Membrane phenomena and mass transfer kinetics in peritoneal dialysis

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Abstract

Continuous ambulatory peritoneal dialysis (CAPD) is a process for the treatment of chronic renal failure in which metabolic waste products and excess body water are removed through the peritoneum, an intricate membrane-like tissue that lines the internal abdominal walls and covers the liver, intestine and other internal organs. As the newest of the widely-utilized modalities for chronic renal disease, CAPD is the most rapidly growing and, in many respects, the most subtle and poorly understood treatment. The peritoneum is not a simple barrier between two phases but rather a heterogeneous mucopolysaccharide hydrogel containing a labyrinthine vasculature through which blood flows as it equilibrates with a stagnant pool of dialysate residing within the peritoneal cavity. Despite the complexity of this transport medium, investigators have found it not only possible but quite useful to characterize the peritoneum in terms analogous to the mass transfer properties of a planar membrane separating well-mixed pools of blood and dialysate. This review begins with a summary of peritoneal dialysis and its contemporary role in the treatment of kidney failure. Measurements of equivalent peritoneal hydraulic permeability and of sieving coefficients and diffusive permeabilities as functions of molecular weight are subsequently tabulated from the literature and compared and contrasted to similar values for hemodialysis membranes. In addition, several published kinetic models, both analytical and numerical, which use a knowledge of peritoneal barrier properties and baseline clinical parameters for predicting rates of toxin and fluid removal during CAPD, are described and critically evaluated.

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