Abstract
Hypertonic peritoneal dialysis is frequently utilized to remove excess sodium and water from the body. It is shown that the ultrafiltrate is probably of extracellular origin and is invariably hyponatric to serum. Sodium accompanies the bulk flow of water in varying amounts from patient to patient. Factors that influence the transperitoneal transport of sodium, in response to slight diffusion gradients and the solvent drag effect of bulk flow, seem to include peritoneal membrane permeability and the extracellular anionic environment. A method for the proper management of sodium and water removal by hypertonic peritoneal dialysis is described by which hypernatremia, a frequently reported complication, may be prevented. The increase in serum sodium concentration results from the proportionally greater removal of extracellular water than sodium and is not dependent on the development of hyperglycemia or sodium diffusion from dialysate to extracellular fluid, as has been previously reported.
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