? ?????S??S?? ??? ?????? S??? ??????????? ??T??S?

1
? ?????S??S?? ??? ?????? S??? ??????????? ??T??S?

• F?te??? ?. ???st?d??
• ????da ?e???t?? ?ef???
• G. ??s???µe?? ?a???d????

2
Ge????

• ? ap?µ?????s? t?? ? st??? as?e?e?? t??
  pe??t??a???? ???a?s?? e??a? ??a??p???t??? (30-40
  mmol/?µ??a)
• ?p?t??pe? a??et? ape?e??e??µ??? d?at??f?
• ?? f?s???????? ep?peda ? de? e??a? sp???a
• ??s?st? 10-30 t?? as?e??? a?e???s???ta?
  ?p??a??a?µ????

3
?a?????te? p?? ep??e????? ta ep?peda t?? ?

• ?a?e??µe?? pe??t??a??? ???a?s?
• ?p??e?µµat??? ?ef???? ?e?t?????a
• ?p??e?e? ? ap? t? G?S
• ??at??f? t?? as?e????

4
(No Transcript)
5
S?st?µa p???? t???? µe?e???

• ?? µ????? p???? (µ?s? a?t??a 40-50 Å) ??a ??s?e?
  ?aµ???? ?? p?? ? µetaf??? t??? pe??????eta? ap?
  t?? a???µ? t?? p????. T?se?? µetaf???? ?a????.
• ?? µe????? p????, 0,1 t?? s?????? (µ?s? a?t??a
  gt150 Å), µ?s? t?? ?p???? µeta??????ta? ??
  p??te??e?.
• ?? p??? µ????? p???? p?? d?µ???????? ?? d?a????
  ?dat?? ?a? ap?te???? t? s?st?µa t?? aquaporin-1
  (µ?s? a?t??a 3-5 Å). ???a? d?ape?at?? µ??? ap? t?
  ?e?? ?a? a?e???s???ta? st? e?d?????? t??
  t????e?d???? ?????f???a? t?? pe??t??a???.

6
???p?? µetaf???? t?? d?a??t?? ??s??? d?a t??
pe??t??a???? µeµß?????

1. ? d????s? (??a ??s?e? µ????? ??) e?a?t?ta?
   e????? ap? t? d?af??? s?????t??s?? ?a? e??a?
   a?t?st??f?? a?????? t?? µe?????? t??
   µeta?????µe??? ap? t? p??sµa st? pe??t??a???
   d????µa ??s?a?.
2. ? s?µµetaf??? a?af??eta? st?? µetaf??? µ?a?
   ??s?a? µe????? ?? ? ?p??a s??d?eta? µe t??
   ?pe?d????s?, d??ad? t? µetaf??? ?dat??.
3. ? ?sµ?t??? d?af??? (d?a??µata ????????) ?a? ?
   d?af??? p?es?? (icodextrin) p?? d?µ?????e? ?
   pa???s?a µ?a? µe?a??µ???a??? ???s?? ??a t?
   µetaf??? t?? ?dat??.

7
???S???? ??????S ??a t? µetaf??? ???e d?a??t??
??s?a?

• ? s?µµetaf??? µet??ta? µe t? de??t? sieving
  coefficient (S)
• ? ?sµ?t??? d?ape?at?t?ta se s??s? µe µ?a µeµß????
  µet??ta? µe t? de??t? reflection coefficient (rc)
• ? e??e?t???t?ta µe?????? t?? pe??t??a????
  µeµß????? e?f???eta? µe t?? ??? restriction
  coefficient
• ? µ???st? pe??t??a??? ???a?s? µ?a? ??s?a? µe
  d????s? st? ????? 0 e?f???eta? µe t? de??t? MTAC
  (mass transfer area coefficient)

8
???s?se?? µetaf???? ??s??? s?µf??a µe t??? Kedem
Katchalsky

• ?. G?a µ? ??e?t????te?
• ??? d?a??t?? ?d?a????? ??? ?sµ?t??? ???
• ??? d?a??µ???? ??s?a? ?pe?d????s? d????s?
• ?. G?a ??e?t???? f??t?sµ??e? d?a??t?? ??s?e?
• ??? d?a??t?? ?d?a????? ??? ?sµ?t??? ???
  ??e?t???sµ?t??? ???
• ??? d?a??µ???? ??s?a? ?pe?d????s? d????s?
  ??e?t??f???t??? µeta????s?

9
?etaf??? t?? ?at???t??

• St? pe??t??a??? d????µa ? s?????t??s? t?? Na
  (Cl-), t?? Ca2 ?a? t?? Mg2 e??a? ???t? sta
  ep?peda t?? p??sµat??
• ?e? pe????eta? ?a????? ????? ?a? f?sf????
• ?e??p?? t? 50 t?? s???????? Ca2, t? 60-70 t??
  Mg2 ?a? pe??p?? 98 t?? Na ?a? ? e??a?
  e?e?????? d?a?e?µe?a
• ???? µ????? d?af???? s?????t??s?? se s??s? µe t?
  p??sµa t?? Na, Ca2 ?a? Mg2, ? µetaf??? t???
  e?a?t?ta? ap? t?? ?pe?d????s?, t? ????? pa?aµ????
  ?a? t?? ?sµ?t???t?ta t?? d?a??µat?? ?a? ta
  ep?ped? t??? st? p??sµa

10
?etaf??? t?? ?

• St?? IPD
• ??? p??te? 1-2 ??e? ta?e?a pt?s? t?? s?????t??s??
  t?? ?, (µeta????s? t?? e?d???tt???a ?a?
  ap?µ?????s? t??).
• ?????? 60-?ept?? ep?t???????? e??s????p?s? 70
  µeta?? t?? ep?p?d?? d?a??µat?? ?a? p??sµat??, e??
  ?????? 30-?ept?? e??s????p?s? 55
• St?? CAPD
• ?e ??????? gt 4 ????, ep?t?????eta? e??s????p?s?
  8388.
• ?e 2-l x 4 CAPD ????? p??s???? ?, ?a? t?µ? ?
  st? p??sµa 5 mmol/l, ap?µa??????ta? pe??p?? 3335
  mmol/24???.
• ?p?p??s?eta µe ?pe?d????s? 2l ap?µa??????ta? ???a
  89 mmol/24???

11
?et???µe?? ?a? a?aµe??µe?? MTAC (ml/min) ta p??ta
60 min
????a ??eat????? ??????? ? Ca Na HCO³- as?e?e??
SE Å a?t??a 1.8 3.0 3.66 2.0 2.2 2.3 2.05
Predicted PS 20.79 11.01 8.40 18.33 16.33 15.45 17.80
29.511.9 10.65.7 10.72.7 12.85.5 18
18.13.5 12.43.9 9.63.7 13.64.3 4.62.6a 9/23a
17.13.2a 9.34.2a 10.62.5a 10.44.6
18.00.9b 11.51.0b 16.41.5 8.31.1b 10
a 3.86 ???????, b p??? ?aµ??? ??t???
d?a??µat?? Perit Dial Int (2004) 24(1)10-27
12
S??S? ????F???S ???? ????T???? ?2?

• ? µeta????s? t?? ? ep??e??eta? ap? t?? µetaf???
  t?? µe t?? a?µat??? ?????f???a ?a? ap? t??
  ?????s? t?? t?p???.
• ?? t?p??? ape?e??e??µ??? ? e?????eta? ap? ta
  pe??t??a??? ??tta?a se p?s? 2,7 mmol sta 60 min
  µ?a? a??a??? 3,86 ? 4,25 ?a? 1,4 mmol se 240
  min se as?e?e?? st?? p??t? ????? ??
• ? t?p??? e??????µe?? p?s?t?ta s?et??eta? ?et???
  µe t? p?s? t?? e?e?????? µetafe??µe??? ?dat??,
  d??t?
• Y???? s?????t??s? ????????
  
• µe???? µetaf??? e?e?????? ?2?
• s???????s? t?? ??tt???? t??
  pe??t??a??? a???s? t??
  ep?p?d?? t?? e?d???tt????? K
• a???s? t?? pa??t????
  µeta????s?? t?? e?t?? t?? ??tt???? d?a t??
  d?a???? K

13
?etaf??? e?e?????? ?2? a????e? ??? ta 120 min
pa?aµ????, µe s?µa?t??? d?af??? µeta?? t?? ?µ?d??
(P lt 0.01). ????st? t?µ? ??a t?? ?µ?da II,
?aµ???te?? ??a t?? ?µ?da III. Annemieke M.
Coester, et al. The cellular contribution to
effluent potassium and its relation t? free water
transport during peritoneal dialysis. Nephr Dial
Transpl 2007 22(12)3593-3600.
14
????t??? t?? µeta????s?? t?? ? p??a? t??
d????s?? Se ??e? t?? ?µ?de? pa?at??????e a?????
a???s? t?? ?????s?? ?, µet? µe??s?. ????st? t?µ?
sta 60 min. S?µa?t??? d?af??? µeta?? t?? ?µ?d??
(P lt 0.01). ????ste? t?µ?? st?? ?µ?da II,
?aµ???te?e? st?? ?µ?da III, µe p??e?a a?????? t??
µetaf???? t?? e?e?????? ?dat??.
15
S??S? ????F???S ???? ??????????S ???????T?S?S

• ? µetaf??? t?? µ????µ???a??? ??s??? a????e? µe ta
  ?????a, ???? t?? a???µ???? a??e??ß???e?a? t??
  µeµß?????
• ?s?e?e?? µe a?ep???e?a t?? ?pe?d????s??
  pa???s?????? µ????te?? ?????s? K ?a? µ????te??
  p?s?t?ta e?e?????? µetafe??µe??? ?2?
• ?ta? ? s??ta?????f?s? t?? CAPD ? t?? CCPD e??a?
  e?at?µ??e?µ???, de? d?ap?st??eta? d?af??? st??
  ep?t???a??µe?? ???a?s? ?a? t?? ?at?stas? ??????.
• S???? a?e???s???ta? ?aµ???te?a ep?peda ?a???? st?
  CCPD

16
Nefrologia 201030(1)95-102 Doi.
10.3265/Nefrologia.pre2009.Dic.5646 Correlates of
potassium transport during peritoneal
equilibration tests using different dialysate
glucose concentrations
17
Table 3 - Clinical correlates of potassium
transport. Multivariate
18
Table 2 - Clinical correlates of potassium
transport during PET. Univariate.
Figures denote mean values of D/PK-240 and
corresponding p value for each PET. Comparisons
made using Mann Whitneys test and ANOVA GFR
Glomerular filtration rate. CRP C-reactive
protein.
19
D/P potassium profiles during PET using 2,.27 or
3,86 glucose-based dialysate (differences not
significant). Data presented as meanSD.
20
Bland Altman plot for agreement between D/PK-240
min in PET using 2,27 or 3,86 glucose-based
dialysate
21
Correlation between D/PCr-240 min and D/PK-240
min in PET using 2,27 or 3,86 glucose-based
dialysate (Spearman)
22
D/P potassium profiles during PET using 2.27
(4a) or 3.86 (4b) glucose-based dialysate
according to ongoing therapy with ACEI-ARA drugs.
Data presented as mean SD. a p 0.08 b p lt
0.05 c p lt 0.001.
23
Correlation between urinary potassium excretion
and D/PK-240 min in PET using 2,27 or 3,86
glucose-based dialysate (anuric patients not
represented), (Spearman)
24
? ?e?d??p???a (???? t?? ?????? s?????t??s??
????????) p???a?e?

• ????s? t?? a?a????a? NADH/NAD e?d???tt???a
• ??ast??? t?? d?a???? K ?a? a???s? t??
  e?d???tt????? ep?p?d?? t??
• ?e??s? t?? ap?pt?s?? ?a? d???e?s? t??
  p???ap?as?asµ?? t?? ??tt???? ?a? t?? a??pt????
  pe??t??a???? ???s??
• ????µ??? pa?a???? t?? a???t???? pa?????ta t??
  e?d??????? t?? a??e???, VEGF, ?e?a??e?????es? ?a?
  pa?a???? a?t?ap?pt?t???? p??te????
• ?e??s? t?? µetaf???? e?e?????? ?dat?? ?a?
  a?ep???e?a t?? ?pe?d????s??

25
??F???? ??T??S? ? S?? ???

• Se f?s???????? ?t?µa ? ?µe??s?a p??s???? ? e??a?
  90 mEq, ap? ta ?p??a ap????f?ta? t? 90 ?a? ??a
  a?????? p?s? ap?ß???eta? ap? ta ???a
• ?? ?, t? ????? e?d???tt???? ?at???, se ??a? ????
  e?????a a?e???s?eta? se p?s?t?ta 3700 mmol. ?ta?
  ? GFR µe???e? pe?? t? 20, ? s?ss??e?s? t??
  ap?te?e? ???d???
• St? ??? e?e???p?????ta? µ??a??sµ?? µe t???
  ?p????? ap?fe??eta? ? eµf???s? ?pe??a??a?µ?a?,
  ?p?? ? d?a t?? a?d?ste????? a???µ??? ap?????s? ?
  st? ?p? espe??aµ??? s???????? ?a? t? e?te????
  ep??????
• ?? Musso C ?a? s??. d?ap?st?sa? s?µa?t???
  a???t??? s?s??t?s? t?? GFR ?a? t??
  d?as????a??a??? ???s?? ? se ??????µ????? a???
  ??? se as?e?e?? µe ???

26
???????? ??????? ?

• ? a???µ??? ?????s? a?d?ste????? ?a? ? a???s? t??
  e?te????? ap?ß???? ? ap?te???? t??? ???????
  e???ef?????? ???µ?st????? µ??a??sµ??? t??
  ?µ???stas?? t?? K µ???? GFR sta 10 ml/min
• ? ?pe?a?d?ste????sµ?? a????e? t?? ap?????s?
  ?a???? sta ??p?a?a pe??p?? ?at? 3 mEq/24???, e??
  µe t? ??????s? ???ta?ta??a?t???? ??t???? ap? t?
  st?µa, ? ap??e?a µe ta ??p?a?a f???e? ta 40
  mEq/24???
• ? ?e???a t?? a???µ???? e?te????? ap?ß???? ? st??
  ???a?µ?a de? fa??eta? ?d?a?te?a ??a??p???t???

27
??O??F???? ??T??S? K

• ? e???ef???? ???µ?s? t?? ?a???? st????eta? st?
  ????t?p???s? µ??a??sµ?? p?? d?ata??ss??ta? st?
  st?d?? t?? ???a?µ?a?
• S?µa?t???? e??a? ?a? ? ????? t?? ??s??????? ??a
  t?? e?d???tt???a µeta????s? t?? K ?a? t??
  a?t?µet?p?s? t?? ?pe??a??a?µ?a?, ?d???
  µeta?e?µat???
• ?eta?e?µat???, ?p?? ?a? µet? ap? ??t??? ?s??s?, ?
  ?????s? e?d??e??? ?ate???aµ???? d?a p??state?t???
  st?? ??e?a a???s? t?? ep?p?d?? K
• ???t?? st?? a????? a?t?µet?p?s? t??
  ?pe??a??a?µ?a? ep?ß???eta? ?a pe???aµß??eta?
  p??ta ? ??????s? ??s??????? µe ???????, e?? ?
  s??d?asµ??? ??????s? ß2-a????st?? ?a? ??s???????
  e??a? ep?s?? ap?te?esµat??? ?a? p???aµß??e? t??
  e?d???s? ?p?????a?µ?a? ???? t?? ??s???????

28
? S???S?? ??S ?????????????S ??F????S ???????G??S
S??? ??

• ????s? ?at? 10L/eßd?µ?da/1,73m² t?? GFR t??
  as?e??? s?et???ta? µe µe??s? t?? s?et????
  ???d???? ?a??t?? ?at? 12 ?a? t?? ap??e?a? t??
  µe??d?? ?at? 10 ??a (2003 µe??t? NECOSAD)
• ? a???s? t?? pe??t??a???? ???a?s?? de? e??e
  ep?d?as? st?? ep?ß??s? t?? as?e??? (2002 µe??t?
  ADEMEX)
• ? a???µ??? pe??t??a??? ???a?s? µeµ???µ??a ?a? ???
  ? p????pt??sa ap? s?µa?t??? RRF, de? a????e?
  s?µa?t??? t?? ep?ß??s?

29
? ????S ??S ??????F?S

• ?? Lu XH ?a? s??, µe??t?sa? 84 sta?e??p???µ?????
  pe??t??a????? as?e?e?? ??a 6 µ??e?, ap? t???
  ?p????? ??t????e se ???e ep?s?e?? st?? ??????? ?a
  p??s??µ????? ta st???e?a t?? ?e?ape?a? t??? ?a?
  ta st???e?a t?? d?a?t??????? t???
• ????e ??e???? t?? ep???e?a? t?? ???a?s??, t??
  d?at??f???? s????e??? t?? as?e??? ?a? t??
  ap?µ?????s?? t?? ?a???? ?a? t?? f?sf???? st??
  a??? ?a? t? t???? t?? µe??t??

p?? 3 µ??e? 6 µ??e?
?p??a??a?µ?a 14,3 8,3 7,1
?pe??a??a?µ?a 14,3 10,7 6
30
? ???? ??S ???????S ?????????T?S?S ?O? ?ST??O?

• ??a??a?a ? ta?t??? pa?a???????s? ?a? ? s????
  p??sa?µ??? t?? d?at??f???? s????e??? t??
  pe??t??a???? as?e???, ?ste ?a pe?????s???? ??
  d?ata?a??? t?? ep?p?d?? K
• ? ?p??a??a?µ?a e??a? s???? p??ß??µa ?a? ta
  ep?peda ?a???? ????? s?et?s?e? µe t?? ?at?stas?
  ?????? ?a? t? s???d? ??s???t?ta t?? as?e???
• ?pe?d? ? ?p??a??a?µ?a ap?te?e? a?e???t?t?
  pa?????ta ???d???? ??a t??? as?e?e??, ?a ?ta?
  ???s?µe? pe?a?t??? µe??te? s?et??? µe ta
  a?aµe??µe?a ?f??? ap? t?? d?????s? t??