Small and middle molecular weight solute clearance in nocturnal intermittent peritoneal dialysis

Donald F. Brophy, Kevin M. Sowinski, Michael A. Kraus, Sharon M. Moe, James E. Klaunig, Bruce A. Mueller

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Objectives: To determine the dialysate-to-plasma (D/P) concentration ratios and peritoneal dialytic clearance (CI(D)) of substances with a wide range of molecular weights in subjects receiving a simulated nocturnal intermittent peritoneal dialysis (NIPD) session. Design: Open-label single-dose study. Subjects: Six end-stage renal disease patients undergoing peritoneal dialysis (PD). Setting: Clinical research center of a university-affiliated hospital. Interventions: Subjects received intravenous gentamicin and vancomycin on the first day of the study. Subjects received no PD until their return on the following day, when subjects underwent a simulated NIPD session utilizing four 2- to 2.5-L peritoneal dialysate dwells of 2 hours. Blood and dialysate samples were collected immediately before the session and after each dialysate dwell for determination of urea, creatinine, gentamicin, vancomycin, and β2-microglobulin (β2M) concentrations. Each solute's D/P concentration ratio and peritoneal CI(D) were calculated. Measurements and Main Results: The (mean ± SD) 2-hour D/P concentration ratios were 0.78 ± 0.05 (urea), 0.49 ± 0.11 (creatinine), 0.38 ± 0.08 (gentamicin), 0.11 ± 0.06 (vancomycin), and 0.07 ± 0.03 (β2M). Peritoneal CI(D) values (mL/min of dialysis) were 19.0 ± 2.8 (urea), 12.1 ± 3.5 (creatinine), 8.4 ± 2.8 (gentamicin), 2.7 ± 1.5 (vancomycin), and 1.7 ± 0.8 (β2M). The D/P concentration ratios and peritoneal CI(D) values for urea, creatinine, and gentamicin were significantly different from vancomycin and β2M (repeated measures ANOVA, p < 0.05). β2-Microglobulin peritoneal CI(D) was strongly related to gentamicin peritoneal CI(D) (r = 0.96, p < 0.05). Conclusion: Small molecular weight solutes have significantly greater D/P and peritoneal CI(D), than middle molecular weight solutes in NIPD. In NIPD, daily peritoneal CI(D), of β2M is lower than that reported in continuous ambulatory PD. NIPD also results in lower drug CI(D), than that reported in continuous ambulatory PD studies.

Original languageEnglish (US)
Pages (from-to)534-539
Number of pages6
JournalPeritoneal Dialysis International
Volume19
Issue number6
DOIs
StatePublished - 1999

Keywords

  • β2-microglobulin
  • Creatinine
  • Dialytic clearance
  • Gentamicin
  • Middle molecule
  • NIPD
  • Urea
  • Vancomycin

ASJC Scopus subject areas

  • Nephrology

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