Kinetic studies with hypertonic glucose permit better identification of ultrafiltration failure. What is the contribution of sodium sieving?
Las cinéticas con glucosa hipertónica permiten identificar mejor el fallo de ultrafiltración. ¿Qué aporta el cribado de sodio?
Read
8193
Timeswas read the article
2355
Total PDF
5838
Total HTML
Share statistics
array:21 [ "pii" => "X2013251410036132" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2010.Mar.10333" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2010;30:208-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4316 "formatos" => array:3 [ "EPUB" => 299 "HTML" => 3433 "PDF" => 584 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699510036135" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2010.Mar.10333" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2010;30:208-13" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7746 "formatos" => array:3 [ "EPUB" => 266 "HTML" => 6846 "PDF" => 634 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "Las cinéticas con glucosa hipertónica permiten identificar mejor el fallo de ultrafiltración. ¿Qué aporta el cribado de sodio?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "208" "paginaFinal" => "213" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Kinetic studies with hypertonic glucose permit better identification of ultrafiltration failure. What is the contribution of sodium sieving?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1033318078_tripav30_n2_2010_t2_pag210.jpg" "Alto" => 152 "Ancho" => 1081 "Tamanyo" => 32325 ] ] "descripcion" => array:1 [ "es" => "Resultados de los estudios cinéticos peritoneales en pacientes con y sin antecedentes de peritonitis" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María José Fernández-Reyes, M.A. Bajo Rubio, G. del Peso Gilsanz, P. Estrada, S. Sousa, R. Sánchez-Villanueva, M. Heras, M. Ossorio, C. Vega, R. Selgas" "autores" => array:10 [ 0 => array:2 [ "nombre" => "María José" "apellidos" => "Fernández-Reyes" ] 1 => array:2 [ "Iniciales" => "M.A." "apellidos" => "Bajo Rubio" ] 2 => array:2 [ "Iniciales" => "G." "apellidos" => "del Peso Gilsanz" ] 3 => array:2 [ "Iniciales" => "P." "apellidos" => "Estrada" ] 4 => array:2 [ "Iniciales" => "S." "apellidos" => "Sousa" ] 5 => array:2 [ "Iniciales" => "R." "apellidos" => "Sánchez-Villanueva" ] 6 => array:2 [ "Iniciales" => "M." "apellidos" => "Heras" ] 7 => array:2 [ "Iniciales" => "M." "apellidos" => "Ossorio" ] 8 => array:2 [ "Iniciales" => "C." "apellidos" => "Vega" ] 9 => array:2 [ "Iniciales" => "R." "apellidos" => "Selgas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251410036132" "doi" => "10.3265/Nefrologia.pre2010.Mar.10333" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036132?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699510036135?idApp=UINPBA000064" "url" => "/02116995/0000003000000002/v0_201502091329/X0211699510036135/v0_201502091331/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X2013251410036124" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2009.Dic.5774" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2010;30:214-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 7258 "formatos" => array:3 [ "EPUB" => 288 "HTML" => 6272 "PDF" => 698 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Does methodology of Stewart-Fencl improve characterization of acid-base status in patients on hemodiafiltration?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "214" "paginaFinal" => "219" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Mejora la aproximación físico-química de Stewart-Fencl la valoración del equilibrio ácido-base en pacientes estables en hemodiafiltración?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10037108_a11_t1.jpg" "Alto" => 292 "Ancho" => 1094 "Tamanyo" => 56692 ] ] "descripcion" => array:1 [ "en" => "Measured parameters of acid-base status pre- and post-HDF" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Julio Hernández Jaras, I. Rico Salvador, E. Torregrosa de Juan, R. Pons Prades, A. Rius Peris, M.A. Fenollosa Segarra, J.J. Sánchez Canel, T. Carbajo Mateo" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Julio" "apellidos" => "Hernández Jaras" ] 1 => array:2 [ "Iniciales" => "I." "apellidos" => "Rico Salvador" ] 2 => array:2 [ "Iniciales" => "E." "apellidos" => "Torregrosa de Juan" ] 3 => array:2 [ "Iniciales" => "R." "apellidos" => "Pons Prades" ] 4 => array:2 [ "Iniciales" => "A." "apellidos" => "Rius Peris" ] 5 => array:2 [ "Iniciales" => "M.A." "apellidos" => "Fenollosa Segarra" ] 6 => array:2 [ "Iniciales" => "J.J." "apellidos" => "Sánchez Canel" ] 7 => array:2 [ "Iniciales" => "T." "apellidos" => "Carbajo Mateo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699510036127" "doi" => "10.3265/Nefrologia.pre2009.Dic.5774" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699510036127?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036124?idApp=UINPBA000064" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036124/v0_201502091606/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251410036140" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2010.Jan.10230" "estado" => "S300" "fechaPublicacion" => "2010-03-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2010;30:202-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4447 "formatos" => array:3 [ "EPUB" => 270 "HTML" => 3549 "PDF" => 628 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Renal function evolution and progressive factors in nefrectomized patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "207" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución de la función renal y factores de progresión en pacientes nefrectomizados" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1023018078_tripav30_n2_2010_t1_pag203_copy1.jpg" "Alto" => 179 "Ancho" => 525 "Tamanyo" => 20639 ] ] "descripcion" => array:1 [ "en" => "Current stage according to glomerular filtration rate." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabel Juan García, M.J. Puchades, M.A. Solís, B. Pascual, I. Torregrosa, C. Ramos, M. González, A. Miguel" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Isabel" "apellidos" => "Juan García" ] 1 => array:2 [ "Iniciales" => "M.J." "apellidos" => "Puchades" ] 2 => array:2 [ "Iniciales" => "M.A." "apellidos" => "Solís" ] 3 => array:2 [ "Iniciales" => "B." "apellidos" => "Pascual" ] 4 => array:2 [ "Iniciales" => "I." "apellidos" => "Torregrosa" ] 5 => array:2 [ "Iniciales" => "C." "apellidos" => "Ramos" ] 6 => array:2 [ "Iniciales" => "M." "apellidos" => "González" ] 7 => array:2 [ "Iniciales" => "A." "apellidos" => "Miguel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699510036143" "doi" => "10.3265/Nefrologia.pre2010.Jan.10230" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699510036143?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036140?idApp=UINPBA000064" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036140/v0_201502091606/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Kinetic studies with hypertonic glucose permit better identification of ultrafiltration failure. What is the contribution of sodium sieving?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "208" "paginaFinal" => "213" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "María José Fernández-Reyes, M.A. Bajo Rubio, G. del Peso Gilsanz, P. Estrada, S. Sousa, R. Sánchez-Villanueva, M. Heras, M. Ossorio, C. Vega, R. Selgas" "autores" => array:10 [ 0 => array:4 [ "nombre" => "María José" "apellidos" => "Fernández-Reyes" "email" => array:1 [ 0 => "jfernandezre@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "Iniciales" => "M.A." "apellidos" => "Bajo Rubio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "G." "apellidos" => "del Peso Gilsanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 3 => array:3 [ "Iniciales" => "P." "apellidos" => "Estrada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 4 => array:3 [ "Iniciales" => "S." "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 5 => array:3 [ "Iniciales" => "R." "apellidos" => "Sánchez-Villanueva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 6 => array:3 [ "Iniciales" => "M." "apellidos" => "Heras" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 7 => array:3 [ "Iniciales" => "M." "apellidos" => "Ossorio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 8 => array:3 [ "Iniciales" => "C." "apellidos" => "Vega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 9 => array:3 [ "Iniciales" => "R." "apellidos" => "Selgas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General de Segovia, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario La Paz, Madrid, España, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las cinéticas con glucosa hipertónica permiten identificar mejor el fallo de ultrafiltración. ¿Qué aporta el cribado de sodio?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10333108_a10_f1.jpg" "Alto" => 637 "Ancho" => 1094 "Tamanyo" => 55263 ] ] "descripcion" => array:1 [ "en" => "DifNa according to ultrafiltration quartiles." ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION </span></p><p class="elsevierStylePara">The peritoneal equilibrium test (PET), first described by Twardowski et al. in 1987,<span class="elsevierStyleSup">1 </span>is performed with a four-hour exchange with a 2.27 or 2.5% glucose solution. This test provides good information about the peritoneum’s permeability to small molecules, but does not provide early detection of abnormalities in water transport. Ultrafiltration (UF) failure develops over time in 20% to 30% of all patients on peritoneal dialysis (PD)<span class="elsevierStyleSup">2 </span>and it is one of the main causes of PD failure.<span class="elsevierStyleSup">3 </span>It is therefore necessary to find tools allowing us to identify it in early stages and further our knowledge of its causes. The International Society for Peritoneal Dialysis (ISPD), through its Ultrafiltration Committee (UF), recommends performing the peritoneal kinetic study with a hypertonic glucose solution (3.86% or 4.25%) which allows us to measure the peritoneum’s fluid transport capacity under extreme conditions, standardise UF measurements and define ultrafiltration failure (UFF).<span class="elsevierStyleSup">4 </span>Past preliminary studies of hypertonic glucose kinetics showed results that are similar to those from kinetic studies with 2.27% or 2.5% glucose with respect to small molecule transport (creatinine and urea D/P),<span class="elsevierStyleSup">5 </span>and have also contributed further information about transcellular water transport through sodium sieving measurements.<span class="elsevierStyleSup">5-7 </span>During the first hour or two of a hypertonic glucose exchange, we observed a decrease in sodium concentration in the dialysate. This phenomenon, known as sodium sieving, is explained by the passage of free water through transcellular channels that are impermeable to other solutes (aquaporin-1). A decrease in transcellular water transport (TWT) though aquaporins is currently accepted as yet another cause of UF failure,<span class="elsevierStyleSup">6 </span>which is why the ISPD recommends measuring sodium sieving after 60 minutes or while performing the kinetic studies. On the other hand, we know that in initial PD phases, the correlation between peritoneal permeability and UF is lower than that described for patients who have spent more than a year on PD,<span class="elsevierStyleSup">8 </span>which indicates that factors other than permeability may lead to UF in early stages. The purpose of this study is to analyse the UF capacity and its relationship with peritoneal permeability and sodium transport in patients treated with PD, using kinetic studies with hypertonic solutions. An additional objective is to confirm that the relationship between UF capacity and peritoneal permeability is different in early stages of PD. </p><p class="elsevierStylePara"><span class="elsevierStyleBold">PATIENTS AND METHODS </span></p><p class="elsevierStylePara">We performed 184 peritoneal studies in 184 stable patients on PD with a mean age of 50.7 ± 15.9. Of these patients, 75 were treated with continuous ambulatory peritoneal dialysis (CAPD) and 109 with automatic peritoneal dialysis (APD). All of the patients used standard solutions with glucose as the osmotic agent and lactate as a buffer. Mean time on PD was 15.7 ± 22 (1-122 months), 53% of patients were male and 15% were diabetic. Thirty-eight patients had previously experienced an episode of peritonitis. The peritoneal kinetic study was performed while the patient was stable and after resolution of any episodes of peritonitis, haemoperitoneum or an abdominal surgical procedure, where applicable. It was performed according to standard protocol, using a two-litre bag of hypertonic glucose (3.86%/4.25%) with a four-hour dwell. During the peritoneal function study, patients fasted and received no medication except for low doses of insulin subcutaneously where necessary. To measure diffusive function, we collected six peritoneal effluent samples (at minutes 0, 30, 60, 120, 180 and 240) and a baseline blood sample. After making these measurements, we calculated the creatinine dialysate to plasma ratio at 240 minutes (D/P Cr) and the urea and creatinine mass transfer-area coefficients (Urea and creatinine MTACs), according to the previously described mathematical model.<span class="elsevierStyleSup">2 </span>Standard UF was calculated as the difference between the drained and filled volumes after weighing the bags. Failure (UFF) is considered when UF after a four-hour dwell with a 3.86% glucose exchange is less than 400ml, according to data described by Krediet.<span class="elsevierStyleSup">9 </span>We measured the percentage of decrease in the sodium concentration against the baseline concentration at 60 minutes (difNa<span class="elsevierStyleSup">60 </span>min = [baseline dialysate sodium – dialysate sodium level after 60 min) * 100/[baseline dialysate sodium]). Patients were categorised in four groups according to UF quartiles, and each group was subjected to an independent analysis of the correlations between permeability, UF and sodium sieving. Kinetic studies carried out during the first 5 months were also subjected to a later analysis in order to check whether the factors that may lead to UF and their relationships with permeability or water transport are different in early stages. Likewise, we performed a separate analysis of kinetic studies from patients whose history included an episode of peritonitis. </p><p class="elsevierStylePara"><span class="elsevierStyleBold">Statistical analysis </span></p><p class="elsevierStylePara">Statistical analysis was carried out using SPSS software version 11.0. Values were expressed as percentages or the mean ± standard deviation (SD). P-values < 0.05 were considered to be statistically significant. Student’s t-test was used to compare means, and the Pearson test was used to establish linear correlation coefficients. Spearman’s test was used for ordinal variables or those without a normal distribution. To establish what variables had an independent association with sodium sieving or UF, we performed a stepwise linear regression analysis, using variables that correlated with these parameters. </p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS </span></p><p class="elsevierStylePara">No adverse effects were observed during the test procedure, except for some mild symptoms of volume depletion in patients with residual diuresis and high UF which did not require extraordinary measures to be taken. Table 1 shows the results of the peritoneal kinetic study, expressed as means, range and D/P Cr, MTAC-creatinine, MTAC-urea, UF and percentage of decrease in sodium concentration after 60 minutes (difNa<span class="elsevierStyleSup">60</span>). We observed a strong correlation between MTAC-creatinine and D/P Cr (r = 0.86; p = 0.000). There were no differences in MTACcreatinine or MTAC-urea, D/P Cr, UF or difNa<span class="elsevierStyleSup">60 </span>at any time between patients dialysed with CAPD and those on APD. Patients on APD were younger (45 ± 14 vs. 58 ± 14 years) and they had spent more time on PD (12 ± 16 vs. 20 ± 27 months). Thirty-eight patients had presented an episode of peritonitis prior to the kinetic studies (one episode in 17 cases, two in 14 cases, and seven patients had experienced three or more). As shown in Table 2, there were no differences in UF, MTAC-Creatinine or D/P Cr between these patients and the rest. However, patients with a history of peritonitis had a significantly lower difNa<span class="elsevierStyleSup">60 </span>(3.7 ± 2.8 vs. 4.9 ± 2.1; p = 0.002). In the whole group, difNa<span class="elsevierStyleSup">60 </span>maintained a very close correlation to UF (r = 0.49) and permeability, measured using both MTAC-Cr (r = –0.45) and by D/P Cr (r = –0.49). It also correlated to a patient’s having had a previous episode of peritonitis (r = –0.22; p = 0.002). The model which best explains sodium sieving (r = 0.61; r<span class="elsevierStyleSup">2 </span>= 0.38; p < 0.0001) is the model which includes UF, MTAC-creatinine, peritonitis and age, shown in Table 3. Figure 1 shows the evolution of sodium sieving at 30, 60 and 120 minutes, according to the UF quartiles. Patients in the lower percentile for UF (< 600ml/4 h) were clearly differentiated from the rest by the difNa. A difNa greater than or equal to 5% would rule out an UF failure. UF is fundamentally correlated to difNa<span class="elsevierStyleSup">60 </span>(r = 0.49; p = 0.00), peritoneal permeability of small solutes, measured using either MTAC-creatinine (r = –0.39; p = 0.00) or D/P Cr (r = –0.32; p = 0.00), and time on PD (r = –0.17; p = 0.019). The model which best explains UF (r = 0.57; p < 0.0001) is the one including difNa<span class="elsevierStyleSup">60</span>,MTAC-creatinine, age and time on PD, shown in Table 4. The peritonitis episodes are not included. When we categorise patients in four groups according to UF quartiles, we observe that although MTAC-creatinine was significantly higher in subgroups with less UF, the correlations between UF and permeability within each of the groups disappear (Table 5). Correlations between UF and difNa<span class="elsevierStyleSup">60 </span>also disappear in the three groups with the highest UF, but in the patient group with UF < 600ml/4 h (P25), a good correlation between UF and difNa<span class="elsevierStyleSup">60 </span>remains (r = 0.48; p < 0.001) (Table 5). Lastly, we compared the 72 kinetic studies performed in patients who had been on dialysis during less than six months with the other studies. There were no significant differences for UF (753 ± 232ml/4 h, < 6 months vs. 763 ± 237ml/4 h > 6 months), difNa<span class="elsevierStyleSup">60 </span>(4.6 ± 2.3 vs. 4.7 ± 2.3), D/P Cr (0.72 ± 0.1 vs. 0.71 ± 0.1) or MTAC-creatinine (9.3 ± 4.5 vs. 8.9 ± 4.5ml/min). The correlation between UF and MTAC-creatinine is less pronounced in kinetic studies performed before six months on dialysis (r = –0.33 vs. r = –0.43; p < 0.05). </p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION </span></p><p class="elsevierStylePara">UF deficit, whether inherent or developing over time on PD, is currently one of the main factors determining patient and technique survival.<span class="elsevierStyleSup">3 </span>For that reason, it is crucial to measure UF in a standardised way at baseline and on a regular basis afterward to further our knowledge of the causes of UF failure. In our unit, the peritoneal kinetic studies have been performed with 3.86%/4.25% hypertonic glucose since 1999. The first thing we notice in the present study is that the prevalence of UF failure (4.9%, 9/184 patients) is lower than that reported by other authors.<span class="elsevierStyleSup">7-10 </span>This may be due to the low values for both mean time on dialysis (15.6 months) and the incidence rate of previous peritonitis episodes, both of which are considered to be principal determining factors for UF loss.<span class="elsevierStyleSup">3 </span>However, the definition of UF failure as UF below 400ml/4 h does not imply that smaller decreases or progressive losses of UF are not pathological. Milla et al.<span class="elsevierStyleSup">11 </span>studied 95 incident patients on PD with kinetic studies using 3.86% glucose by taking baseline and yearly measurements. They observed that a decrease in UF occurs over time on PD, and this decrease is significant beginning at the threeyear mark. It is only preceded by changes in sodium sieving; the rest of the peritoneal transport parameters (D/P Cr and D/P glucose) remain stable over time. As our group has already stated, peritonitis is one of the main factors determining loss of UF.<span class="elsevierStyleSup">3,12 </span>According to the present study, difNa<span class="elsevierStyleSup">60 </span>is very likely to be the earliest parameter to change following peritoneal inflammation in patients with a history of peritonitis. According to our results and those generated by Milla et al., it is recommended to carry out kinetic studies with hypertonic glucose following peritonitis episodes. By doing so, we can predict which patients are at risk of developing UF failure at an early stage, and evaluate the need for therapeutic measures such as peritoneal rest. Carrying out kinetic studies with hypertonic glucose enables us to measure not only diffusive transport (with results showing similar small molecule permeability to those obtained with 2.27% glucose) but also the maximum peritoneal water transport capacity, as well as to analyse the relationship between permeability and UF. The latter is attained in PD thanks to glucose’s osmotic capacity, which disappears rapidly if the peritoneum is very permeable. It is therefore logical that the UF after a four-hour exchange would depend on peritoneal permeability. In our study, we have found a correlation between peritoneal permeability and UF, but it is not as high as that found by other authors.<span class="elsevierStyleSup">10 </span>Furthermore, as found by other preliminary studies done by our group,<span class="elsevierStyleSup">8 </span>this correlation is smaller in kinetic studies performed before the first six months, which indicates that factors other than peritoneal permeability determine the UF, especially in initial stages of PD. This lower correlation between permeability and UF can be observed most of all in groups of patients with high transport rates or a low UF.<span class="elsevierStyleSup">8 </span>An interesting finding from this study is that patients with a UF below 600ml/4 h (P<span class="elsevierStyleSup">25</span>) lose the correlation between UF and MTAC-creatinine or D/P Cr, but maintain the correlation between UF and difNa<span class="elsevierStyleSup">60 </span>(r = 0.48; p < 0.001). This is a very important finding, since in these patients, performing the kinetic study with 3.86% glucose enables us to detect and quantify UF failures that the D/P Cr and MTAC-creatinine readings may not identify properly. Therefore, in extreme situations, such as high peritoneal transport rate or UF failure, a kinetic study with 3.86% glucose, standardised UF measurement and sodium sieving becomes a highly useful and more sensitive tool for detecting abnormalities in transcellular water transport. In conclusion, kinetic studies performed with hypertonic glucose are well-tolerated. Furthermore, thanks to standardised UF and sodium sieving measurements, they allow us to detect and offer a better definition of alterations in peritoneal water transport that are not solely caused by an increase in peritoneal permeability, particularly after peritonitis episodes or in patients with a low UF.  </p><p class="elsevierStylePara"><a href="grande/10333108_a10_f1.jpg" class="elsevierStyleCrossRefs"><img src="10333108_a10_f1.jpg" alt="DifNa according to ultrafiltration quartiles."></img></a></p><p class="elsevierStylePara">Figure 1. DifNa according to ultrafiltration quartiles.</p><p class="elsevierStylePara"><a href="grande/1033318078_v30_n2_v.i.2010_t1_pag210.jpg" class="elsevierStyleCrossRefs"><img src="1033318078_v30_n2_v.i.2010_t1_pag210.jpg" alt="Overall results from the five peritoneal kinetic studies"></img></a></p><p class="elsevierStylePara">Table 1. Overall results from the five peritoneal kinetic studies</p><p class="elsevierStylePara"><a href="grande/1033318078_v30_n2_v.i.2010_t2_pag210.jpg" class="elsevierStyleCrossRefs"><img src="1033318078_v30_n2_v.i.2010_t2_pag210.jpg" alt="Results from the peritoneal kinetic studies in patients with and without a history of peritonitis"></img></a></p><p class="elsevierStylePara">Table 2. Results from the peritoneal kinetic studies in patients with and without a history of peritonitis</p><p class="elsevierStylePara"><a href="grande/1033318078_v30_n2_v.i.2010_t3_pag211.jpg" class="elsevierStyleCrossRefs"><img src="1033318078_v30_n2_v.i.2010_t3_pag211.jpg" alt="Multivariate analysis of the factors associated with difNa60 60"></img></a></p><p class="elsevierStylePara">Table 3. Multivariate analysis of the factors associated with difNa60 60</p><p class="elsevierStylePara"><a href="grande/1033318078_v30_n2_v.i.2010_t4_pag212.jpg" class="elsevierStyleCrossRefs"><img src="1033318078_v30_n2_v.i.2010_t4_pag212.jpg" alt="Multivariate analysis of the factors associated with ultrafiltration"></img></a></p><p class="elsevierStylePara">Table 4. Multivariate analysis of the factors associated with ultrafiltration</p><p class="elsevierStylePara"><a href="grande/1033318078_v30_n2_v.i.2010_t5_pag212.jpg" class="elsevierStyleCrossRefs"><img src="1033318078_v30_n2_v.i.2010_t5_pag212.jpg" alt="Correlations between ultrafiltration and MTAC-creatinine, D/P creatinine and sodium sieving according to ultrafiltration quartiles"></img></a></p><p class="elsevierStylePara">Table 5. Correlations between ultrafiltration and MTAC-creatinine, D/P creatinine and sodium sieving according to ultrafiltration quartiles</p>" "pdfFichero" => "P1-E47-S1877-A10333-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437439" "palabras" => array:1 [ 0 => "Cribado de sodio" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437441" "palabras" => array:1 [ 0 => "Ultrafiltración" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437443" "palabras" => array:1 [ 0 => "Glucosa hipertónica" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec437445" "palabras" => array:1 [ 0 => "Cinética peritoneal" ] ] ] "en" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437440" "palabras" => array:1 [ 0 => "Sieving of sodium" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437442" "palabras" => array:1 [ 0 => "Ultrafiltration" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437444" "palabras" => array:1 [ 0 => "Hypertonic glucose" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec437446" "palabras" => array:1 [ 0 => "Peritoneal kinetics study" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Introduction: </span></span><span class="elsevierStyleItalic">The use of solutions containing hypertonic glucose (3.86%/4.25%) has been postulated as the method of choice for study the peritoneal function, and permits a better evaluation of the ultrafiltration (UF) capacity. </span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Objective: </span></span><span class="elsevierStyleItalic">The aim of our study was to analyze the UF capacity and its relation with the peritoneal permeability and sieving of sodium, performing the peritoneal kinetic study with hypertonic glucose solutions. </span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Patients and methods: </span></span><span class="elsevierStyleItalic">We performed 184 peritoneal kinetic studies with hypertonic glucose solutions in stable patients on peritoneal dialysis (PD), with a mean time on PD of 16 ± 22 months. We measured the mass transfer coefficient of creatinine (CrMTC), dialysate to plasma ratio of creatinine (D/PCr), UF capacity and sieving of sodium at 60 minutes (difNa</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">60</span></span><span class="elsevierStyleItalic">). </span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Results: </span></span><span class="elsevierStyleItalic">The mean values were: CrMTC: 9.1 ± 4.5 ml/min, D/PCr: 0.71 ± 0.09, UF 759 ± 233 ml/4 h and difNa</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">60</span></span><span class="elsevierStyleItalic">: 4.7 ± 2.3. The best multivariate model that predicts the UF capacity included: difNa<span class="elsevierStyleInf">60</span>, CrMTC, age and time on PD (r = 0.57; p >0.0001). In patients with UF lower than 600 ml/4 h (Percentil 25) the correlation between UF and CrMTC was lost, but remains the correlation with difNa</span><span class="elsevierStyleItalic">60 </span><span class="elsevierStyleItalic">(r = 0.48). The patients with previous peritonitis (n = 38) showed no differences in UF, CrMTC or D/Pcr, but the had lower difNa</span><span class="elsevierStyleItalic"><span class="elsevierStyleInf">60</span> </span><span class="elsevierStyleItalic">(3.7 ± 2.8 vs. 4.9 ± 2.1; p = 0.002) than the remaning patients. </span><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Conclusions: </span></span><span class="elsevierStyleItalic">The peritoneal kinetic study performed with hypertonic glucose allows to standarize the UF capacity and by determination of sieving of sodium, the early detection of water transport alterations, before the UF capacity and small solutes permeability alteration develops.</span>  </p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Introducción:</span> La utilización de soluciones con glucosa al 3,86%/4,25% se ha postulado como el método ideal para estudiar la función peritoneal, ya que permite evaluar mejor la capacidad de ultrafiltración (UF). <span class="elsevierStyleBold">Objetivo:</span> El objetivo del estudio es analizar la UF y sus relaciones con la permeabilidad peritoneal y el cribado de sodio mediante la realización de cinéticas peritoneales con glucosa hipertónica.<span class="elsevierStyleBold"> Pacientes y métodos: </span>Realizamos 184 cinéticas con glucosa hipertónica en pacientes estables en diálisis peritoneal (DP), con un tiempo medio en DP de 16 ± 22 meses. Se midieron el coeficiente de transferencia de masa de creatinina (MTCcr), el cociente dializado/plasma de creatinina (D/Pcr), la UF y el cribado de sodio a los 60 minutos (difNa<span class="elsevierStyleInf">60</span>). <span class="elsevierStyleBold">Resultados:</span> Los valores medios fueron: MTC-Cr: 9,1 ± 4,5 ml/min, D/Pcr: 0,71 ± 0,09, UF 759 ± 233 ml/4 h y difNa<span class="elsevierStyleInf">60</span>: 4,7 ± 2,3. El modelo que mejor explica la UF es el que incluye difNa<span class="elsevierStyleInf">60</span>, MTCcr, edad y tiempo en DP (r = 0,57; p >0,0001). En los pacientes con UF menor de 600 ml (percentil 25) se pierde la correlación entre la UF y el MTCcr, pero se mantiene con difNa60 (r = 0,48). Los 38 pacientes con antecedentes de peritonitis no presentaron diferencias en UF, MTCcr o D/Pcr, pero tienen menor difNa60 (3,7 ± 2,8 frente a 4,9 ± 2,1; p = 0,002) que el resto de pacientes. Conclusiones: La cinética peritoneal realizada con glucosa hipertónica permite no sólo hacer una medida estandarizada de la UF sino también determinar el cribado de sodio, que es el parámetro más sensible para detectar alteraciones del transporte de agua.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10333108_a10_f1.jpg" "Alto" => 637 "Ancho" => 1094 "Tamanyo" => 55263 ] ] "descripcion" => array:1 [ "en" => "DifNa according to ultrafiltration quartiles." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1033318078_v30_n2_v.i.2010_t1_pag210.jpg" "Alto" => 194 "Ancho" => 1027 "Tamanyo" => 42221 ] ] "descripcion" => array:1 [ "en" => "Overall results from the five peritoneal kinetic studies" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1033318078_v30_n2_v.i.2010_t2_pag210.jpg" "Alto" => 149 "Ancho" => 1032 "Tamanyo" => 34622 ] ] "descripcion" => array:1 [ "en" => "Results from the peritoneal kinetic studies in patients with and without a history of peritonitis" ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Tab. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1033318078_v30_n2_v.i.2010_t3_pag211.jpg" "Alto" => 197 "Ancho" => 1032 "Tamanyo" => 41189 ] ] "descripcion" => array:1 [ "en" => "Multivariate analysis of the factors associated with difNa60 60" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Tab. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1033318078_v30_n2_v.i.2010_t4_pag212.jpg" "Alto" => 196 "Ancho" => 1033 "Tamanyo" => 38001 ] ] "descripcion" => array:1 [ "en" => "Multivariate analysis of the factors associated with ultrafiltration" ] ] 5 => array:8 [ "identificador" => "fig6" "etiqueta" => "Tab. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1033318078_v30_n2_v.i.2010_t5_pag212.jpg" "Alto" => 242 "Ancho" => 1029 "Tamanyo" => 42992 ] ] "descripcion" => array:1 [ "en" => "Correlations between ultrafiltration and MTAC-creatinine, D/P creatinine and sodium sieving according to ultrafiltration quartiles" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Twardowski ZJ, Nolph KD, Khanna R , Prowant BF, Ryan LP, Moore HL. Peritoneal equilibration test. Perit Dial Bull 1987;7:138-47." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Selgas R, Fernández-Reyes M.J, Bosque E, Bajo MA, Borrego F, Jiménez C, et al. Funtional longevity of human peritoneum-for how long is chronic peritoneal dialysis possible? Results of a prospective medium long-term study. Am J Kidney Dis 1994;23:64-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8285200" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ates K, Nergizoglu G, Keven K, Sen A, Kutlay S, Ertürk S, et al. Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. Kidney Int 2001;60:767-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11473661" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nolph K, Gokal R, Mujais S. ISPD Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit Dial Int 2000;20(Suppl 4):S3-S4." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pride ET, Gustafson J, Graham QA, Spainhour L, Mauck V, Brown P, et al. Comparison of a 2.5% and 4.25% dextrose peritoneal equilibration test. Perit Dial Int 2002;22:365-70." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ho-Dac-Pannekeet MM, Atesever B, Strujik DG, Krediet RT. Analysis of ultrafiltration failure in peritoneal dialysis patients by means of standar peritoneal permeabilytiy analysis. Perit Dial Int 1997;17:144-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9159834" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Smit W, Van Dijk P, Langedijk MJ, Schouten N, Van den Berg N, Struijk DG, et al. Peritoneal function and assessment of reference values using a 3.86% glucose solution. Perit Dial Int 2003;23:440-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Selgas R, Bajo MA, Cirugeda A, Del Peso G, Valdés J, Castro MJ, et al. Ultrafiltration and small solute trasport at initiation of PD: questioning the paradigm of peritoneal function. Perit Dial Int 2005;25:68-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15770928" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Krediet R. The peritoneal membrane in chronic peritoneal dialysis patients. Kidney Int 1999;55:341-56. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9893150" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ortiz A, Marrón B, Berlanga JR, Reyero A, Gazapo R. Peritoneal equilibrium test with hypertonic exchange: practical application in a peritoneal dialysis program. Nefrologia 2001;21(4):362-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11816512" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Milla V, Pozzoni P, Virga G, Crepaldi M, Vecchio L, Andrulli S, et al. Peritoneal transport assessment by peritoneal equilibration test with 3.86% glucose: a long-term prospective evaluation. Kidney Int 2006;69:927-33. " "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Del Peso G, Fernández-Reyes MJ, Hevia C, Bajo MA, Castro MJ, Cirujeda A, et al. Factors influencing peritoneal transport parameters during the first year on peritoneal dialysis: peritonitis the main factor. Nephrol Dial Transplant 2005;20:1201-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15827050" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000002/v0_201502091606/X2013251410036132/v0_201502091606/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000002/v0_201502091606/X2013251410036132/v0_201502091606/en/P1-E47-S1877-A10333-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410036132?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 6 | 10 |
| 2024 October | 48 | 47 | 95 |
| 2024 September | 72 | 32 | 104 |
| 2024 August | 70 | 51 | 121 |
| 2024 July | 63 | 31 | 94 |
| 2024 June | 62 | 43 | 105 |
| 2024 May | 71 | 46 | 117 |
| 2024 April | 46 | 38 | 84 |
| 2024 March | 31 | 27 | 58 |
| 2024 February | 39 | 35 | 74 |
| 2024 January | 37 | 20 | 57 |
| 2023 December | 32 | 28 | 60 |
| 2023 November | 50 | 42 | 92 |
| 2023 October | 39 | 39 | 78 |
| 2023 September | 36 | 35 | 71 |
| 2023 August | 52 | 16 | 68 |
| 2023 July | 54 | 40 | 94 |
| 2023 June | 41 | 31 | 72 |
| 2023 May | 49 | 35 | 84 |
| 2023 April | 23 | 21 | 44 |
| 2023 March | 58 | 21 | 79 |
| 2023 February | 62 | 18 | 80 |
| 2023 January | 48 | 18 | 66 |
| 2022 December | 50 | 32 | 82 |
| 2022 November | 71 | 27 | 98 |
| 2022 October | 43 | 39 | 82 |
| 2022 September | 46 | 34 | 80 |
| 2022 August | 76 | 49 | 125 |
| 2022 July | 54 | 48 | 102 |
| 2022 June | 65 | 48 | 113 |
| 2022 May | 52 | 29 | 81 |
| 2022 April | 75 | 62 | 137 |
| 2022 March | 56 | 59 | 115 |
| 2022 February | 38 | 43 | 81 |
| 2022 January | 30 | 34 | 64 |
| 2021 December | 41 | 42 | 83 |
| 2021 November | 39 | 30 | 69 |
| 2021 October | 45 | 46 | 91 |
| 2021 September | 29 | 33 | 62 |
| 2021 August | 26 | 30 | 56 |
| 2021 July | 29 | 30 | 59 |
| 2021 June | 14 | 25 | 39 |
| 2021 May | 25 | 37 | 62 |
| 2021 April | 49 | 70 | 119 |
| 2021 March | 29 | 27 | 56 |
| 2021 February | 29 | 34 | 63 |
| 2021 January | 33 | 21 | 54 |
| 2020 December | 29 | 10 | 39 |
| 2020 November | 30 | 15 | 45 |
| 2020 October | 14 | 13 | 27 |
| 2020 September | 16 | 7 | 23 |
| 2020 August | 31 | 10 | 41 |
| 2020 July | 19 | 6 | 25 |
| 2020 June | 20 | 8 | 28 |
| 2020 May | 28 | 11 | 39 |
| 2020 April | 32 | 25 | 57 |
| 2020 March | 33 | 9 | 42 |
| 2020 February | 36 | 19 | 55 |
| 2020 January | 26 | 14 | 40 |
| 2019 December | 31 | 20 | 51 |
| 2019 November | 27 | 12 | 39 |
| 2019 October | 8 | 12 | 20 |
| 2019 September | 25 | 19 | 44 |
| 2019 August | 14 | 19 | 33 |
| 2019 July | 12 | 18 | 30 |
| 2019 June | 29 | 19 | 48 |
| 2019 May | 21 | 19 | 40 |
| 2019 April | 49 | 32 | 81 |
| 2019 March | 37 | 22 | 59 |
| 2019 February | 30 | 23 | 53 |
| 2019 January | 31 | 14 | 45 |
| 2018 December | 104 | 35 | 139 |
| 2018 November | 54 | 10 | 64 |
| 2018 October | 88 | 13 | 101 |
| 2018 September | 65 | 21 | 86 |
| 2018 August | 46 | 17 | 63 |
| 2018 July | 52 | 11 | 63 |
| 2018 June | 47 | 13 | 60 |
| 2018 May | 44 | 16 | 60 |
| 2018 April | 69 | 9 | 78 |
| 2018 March | 62 | 8 | 70 |
| 2018 February | 43 | 6 | 49 |
| 2018 January | 47 | 5 | 52 |
| 2017 December | 57 | 9 | 66 |
| 2017 November | 52 | 15 | 67 |
| 2017 October | 39 | 6 | 45 |
| 2017 September | 38 | 17 | 55 |
| 2017 August | 31 | 17 | 48 |
| 2017 July | 35 | 9 | 44 |
| 2017 June | 31 | 6 | 37 |
| 2017 May | 39 | 11 | 50 |
| 2017 April | 35 | 6 | 41 |
| 2017 March | 30 | 7 | 37 |
| 2017 February | 30 | 11 | 41 |
| 2017 January | 22 | 12 | 34 |
| 2016 December | 52 | 6 | 58 |
| 2016 November | 83 | 6 | 89 |
| 2016 October | 134 | 6 | 140 |
| 2016 September | 205 | 7 | 212 |
| 2016 August | 180 | 5 | 185 |
| 2016 July | 171 | 10 | 181 |
| 2016 June | 122 | 0 | 122 |
| 2016 May | 119 | 0 | 119 |
| 2016 April | 85 | 0 | 85 |
| 2016 March | 68 | 0 | 68 |
| 2016 February | 82 | 0 | 82 |
| 2016 January | 88 | 0 | 88 |
| 2015 December | 117 | 0 | 117 |
| 2015 November | 76 | 0 | 76 |
| 2015 October | 71 | 0 | 71 |
| 2015 September | 78 | 0 | 78 |
| 2015 August | 62 | 0 | 62 |
| 2015 July | 49 | 0 | 49 |
| 2015 June | 30 | 0 | 30 |
| 2015 May | 42 | 0 | 42 |
| 2015 April | 5 | 0 | 5 |
Show all
