Fluid and Solute Transport using Different Sodium Concentrations in Peritoneal Dialysis Solutions

Abstract

Fluid and sodium balance is important for the success of long-term peritoneal dialysis. Convective transport is the major determinant for sodium removal during peritoneal dialysis using conventional dialysis solutions. However, recent studies showed that lower sodium concentration in dialysate could significantly increase sodium removal by increasing the diffusion gradient, thereby increasing diffusive transport. In the present study, we investigated the influence of the sodium concentration gradient on the diffusive transport coefficient, K(BD) for sodium. A 4-hour dwell study was done in Sprague-Dawley rats using 25 mL 5% glucose (NS), 5% glucose + 0.3% NaCl (LS), 5% glucose + 0.6% NaCl (MS), or 5% glucose + 0.9% NaCl (HS), with frequent dialysate and blood sampling. Radiolabeled human albumin (RISA) was added to the solution as an intraperitoneal volume marker. The peritoneal fluid and sodium transport characteristics were evaluated. Significant ultrafiltration (both net ultrafiltration and transcapillary ultrafiltration) was observed in each group despite the osmolality of the 5% glucose solution being slightly lower than the plasma osmolality. There was no difference in peritoneal fluid absorption rate and direct lymphatic absorption among the four groups. With the sieving coefficient for sodium set to 0.55, a significantly higher K(BD) for sodium was found in the NS compared to the HS group. The K(BD) for sodium was 0.21+/-0.01, 0.20+/-0.01, 0.17+/-0.01, and 0.09+/-0.01 mL/min for the NS, LS, MS, and HS groups, respectively. The K(BD) values for glucose were significantly lower in the NS and LS groups compared to the MS and HS groups. Our results suggest that (1) sodium concentration may affect peritoneal sodium K(BD)--as the sodium concentration gradient increased, the K(BD) decreased; (2) 5% glucose solution could induce significant peritoneal ultrafiltration in normal rats despite its initial hypo-osmotic nature, this was due to the significantly lower glucose transport rate than sodium transport rate; and (3) a lower dialysate sodium concentration may decrease peritoneal glucose absorption.