The header captures the thrust of this blog. Is it better to have a stomach lining with high or low transport? I turned to Perplexity to address this question with the following prompt and response. Spoiler, less is better!
Prompt: In peritoneal dialysis, what is better, a high or low transport function, especially regarding dialysis longevity
The best peritoneal transfer function for longevity on the peritoneal lining in peritoneal dialysis (PD) is generally a low transport status—that is, a low peritoneal solute transfer rate (PSTR) or low permeability—rather than a high transport status.
Why Low Transport Is Preferable
- High Transport Status and Risks:
- High transport status is associated with increased mortality risk, more comorbid diseases, and a higher likelihood of technical failure (failure to continue PD due to inadequate dialysis or complications)1.
- High transporters tend to have lower ultrafiltration (fluid removal) and are at greater risk for fluid overload, which can lead to hypertension and cardiac dysfunction1.
- Over time, the peritoneal membrane in long-term PD patients often becomes more permeable (higher transport), which is linked to worsening functional and morphological states of the membrane, including increased fibrosis and decreased ultrafiltration capacity12.
- Low Transport Status Benefits:
- Patients with low transport status generally maintain better ultrafiltration and have less risk of overhydration.
- Lower transport rates are associated with better preservation of the peritoneal membrane and a lower risk of encapsulating peritoneal sclerosis (EPS), a rare but serious complication of long-term PD23.
- Studies show that as PD continues, solute transport tends to increase and ultrafiltration declines, but those who start with or maintain lower transport rates have better outcomes12.
Impact of Peritonitis and Glucose Exposure
- Peritonitis:
- Frequent peritonitis episodes accelerate the increase in small solute transport and decrease in ultrafiltration, further compromising the peritoneal membrane’s longevity4.
- Glucose Exposure:
- Long-term exposure to glucose-based dialysis solutions causes structural and functional alterations, including fibrosis and vasculopathy, which are more pronounced in patients with higher transport rates23.
- These changes lead to reduced free water transport and, ultimately, ultrafiltration failure23.
Summary Table
| Transport Status | Ultrafiltration | Mortality Risk | Membrane Longevity | Risk of Fluid Overload |
|---|---|---|---|---|
| High | Lower | Higher | Worse | Higher |
| Low | Higher | Lower | Better | Lower |
Conclusion
For longevity of the peritoneal lining in PD, low transport status is preferable because it is associated with better ultrafiltration, lower mortality, and a reduced risk of serious complications like encapsulating peritoneal sclerosis12. High transport status is linked to worse outcomes and more rapid deterioration of the peritoneal membrane. A little filet is always better than lots of lettuce!
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7428920/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC9096116/
- https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2024.1322493/full
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4934441/
- https://pubmed.ncbi.nlm.nih.gov/8285200/
- https://www.sciencedirect.com/science/article/abs/pii/S0272638612808146
- https://www.sciencedirect.com/science/article/pii/S0085253815308607
- https://www.mdpi.com/2077-0375/12/3/276
- http://ispd.org/NAC/wp-content/uploads/2010/11/Modalities-PD-Devita-May-2011.pdf
- https://www.ncbi.nlm.nih.gov/books/NBK72297/
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