Chapter 45
Small Solute Clearance in Peritoneal Dialysis
Kannaiyan S. Rabindranath,
Sharon J. Nessim,
Joanne M. Bargman,
Kannaiyan S. Rabindranath
Renal Unit, Waikato Hospital, Hamilton, New Zealand
Search for more papers by this authorSharon J. Nessim
Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Canada
Search for more papers by this authorJoanne M. Bargman
Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Canada
Search for more papers by this authorKannaiyan S. Rabindranath,
Sharon J. Nessim,
Joanne M. Bargman,
Kannaiyan S. Rabindranath
Renal Unit, Waikato Hospital, Hamilton, New Zealand
Search for more papers by this authorSharon J. Nessim
Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Canada
Search for more papers by this authorJoanne M. Bargman
Department of Medicine, Division of Nephrology, University of Toronto, Toronto, Canada
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
The ideal method of assessing the adequacy of peritoneal dialysis (PD) has yet to be determined. While measures of solute clearance have traditionally focused on small solutes such as urea and creatinine, little attention has been paid to clearance of larger molecular weight uremic toxins, the so-called “middle molecules” and protein-bound uremic toxins which may have important pathophysiological impacts on mortality and morbidity. The peritoneum is a serous semipermeable membrane composed of a thin layer of connective tissue covered by a mesothelial cell monolayer. The peritoneal equilibration test is the most widely used test to characterize the rate of solute and water transfer in patients undergoing PD. The routine measurement of small solute clearance serves to screen patients for evidence of underdialysis. Aminoglycosides are frequently used to treat peritonitis in PD patients because of their effectiveness as bactericidal agents and the ease of intraperitoneal administration.
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