Isolated ultrafiltration and new techniques of ultrafiltration during dialysis.
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Biomedical subjects
Publications and source records attributed to T S Ing.
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Previous measurements of fluid absorption from the peritoneal cavity were made after a single injection of a protein-bound marker by following changes in the concentration of the marker with time. Absorption of the marker substance itself had to be estimated. The present study measured absorption of peritoneal fluid by more direct methods. 1.5 to 2.1 L of 0.9% saline, along with 10 muCi of RISA were infused into the abdomens of nine chronic renal failure patients through peritoneal dialysis catheters. Initial paritoneal fluid volumes were determined by dilution. After 7 hr, a second dose of RISA (5 muCi) was infused, and volumes in the peritoneal cavity were again determinted by dilution of the increment dose. At 8 hr, an attempt was made to recover the RISA remaining in the peritoneal cavity by draining and repeatedly flushing that space. The amount of RISA recovered was used to calculate independently the amounts of RISA and fluid which had been absorbed during the 8 hr period. There was good agreement between peritoneal fluid volumes calculated at 7 and 8 hr by these and other techniques. By 7 hr, 23.8% +/- 10.9 S.D. of the initial peritoneal fluid volume ahd been absorbed. The amount of RISA absorbed during the same period was 17.3% +/- 4.9 of the initially administered dose. At 7 hr, only 23.7% +/- 6.3 of the absorbed RISA was in the plasma. The proposed techniques of volume measurement are valid and point to great variation among patients in the rate of fluid absorption from the peritoneal cavity.
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Five patients receiving maintenance peritoneal dialysis (duration, three months to four years) required surgical exploration of the abdomen for various reasons. Four had a prior history of bacterial peritonitis, and four of aseptic peritonitis. At laparotomy, the peritoneal membrane was found to be markedly thickened and sclerotic in all patients, and loops of bowel were bound together in a dense, opaque casing. On microscopic examination, an increase in fibroconnective tissue in the peritoneum was observed.
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Three patients with dialysis ascites improved markedly after treatment with isolated ultrafiltrations. This simple, noninvasive technique should be applied first to patients with dialysis ascites before resorting to more drastic therapeutic measures.
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Hemofiltration using the postdilution technique and a modified saline solution as the replacement fluid succeeded in treating the metabolic alkalosis of two patients with renal failure.
An 'epidemic' of aseptic peritonitis occurred in our peritoneal dialysis unit, affecting 5 of 20 patients. Acute and convalescent viral titers were normal in all 5. The peritoneal fluid of the affected patients was not tested for endotoxin, but endotoxin was found in subsequent dialysis fluids from two machines in the unit. This endotoxin might have been the causative agent of this outbreak. Rapid recovery ensued in all patients following peritoneal lavage.
Olecranon bursitis with effusion in four maintenance hemodialysis patients was successfully treated with simple aspiration.
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