Day-to-day variability of fluid and solute transport in upright and recumbent positions during CAPD.

Abstract

The effect of posture on peritoneal transport characteristics during CAPD is unpredictable because (1) although the capillary pressure is higher in the upright position, the intraperitoneal pressure is also elevated, and (2) the contact of dialysate with the subdiaphragmatic lymphatics is probably more extensive during recumbency. In eight CAPD patients, six peritoneal permeability tests (4 h, glucose 2.27%, dextran 70 as volume marker) were performed within 2 weeks, while the body posture was either recumbent (3 tests) or upright (3 tests). In addition, intraperitoneal pressure measurements were done in the recumbent and upright positions. The intraperitoneal pressure, not corrected for the contribution of the hydrostatic column, was higher in upright position (12.6 +/- 0.8 mmHg, mean +/- SEM) than during recumbency (6.7 +/- 0.8; P < 0.0005). Net ultrafiltration rate was lower when upright: 0.96 +/- 0.09 ml/min/1.73 m2, compared to 1.14 +/- 0.12 in the supine position (P < 0.05). This was achieved because the effective lymphatic absorption rate was marginally higher and the transcapillary ultrafiltration rate was slightly lower in the upright position. The mass transfer area coefficient of creatinine, representing effective peritoneal surface area, decreased from 10.7 +/- 1.3 ml/min/1.73 m2 (recumbent) to 9.9 +/- 1.4 (upright; P = 0.08). The clearances of five serum proteins decreased more the higher the molecular weight. As a consequence the restriction coefficient was 2.07 +/- 0.09 (recumbent) vs 2.23 +/- 0.08 (upright; P = 0.06). Hence the intrinsic permeability to macro-molecules was higher during recumbency. The intraperitoneal pressure was correlated with the net ultrafiltration rate (r = -0.71, P = 0.05) only during recumbency. In upright position relations were found between the effective lymphatic absorption rate and the mass transfer area coefficients of low molecular solutes. The coefficients of variation of fluid and solute parameters were not different between both positions. It is concluded that the decrease in net ultrafiltration rate in the upright position is only small and probably caused by counteracting effects of a higher intra-abdominal pressure and the effect of gravity. The upright position also led to only small decreases in solute transport parameters.