM., FonsecaI., MartinsM., CarvalhoM.J., SilvaF.Peritoneal fast transport in incident peritoneal dialysis patients is not consistently associated with systemic inflammation.Nephrol Dial Transplant2002; 17: 1480–6.
34.
ChungS.H., HeimbürgerO., StenvinkelP., QureshiA.R., LindholmB.Association between residual renal function, inflammation and patient survival in new peritoneal dialysis patients.Nephrol Dial Transplant2003; 18: 590–7.
35.
RumpsfeldM., McDonaldS.P., JohnsonD.W.Higher peritoneal transport status is associated with higher mortality and technique failure in the Australian and New Zealand peritoneal dialysis patient populations.J Am Soc Nephrol2006; 17: 271–8.
36.
BrownE.A., DaviesS.J., RutherfordP., MeeusF., BorrasM., RiegelW.Survival of functionally anuric patients on automated peritoneal dialysis: the European APD Outcome Study.J Am Soc Nephrol2003; 14: 2948–57.
37.
Cueto–ManzanoA.M., Rojas–CamposE., Martínez–RamírezH.R., Valera–GonzálezI., MedinaM., MonteónF.Can the inflammation markers of patients with high peritoneal permeability on continuous ambulatory peritoneal dialysis be reduced on nocturnal intermittent peritoneal dialysis?Perit Dial Int2006; 26: 341–8.
38.
Araújo TeixeiraM.R., Pecoits–FilhoR.F., Romão JuniorJ.E., SabbagaE., MarcondesM.M., AbensurH.The relationship between ultrafiltrate volume with icodextrin and peritoneal transport pattern according to the peritoneal equilibration test.Perit Dial Int2002; 22: 229–33.
39.
DaviesS.J., WoodrowG., DonovanK., PlumJ., WilliamsP., JohanssonA.N.Icodextrin improves the fluid status of peritoneal dialysis patients: results of a double-blind randomized controlled trial.J Am Soc Nephrol2003; 14: 2338–44.
40.
FinkelsteinF., HealyH., Abu-AlfaA., AhmadS., BrownF., GehrT.Superiority of icodextrin compared with 4.25% dextrose for peritoneal ultrafiltration.J Am Soc Nephrol2005; 16: 546–54.
41.
KoningsC.J., KoomanJ.P., SchonckM., GladziwaU., WirtzJ., van den Wall BakeA.W.Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study.Kidney Int2003; 63: 1556–63.
42.
KoningsC.J., KoomanJ.P., GladziwaU., van der SandeF.M., LeunissenK.M.A decline in residual glomerular filtration during the use of icodextrin may be due to underhydration.Kidney Int2005; 67: 1190–1.
43.
United States, Food and Drug Administration (FDA), Center for Drug Evaluation and Research.Potential Signals of Serious Risks/New Safety Information Identified by the Adverse Event Reporting System (AERS), January – March 2008 [Web page]. Rockville, MD: FDA; 5 September 2008. [Available at: www.fda.gov/cder/aers/potential_signals/potential_signals_2008Q1.htm; accessed 15 June 2008]
44.
MoberlyJ.B., SorkinM., KucharskiA., OgleK., MongovenJ., SkoufosL.Effects of intraperitoneal hyaluronan on peritoneal fluid and solute transport in peritoneal dialysis patients.Perit Dial Int2003; 23: 63–73.
45.
Rojas–CamposE., Cortés–SanabriaL., Martínez–RamírezH.R., GonzálezL., Martín–del-CampoF., González–OrtizM.Effect of oral administration of losartan, prazosin, and verapamil on peritoneal solute transport in continuous ambulatory peritoneal dialysis patients.Perit Dial Int2005; 25: 576–82.
46.
KolesnykI., DekkerF.W., NoordzijM., le CessieS., StruijkD.G., KredietR.T.Impact of ACE inhibitors and AII receptor blockers on peritoneal membrane transport characteristics in long-term peritoneal dialysis patients.Perit Dial Int2007; 27: 446–53.
47.
SchaeferF., KlausG., MehlsO. and the Mid-European Pediatric Peritoneal Dialysis Study Group. Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis.J Am Soc Nephrol1999; 10: 1786–92.
48.
ZiólkowskaH., Panczyk–TomaszewskaM., DebinskiA., SawickiA., Roszkowska–BlaimM.Bone metabolism and peritoneal membrane transport in children on chronic peritoneal dialysis.Perit Dial Int2003; 23: 487–92.
49.
KangD.H., YoonK., LeeH.Y., HanD.S.Impact of peritoneal membrane transport characteristics on acid–base status in CAPD patients.Perit Dial Int1998; 18: 294–302.
