Clinical Investigation

Kidney International (1990) 37, 971–979; doi:10.1038/ki.1990.73

Kinetics of peritoneal protein loss during CAPD: I. Different characteristics for low and high molecular weight proteins

Alexander Kagan1, Yaacov Bar-Khayim1, Zehava Schafer1 and Menahem Fainaru1

1Lipid Research Laboratory, Department of Medicine 'A', and Division of Nephrology, Kaplan Hospital, Rehovot, Israel

Correspondence: M Fainaru MD, Beilinson Medical Center, Petah-Tiqva, 49100 Israel.

Received 7 March 1989; Revised 22 July 1989; Accepted 22 September 1989.

Top

Abstract

Kinetics of peritoneal protein loss during CAPD: I. Different characteristics for low and high molecular weight proteins. We studied the peritoneal protein loss in 13 patients during CAPD using 2 liters of 1.5% dextrose dialysis solutions. We compared the kinetic characteristics of the peritoneal mass transfer and clearance of proteins over a wide range of molecular size, to those of small molecular weight solutes. The peritoneal clearance of all studied proteins and solutes correlated strongly and negatively with their molecular mass. No changes were observed in these clearances during 58 months of dialysis. Unlike the peritoneal mass transfer and clearance of small molecular weight solutes (< 200) which revealed a remarkable progressive drop after the first hour of an eight-hour dialysis cycle, the mass transfer and clearance of proteins of large molecular weight (> 68,000) was continuous throughout the eight hours. The clearance of proteins of small molecular weight (< 15,000) showed similar kinetics to small solutes (< 200). These results indicate that long dwell times (6 or 8 hr) of peritoneal dialysis are detrimental for the loss of large molecular weight proteins (such as albumin and immunoglobulins) in view of the negligible dialysance of both small solutes (creatinine and potassium) and "intermediate molecules" (represented by the small molecular weight proteins) during the latter hours of long dwell cycles. Thus we suggest that substituting CAPD (3 times 8 hr or 4 times 6 hr) with CCPD (6 times 1 hr) may limit protein loss in these patients.

Top

References

  1. Popovich RP, Moncrief JW, Decherd JB, Bomar JB, Pyle WK: The definition of a novel portable/wearable equilibrium peritoneal dialysis technique (abstract). Am Soc Artif Intern Organs 5:64, 1976
  2. Nolph KD, Boen FST, Farrell PC, Pyle KW: Continuous ambulatory peritoneal dialysis in Australia, Europe and United States: 1981. Kidney Int 23:3–8, 1983
  3. Mailloux LU, Bellucci AG, Mossey RT, Napolitano B, Moore T, Wilkes BM, Bluestone PA: Predictors of survival in patients undergoing dialysis. Am J Med 84:855–862, 1988 | Article | PubMed | ISI | ChemPort |
  4. Dulaney JT, Hatch FE Jr: Peritoneal dialysis and loss of proteins: A review. Kidney Int 26:253–262, 1984 | PubMed | ISI | ChemPort |
  5. Young GA, Young JB, Young SM, Hobson SM, Hildreth B, Brownjohn AM, Parsons FM: Nutrition and delayed hypersensitivity during continuous ambulatory peritoneal dialysis in relation to peritonitis. Nephron 43:177–186, 1986 | PubMed | ISI | ChemPort |
  6. Lowry OH, Rosebrough NJ, Farr AL, Randall RJ: Protein measurement with the folin phenol reagent. J Biol Chem 193:265–275, 1951 | PubMed | ISI | ChemPort |
  7. Blanchard GC, Gardner R: Two nephelometric methods compared with a radial immunodiffusion method for the measurement of IgG, IgA and IgM. Clin Biochem 13:84–91, 1980
  8. Resnitzky P, Danon D: A method for automatic recording of serum lysozyme activity with the fragiligraph. Experientia 32:257–258, 1976
  9. Zar JH: Biostatistical Analysis. Englewood Cliff, New Jersey, Prentice Hall, Inc., 1974
  10. Farrell PC: Peritoneal mass transfer. Perit Dial Bull 2:107–109, 1982
  11. Selgas R, Rodriguez-Carmona A, Martinez ME, Perez-Fontan M, Salinas M, Escuin F, Rinon C, Martinez-Ara J, Sanchez-Sicilia L: Peritoneal mass transfer in patients on long-term CAPD. Perit Dial Bull 4:153–156, 1984
  12. Krediet RT, Berkinshaw K, Boeschoten EW, Arisz L: Clinical aspects of peritoneal permeability. Neth J Med 28:424–434, 1985
  13. Krediet RT, Boeschoten EW, Zuyderhoudt FMJ, Arisz L: Peritoneal transport characteristics of water, low-molecular weight solutes and proteins during long-term continuous ambulatory peritoneal dialysis. Perit Dial Bull 6:61–65, 1986 | ISI |
  14. Blumenkrantz MJ, Gahl GM, Kopple JD, Kamdar AV, Jones MR, Kessel M, Coburn JW: Protein losses during peritoneal dialysis. Kidney Int 19:593–602, 1986
  15. Mancici G, Carbonara AO, Heremans JF: Immunochemical quantitation of antigens by single radial immunodiffusion. Int J Immunochem 2:235–254, 1965
  16. Miller FN, Nolph KD, Harris PD, Rubin J, Wiegman DL, Joshua IG, Twardowski ZJ, Ghods AJ: Microvascular and clinical effects of altered peritoneal dialysis solutions. Kidney Int 15:630–639, 1979
  17. Rubin J, Nolph KD, Arfania D, Brown P, Prowant B: Follow-up of peritoneal clearances in patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 16:619–623, 1979
  18. Diaz-Buxo JA, Chandler JT, Farmer CD, Walker PJ, Holt KL, Orr SL: Long-term observations of peritoneal clearances in patients undergoing peritoneal dialysis. (abstract) Kidney Int 21:166, 1982
  19. Kruska J: Activity of certain enzymes in blood plasma and dialyzing fluid in patients with renal failure treated with peritoneal dialysis. Pol Med J 9:46–50, 1970
  20. Lasrich M, Maher JM, Hirszel P, Maher JF: Correlation of peritoneal transport rate with molecular weight: A method for predicting clearances. Am Soc Artif Intern Organs J 2:107–113, 1979
  21. Giangrande A, Limido A, Cantu P, Allaria P: SDS-Polyacrylamide electrophoresis of protein loss during continuous ambulatory peritoneal dialysis. Rio Clin Lab 10:117–120, 1980
  22. Boesken WH, Schuppe HC, Seidler A, Schollmeyer P: Peritoneal membrane permeability for high and low molecular weight proteins under CAPD. (abstract) Perit Dial Bull 4:S7, 1984
  23. Steinhauer HB, Schollmeyer P: Prostaglandin-mediated loss of proteins during peritonitis in continuous ambulatory peritoneal dialysis. Kidney Int 29:584–590, 1986 | PubMed | ISI | ChemPort |
  24. Krediet RT, Zuyderhoudt FMJ, Boeschoten EW, Arisz L: Peritoneal permeability to proteins in diabetic and nondiabetic continuous ambulatory peritoneal dialysis patients. Nephron 42:133–140, 1986 | PubMed | ISI | ChemPort |
  25. Young GA, Brownjohn AM, Parsons FM: Protein losses in patients receiving continuous ambulatory peritoneal dialysis. Nephron 45:196–201, 1987 | PubMed | ISI | ChemPort |
  26. Krediet RT, Koomen GCM, Koopman MG, Hoek FJ, Struijk DG, Boeschoten EW, Arisz L: The peritoneal transport of serum proteins and neutral dextran in CAPD patients. Kidney Int 35:1064–1072, 1989 | PubMed |
  27. Nolph KD, Popovich RP, Ghods AJ, Twardowski Z: Determinants of low clearances of small solutes during peritoneal dialysis. Kidney Int 13:117–123, 1978 | PubMed | ChemPort |
  28. Nolph KD, Twardowski ZJ, Popovich RP, Rubin J: Equilibration of peritoneal dialysis solutions during long-dwell exchanges. J Lab Clin Med 93:246–256, 1979
  29. Rubin J, Adair C, Barnes T, Bower J: Dialysate flow rate and peritoneal clearance. Am J Kidney Dis 4:260–267, 1984
  30. Miller FN, Nolph KD, Sorkin MI, Gloor HJ: The influence of solution composition on protein loss during peritoneal dialysis. Kidney Int 23:35–39, 1983
  31. Nolph KD: Anatomic and physiologic aspects of peritoneal dialysis, in Nephrology (Proc of the IXth Int Congress of Nephrol) edited by Robinson RR, New York, Springer-Verlag, 1984, Vol 2, pp 1561–1580
  32. Miller FN, Nolph KD, Harris PD, Rubin J, Wiegman DL, Joshua IG, Twardowski ZJ, Ghods AJ: Microvascular and clinical effects of altered peritoneal dialysis solutions. Kidney Int 15:630–639, 1979
  33. Wayland H: Action of histamine on the mocrovasculature, in Proceedings of the 1st International Symposium on CAPD, edited by Legrain M, Amsterdam, Excerpta Medica, 1980, pp. 18–27
  34. Kaysen GA, Schoenfeld PY: Albumin homeostasis in patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 25:107–114, 1984 | PubMed | ISI | ChemPort |
  35. Twardowski ZJ, Janicka L, Tarkowska A, Jankowska H: Kinetics of albumin transport in intermittant peritoneal dialysis (IPD) and continuous ambulatory peritoneal dialysis (CAPD). (abstract) Kidney Int 26:604, 1984
  36. Mactier RA, Khanna R, Twardowski Z, Moore H, Nolph KD: Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis. J Clin Invest 80:1311–1316, 1987 | PubMed | ISI | ChemPort |
  37. Strauch M, Walser P, Henning GE, Roettger G, Christ H: Factors influencing protein loss during peritoneal dialysis. (abstract) Trans Am Soc Artif Intern Organs 13:172, 1967
  38. Robson M, Oreopoulos DG, Izaat S, Ogilvie R, Rapoport A, de Veber GA: Influence of exchange volume and dialysate flow rate on solute clearance in peritoneal dialysis. Kidney Int 14:486–490, 1978
  39. Sandoz P, Walls J: Protein losses in continuous ambulatory and continuous cyclic peritoneal dialysis (CAPD and CCPD). Perit Dial Bull 4:109–110, 1984
  40. Reetze P, Weber MH, Echterhoff HH, Scheler F: Analysis of protein profiles in dialysate, plasma and urine from CAPD patients, in Abstracts of the 10th International Congress of Nephrology, London, edited by Davison AM, Oxford, The Alden Press, 1987, p. 203
  41. Kopple JD, Blumenkrantz M: Nutritional requirements for patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 24(suppl 16): S295–S302, 1983
  42. Schilling H, Wu G, Pettit J, Harrison J, McNeill K, Siccion Z, Oreopoulos DG: Nutritional status of patients on long-term CAPD. Perit Dial Bull 5:12–18, 1985 | ISI |
  43. Sombolos K, Berkelhammer C, Baker J, Wu G, McNamee P, Oreopoulos DG: Nutritional assessment and skeletal muscle function in patients on continuous ambulatory peritoneal dialysis. Perit Dial Bull 6:53–58, 1986
  44. Nolph KD, Sorkin M, Rubin J, Arfania D, Prowant B, Fruto L, Kennedy D: Continuous ambulatory peritoneal dialysis: Three-year experience at one center. Ann Intern Med 92:609–613, 1980 | PubMed | ISI | ChemPort |
  45. Chan MK, Baillod RA, Varghese Z, Sweeny P, Moorhead JF: Immunoglobulins and complement components (C3, C4) in CAPD and hemodialysis patients. Dialysis Transplant 12:777–778, 1983
  46. Lindholm B, Alvestrand A, Fürst P, Tranaeus A, Bergstrom J: Efficacy and clinical experience of CAPD-Stockholm, Sweden, in: Peritoneal Dialysis, edited by Atkins RC, Thomson NM, Farrell PC, New York, Churchill Livingstone, 1981, p. 147
  47. Rubin J, Walsh D, Bower JD: Diabetes, dialysate losses and serum lipids during continuous ambulatory peritoneal dialysis. Am J Kidney Dis 10:104–108, 1987
  48. Blagg CR: Adequacy of dialysis. Am J Kidney Dis 4:218–223, 1984

Extra navigation

.
ADVERTISEMENT