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Airway surface liquid osmolality measured using fluorophore-encapsulated liposomes.

The airway surface liquid (ASL) is the thin layer of fluid coating the luminal surface of airway epithelial cells at an air interface. Its composition and osmolality are thought to be important in normal airway physiology and in airway diseases such as asthma and cystic fibrosis. The determinants of ASL osmolality include epithelial cell solute and water transport properties, evaporative water loss, and the composition of secreted fluids. We developed a noninvasive approach to measure ASL osmolality using osmotically sensitive 400-nm-diam liposomes composed of phosphatidylcholine/cholesterol/polyethylene glycol-phosphatidylcholine (1:0.3:0.08 molar ratio). Calcein was encapsulated in the liposomes at self-quenching concentrations (30 mM) as a volume-sensitive marker, together with sulforhodamine 101 (2 mM) as a volume-insensitive reference. Liposome calcein/sulforhodamine 101 fluorescence ratios responded rapidly (< 0.2 s) and stably to changes in solution osmolality. ASL osmolality was determined from calcein/sulforhodamine 101 fluorescence ratios after addition of microliter quantities of liposome suspensions to the ASL. In bovine airway epithelial cells cultured on porous supports at an air-liquid interface, ASL thickness (by confocal microscopy) was 22 microm and osmolality was 325 +/- 12 mOsm. In anesthetized mice in which a transparent window was created in the trachea, ASL thickness was 55 microm and osmolality was 330 +/- 36 mOsm. ASL osmolality was not affected by pharmacological inhibition of CFTR in airway cell cultures or by genetic deletion of CFTR in knockout mice. ASL osmolality could be increased substantially to > 400 mOsm by exposure of the epithelium to dry air; the data were modeled mathematically using measured rates of osmosis and evaporative water loss. These results establish a ratio imaging method to map osmolality in biological compartments. ASL fluid is approximately isosmolar under normal physiological conditions, but can become hyperosmolar when exposed to dry air, which may induce cough and airway reactivity in some patients.

Animals↗

Studies on the electrical properties of a single plant cell; internodal cell of Nitella flexilis.

Impedance changes of single plant cells of Nitella flexilis were studied under different environmental conditions. With the analysis presented changes in resistance of the protoplasmic membrane and of cell sap can be studied independently and simultaneously. Under "transcellular osmosis," the resistance of the protoplasmic membrane and of the cell sap increase at the part of the cell where water enters, while they decrease where water goes out. Ethanol of low concentration (below 8 per cent) first decreases and later increases the resistance of the protoplasmic membrane. Concentrated ethanol (over 10 per cent), however, brings about a large decrease in resistance of the protoplasmic membrane. Its time course is not simple, but undulatory changes occur. When ethanol is applied to one part of the cell, the resistance of the protoplasmic membrane shows a different type of change, which may be attributed to the local osmotic effect of ethanol; injury generally occurs with comparatively low concentration. Methanol, ethanol, and propanol have almost the same effect upon the cell, while butanol is toxic at the same concentration. When the cell dies, the resistance of the protoplasmic membrane decreases greatly, while the resistance of the cell sap increases to a level (several hundred kilo ohms or more), expected when external solution and cell sap are freely mixed with each other.

Cells↗

The relation between salt and ionic transport coefficients.

The reflection coefficient was originally introduced by Staverman to describe the movement of nonelectrolytes through membranes. When this coefficient is extended to salts, one has a choice of defining this term for the whole salt moving as a single electrically neutral component or for the individual ions of the salt. The latter definition is meaningful only in the absence of an electric field across the permeability barrier. This condition may be achieved with the voltage clamp or short-circuit technique and is especially useful in dealing with biological systems in which one rarely has only a single salt or even equal concentrations of the major anion and cation. The relations between the transport coefficients for the salt and its individual ions are derived. The special conditions which may result in negative osmosis through a charged membrane in the presence of a salt are discussed.

Biological Transport↗

Water chloride provides partial protection during chronic exposure to waterborne silver in rainbow trout (Oncorhynchus mykiss) embryos and larvae.

Rainbow trout embryos and larvae were continuously exposed (at 12.5 degrees C) to waterborne silver in a flow-through setup, from fertilization to swim-up, at nominal silver concentrations of 0, 0.1, or 1.0 microg/L total silver (as AgNO(3)) at three different water Cl(-) levels (30, 300, and 3,000 microM, added as KCl). Exposures were conducted in synthetic soft water (hardness 20 mg CaCO(3)/L generated from reconstituted reverse osmosis freshwater). Continuous exposure to 1.0 microg/L total silver for 58 d at 30 microM water Cl(-) resulted in a pronounced ionoregulatory disturbance (as indicated by a reduction in whole body Na(+),K(+)-ATPase activity, unidirectional Na(+) uptake [Jin Na(+)], and whole body Na(+) and Cl(-) levels) and a reduction in extractable protein and wet weight. Thus, the mechanism of chronic silver toxicity appears to be similar to that observed during acute silver exposure in juvenile and adult fish, specifically an ionoregulatory disturbance. Higher water Cl(-) levels (300 and 3,000 microM Cl(-)) offered some degree of protection from the ionoregulatory disturbance, with only minor protective effects in terms of mortality. The protective effects of water Cl(-) on the toxicity of silver (as AgNO(3)) appear to be far less during chronic than during acute exposure. Mortality and larval Na(+) concentration, Jin Na(+), and Na(+),K(+)-ATPase activity all appear to be correlated with silver body burden and calculated water Ag(+) during chronic silver exposure. Thus, there appears to be potential to model chronic toxicity but not simply by recalibration of an acute model. A chronic model must be based on real chronic data because the protective effects of various ligands appear to be quantitatively very different from those in the acute situation.

Adenosine Triphosphatases↗

Development of low reactive-level laser therapy and its present status.

A new subspecialty in the medical application of the laser has developed, especially over the last decade, depending on the therapeutic rather than the surgical applications of the laser. Laser therapy, or preferably, Low reactive-Level Laser Therapy (LLLT) is now being recognized as a valid medical tool. Two types of LLLT are presented, simultaneous and pure. In surgical laser applications, ranges of heat are generated in the target tissue, destroying or altering its architecture. This is referred to as high reactive-level laser treatment, or HLLT. In addition, nonphotothermally destructive reactions may also occur, such as photo-osmosis. These are also part of HLLT. Simultaneously, nondestructive thermal and nonthermal bioactivation occur at the periphery of the target tissue: this is "simultaneous LLLT" and occurs along with HLLT, explaining some of the advantages of laser surgery. Laser systems have been developed which deliver power and energy densities below the destructive level, only to activate the irradiated tissue. This is "pure LLLT." The history and background of LLLT are presented, the terminology discussed, and practical applications of LLLT are presented.

Female↗

The importance of water quality for media preparation.

The variability in pregnancy rates achieved among in-vitro fertilization (IVF) clinics may be partially attributable to the disparate quality of the water used in the preparation of culture media. The removal of contaminants in the water is of paramount importance since water constitutes the predominant component in any media formulation. To assist in the selection, operation and maintenance of a water purification system, the level of contaminants must be carefully monitored. Conductivity and resistance are used to measure the purity of natural and ultrapure water respectively. Feed water is analysed by an assortment of direct chemical means to determine the necessary system filtration steps. In general, high quality water can be produced by combined reverse osmosis and electrodeionization of treated tap water. Processed water is supplied to an ultrapure water system to provide final polished water. A detailed water processing protocol is presented along with quality assurance guidelines to ensure the consistent production of high quality ultrapure water suitable for in-vitro human embryo culture.

Animals↗

Adequacy of dialysis: trace elements in dialysis fluids.

A number of considerations suggest that trace element disturbances might occur in dialysed patients. These must at least in part be ascribed to the dialysis treatment itself during which these constituents may either be transferred to or removed from the patient. Tap water must be considered as the main source of dialysate trace metal contamination. These can adequately be removed during water treatment provided that, in addition to softening and deionization, reverse osmosis is available. However, even in the presence of the latter devices the possibility of serious contamination of the dialysis fluids leading to either chronic or acute intoxications still exists. The addition of chemical concentrates may also contribute to the increased concentrations of a number of trace metals. The toxic effects of aluminium in dialysis patients are well known and at the present time the element is still responsible for the greater part of trace metal-related problems in dialysis patients. Hence, the need for regular monitoring of aluminium cannot be ruled out at present. Strategies for diagnosis and treatment of aluminium overload have been updated. Recent studies demonstrated the efficacy of low desferrioxamine doses in diagnosis and treatment of aluminium overload, and optimal schedules for administration of the chelator and duration of treatment have been presented. Recently, in an epidemiological survey serum silicon concentrations in dialysis patients were found to be increased up to 100-fold compared to subjects with normal renal function. Moreover, it was noted that silicon concentrations in the dialysis population differ from one centre to another and that increased levels are due to either the use of silicon-contaminated dialysis fluids or an increased oral intake of the element originating from a high silicon content in the drinking water. Besides aluminium and silicon, a transfer towards the patients during dialysis has also been reported for a number of other elements including copper, zinc, nickel, strontium and chromium. The possible consequences of dialysate contamination with these elements will briefly be dealt with in the present paper. In contrast to trace metal accumulation, removal of trace metals during dialysis may at least in part contribute to the relative deficiency of particular essential elements. Selenium deficiency has repeatedly been observed. In view of the element's well-known essential role in glutathion peroxidase activity and the association of its deficiency with the development of some malignant diseases, further studies on the clinical impact of decreased serum selenium in dialysis patients are worthwhile. In conclusion, trace metal dialysate contamination/ depletion may contribute to the disturbed trace element concentration in dialysis patients. Aluminium accumulation is still an important problem in clinical nephrology. The clinical importance of the accumulation/ deficiency of trace elements other than aluminium is not yet fully understood and deserves further investigation.

Aluminum↗

Improved bacteriological surveillance of haemodialysis fluids: a comparison between Tryptic soy agar and Reasoner's 2A media.

BACKGROUND: Accurate microbiological surveillance in haemodialysis centres is important as end-stage renal patients can suffer from pyrogenic reactions due to bacterial contamination of dialysis fluids. To evaluate the microbiological quality of haemodialysis fluids, special nutrient-poor culture techniques are necessary. Although the Association for the Advancement of Medical Instrumentation (AAMI) recommends Tryptic soy agar (TSA) as the standard agar, several studies have resulted in a general preference for Reasoner's 2A (R2A) agar, as it appeared to be more sensitive in demonstrating contamination of typical haemodialysis associated bacteria. In the Netherlands TSA is still used for culturing dialysate, while dialysis water is cultured on R2A. Therefore, the aims of our study were to evaluate bacterial yields of dialysis fluids on both media, and to qualify their use in routine microbiological monitoring within our haemodialysis centre. METHODS: Between April 1995 and March 1996, 229 samples of pre-treated and final purified dialysis water, and samples of dialysates were collected. The specimens were aseptically taken from the tap, various points of the reverse osmosis (RO) water-treatment system, and the effluent tubes of 32 bicarbonate haemodialysis machines. Samples of 0.1 ml were inoculated in duplicate on spread plates with TSA and R2A agars. After 10 days of incubation at 25+/-2 degrees C, the numbers of colonies were quantified. The ranges of spread were taken 0-100 and 0-200 colony-forming units per milliliter (c.f.u./ml). RESULTS: The R2A agar had significantly higher colony counts than TSA agar for both dialysis water and dialysates. Considering 100 c.f.u./ml as the upper allowable bacterial limit for all dialysis fluids, microbiological non-compliance (bacterial growth) would be missed in 16% when using only TSA media (TSA < or =100 c.f.u./ml and R2A >100 c.f.u./ml), while this was 3% when using only R2A (TSA >100 c.f.u./ml and R2A < or =100 c.f.u./ml, P<0.0001). Considering 200 c.f.u./ml as the upper limit, non-compliance would have been missed in 10% when using only TSA (TSA < or =200 c.f.u./ml and R2A >200 c.f.u./ml), and 2% when using R2A (TSA > 200 c.f.u./ml and R2A < or =200 c.f.u./ml, P = 0.0011). CONCLUSIONS: Microbiological surveillance of haemodialysis fluids, including pre-treated dialysis water samples collected from RO treatment systems, can be performed more precisely with R2A media than TSA, when incubated at 25+/-2 degrees C for 10 days.

Agar↗

The quality of dialysis water.

INTRODUCTION: Every week, haemodialysis patients are exposed to approximately 400 l of water used for the production of dialysis fluids which, albeit with the interposition of a semi-permeable artificial membrane, come into direct contact with the bloodstream. It is therefore clearly important to know and monitor the chemical and microbiological purity of dialysis water. METHODS: In this review, we analyse the sources of chemical and microbiological water contamination, and the problems involved in water purification systems and modalities. We also analyse the compliance of dialysis units with the microbiological standards established by the most widely accepted guidelines relating to the quality of dialysis fluids. RESULTS: The risk of chemical contamination is due mainly to the primary pollution of municipal water, whereas the most important microbiological problem is the control of bacterial growth in the water treatment and distribution system. Dialysis water treatment implies various levels of pre-treatment, a final purification module (which, in many cases, is reverse osmosis: RO) and a hydraulic circuit for the distribution of the purified water. RO-based treatment systems produce water of optimal chemical and microbial quality, and so dialysis units need to concentrate on maintaining this quality level in the long term by means of effective maintenance and disinfection strategies. The most widely accepted standards for water purity are those recommended by the Association for the Advancement of Medical Instrumentation and the European Pharmacopea, which respectively allow bacterial growth of <200 and <100 c.f.u./ml, and an endotoxin concentration of <2 and <0.25 IU/ml. However, a number of multicentre studies have reported that 7-35% of water samples have bacterial growth of >200 c.f.u./ml, and up to 44% have endotoxin levels of >5 IU/ml. CONCLUSIONS: The results of multicentre studies indicate that the microbial quality of dialysis fluids is still a too often neglected problem, particularly as there is evidence of a possible relationship between dialysis fluid contamination and long-term morbidity. The time has now come to take advantage of innovations in water treatment processes and improvements in dialysis machines in order to modify clinical practices and start improvement processes aimed at decreasing the risk of microbial contamination to the minimum, as it has already been successfully done in the case of chemical contamination.

Dialysis Solutions↗

Inhibition of contractile vacuole function by brefeldin A.

Brefeldin A (BFA) causes a block in the secretory system of eukaryotic cells. In the scaly green flagellate Scherffelia dubia, BFA also interfered with the function of the contractile vacuoles (CVs). The CV is an osmoregulatory organelle which periodically expels fluid from the cell in many freshwater protists. Fusion of the CV membrane with the plasma membrane is apparently blocked by BFA in S. dubia. The two CVs of S. dubia swell and finally form large central vacuoles (LCVs). BFA-induced formation of LCVs depends on V-ATPase activity, and can be reversed by hypertonic media, suggesting that water accumulation in the LCVs is driven by osmosis. We suggest that the BFA-induced formation of LCVs represents a prolonged diastole phase. A normal diastole phase takes about 20 s and is difficult to investigate. Therefore, BFA-induced formation of LCVs in S. dubia represents a unique model system to investigate the diastole phase of the CV cycle.

Brefeldin A↗

Declassification of radioactive liquid wastes generated in radio immune assay [corrected] (RIA) laboratories.

Radioactive liquid wastes of low-medium activity level are generated in radio immune assay (RIA) laboratories, which are also potentially infectious because of the pathogens from patient blood. The most common way of managing these wastes consists of a temporal storage, for partial radioactivity decay, followed by management by an authorised company. The object of this work is to study the viability of treating radioactive liquid wastes coming from RIA using membrane techniques in order to reduce their volume, which would mean an improvement from the radiological point of view and a decrease in management costs. This paper describes the results of some experiments carried out with RIA real wastes, by means of processes such as ultrafiltration and reverse osmosis. It has been proved that waste volume can be significantly reduced, obtaining a treated liquid that is free of pathogens and organic matter and with an activity level around the environmental background.

Laboratories, Hospital↗

Aluminum exposure in chronic renal failure in iberoamerica at the end of the 1990s: overview and perspectives.

Epidemic aluminum neurotoxicity has virtually disappeared in the dialysis population; however, sporadic toxic effects caused by contamination of water with aluminum are still reported. In this review, the current situation in Iberoamerica is analyzed. Exposure to aluminum through dialysate shows considerable geographical differences even within the same country, including seasonal variability. Sometimes the tap water showed very high aluminum content that does not permit the water treatment system to efficiently remove all the aluminum, forcing the use of water treatment systems with a double reverse-osmosis filter on line. The use of adequate water treatment systems and a correct control policy has improved the quality of the dialysate, minimizing the aluminum exposure. However, an additional problem in Iberoamerica is the difficulty to obtain aluminum-free concentrates for the preparation of the final dialysis solution. Aluminum still seems to be implicated in a great percentage of symptomatic low-bone remodeling lesions in South America compared with Europe, demonstrating that exposure to aluminum through dialysate is still a cause of concern in some areas of the world.

Aluminum↗

Use of bone char as an adsorbent in preparation of water for dialysis.

Currently, deionizers (DI) and reverse osmosis (RO) are used to prepare water for dialysis. When water metal levels increase, for example, with the use of alum, the variation in metal content can reduce RO performance. Pretreatment of water with ethylenediaminetetraacetic acid or alkali can be used to reduce Al fouling. The authors examined adsorption of metal water contaminants with bone char (BRIMAC, Biolab, Oakville, Canada) as a cheaper alternative. Water treatment for the unit consists of a blend valve, 30 mu filter, 2 X 3 cu ft adsorption tanks, 5 mu filter, 30,000 grain automatic water softener, 5 mu filter, Millipore RO 1,000, 2 X 7" mixed bed DI in series, and a polysulfone ultrafilter. During 29 weeks of continuous bone char adsorption, raw water Al ranged from 0.022 to 0.298 ppm (mean, 0.097 +/- 0.075 ppm; cf. the Environmental Protection Agency's proposed drinking water standard of < 0.05 ppm). Postadsorption Al ranged from 0.002 to 0.076 ppm (0.041 +/- 0.04), a decrease of 55-91% (83.0 +/- 8.5%). Final water Al was < 0.001 at all times. No fouling of the RO membrane occurred. Residual chlorine after the first adsorption was < 0.02 to 0.09 ppm. Significant reductions in other metals, notably Pb, Cu, and Zn were noted. Bone char is a cheap, effective, and simple alternative for removing excess trace elements from water for hemodialysis. Further study to evaluate the efficacy of bone char in removing other organic and inorganic water contaminants is needed.

Adsorption↗

In search of sterile, endotoxin-free dialysate.

Sterile dialysate, free of endotoxin (ET) and other cytokine inducing factors, will probably become a future standard. High-flux dialysis with bicarbonate and reuse has the membrane, the pressures, and bacteriologic potential for ET fragments to pass from dialysate to the blood side of the membrane with activation of monocytes and production of cytokines. Ultrafiltration through polysulfone filters has been shown to remove bacteria, ET, and its fragments and other cytotoxic inducing factors. The authors found that in spite of sterile, ET-free, reverse osmosis (RO) water, ET was usually present at the dialyzer inlet and arose from the RO storage tank water with bacteria < 30 CFU/ml, in spite of repeated disinfection. The authors now remove bacteria, ET, and fragments from RO tank water with a 5 mu cellulose filter followed by ultrafiltration with a Fresenius F-80 polysulfone dialyzer inserted between the wall RO delivery port and each delivery system. At the dialyzer inlet, monthly bacterial counts were < 30 cfu/ml, and ET values (n = 38) were not detectable in 89% and < 0.5 EU/ml in 11%. The F-80 filters were used for 180+ dialyses along with the 5 mu filters, which replaced the frequently endotoxin contaminated 10 mu filters in the Monitral-S delivery systems. The costs did not increase.

Colony Count, Microbial↗

Biomedical publication for neurosurgery residents: a program and guide.

One of the most pressing obligations in academic neurosurgery is the publication of clinical and basic science research results. Publication documents intellectual property and communicates findings among researchers working to improve neurosurgical treatment. It documents productivity, justifies funding for research, creates reputations, and builds careers. Nonetheless, the actual writing of reports is a skill often learned by osmosis in academic medicine. To give residents the tools necessary to negotiate the biomedical publication process successfully, we developed a publications program based on the premise that residents seeking an academic career must be prepared to generate publishable reports with maximum efficiency. The program consists of a "publication kit," a series of seminars, and one-on-one tutorials with academic biomedical editors that permit residents individually to improve the quality of their reporting. We describe this program, provide guidelines that can help residents write high-quality papers and publish their work more efficiently, and summarize important content regarding the framework for a successful paper, the elements of a conventional research report, brief guidelines for specific types of papers, reporting standards for clinical trials and meta-analyses, keys to citation in bibliographic indexes, and ethical and legal considerations related to research approval, confidentiality requirements, copyright law, permission to use previously published material, and conflict of interest. Residents who are able to view their work with a sharp critical focus and are educated about the standards of biomedical publication are better prepared to succeed in building a career in academic medicine.

Curriculum↗

The effect of hyperbaric oxygenation on the viability of human fat injected into nude mice.

Autologous free-fat injection for the correction of soft-tissue defects has become a common procedure in plastic surgery. The main shortcoming of this method for achieving permanent soft-tissue augmentation is the partial absorption of the injected fat, an occurrence that leads to the need for both overcorrection and repeated fat reinjection. Improving the oxygenation of the injected fat has been suggested as a means of helping to overcome the initial critical phase that occurs postinjection (when the fat cells are nourished by osmosis), increasing phagocyte activity, accelerating fibroblast activity and collagen formation, and enhancing angiogenesis. In addition, the hyperbaric oxygen-mediated decrement in endothelial leukocyte adhesion will decrease cytokine release, thereby reducing edema and inflammatory responses. The purpose of the present study was to examine the effect of hyperbaric oxygenation on improving the viability of injected fat. Adipose tissue obtained from human breasts by suction-assisted lipectomy was injected into the subcuticular nuchal region in nude mice. The mice were then exposed to daily hyperbaric oxygen treatments, breathing 100% oxygen at 2 atmospheres absolute (ATA) for 90 minutes. The duration of the administered hyperbaric oxygen therapy was 5, 10, or 15 days, according to the study group. Mice exposed to normobaric air alone served as the control group, and each group included 10 animals. The rats were killed 15 weeks after fat injection. The grafts were dissected out, weight and volume were measured, and histologic evaluation was performed. In all of the study groups, at least part of the injected fat survived, giving the desired clinical outcome. No significant differences could be found between the groups regarding fat weight and volume. Histopathologic examination of the dissected grafts demonstrated a significantly better integrity of the fat tissue in the group that received hyperbaric oxygen for 5 days (p = 0.047). This finding was manifested by the presence of well-organized, intact fat cells, along with a normal appearance of the fibrous septa and blood vessels. The worst results were found in animals treated by hyperbaric oxygenation for 15 consecutive days. An inverse correlation was found between an increased dose of the high-pressure oxygen and fat tissue integrity (r = -0.87, p = 0.076). The toxic effects of highly reactive oxygen species on fat cells might explain the failure of an excessively high dose of hyperbaric oxygen to provide any beneficial outcome. The clinical relevance of these results should be further investigated.

Adipose Tissue↗

The role of albumin in fluid and electrolyte balance.

Albumin plays an important role in maintaining homeostasis within the body and depends on the cell membrane and the transport mechanism, including diffusion, osmosis, filtration, and active transport. The dissolved proteins, which are the only substances that do not penetrate the pores of the capillary membrane, are responsible for the osmotic pressure of the capillary membrane. Approximately 75% of the total colloid osmotic pressure is related to albumin.

Fluid Therapy↗

Peritoneal transport characteristics with glucose polymer-based dialysis fluid in children.

Scarce data are available on the use of glucose polymer-based dialysate in children. The effects of glucose polymer-based dialysate on peritoneal fluid kinetics and solute transport were studied in pediatric patients who were on chronic peritoneal dialysis, and a comparison was made with previously published results in adult patients. In nine children, two peritoneal equilibration tests were performed using 3.86% glucose and 7.5% icodextrin as a test solution. Dextran 70 was added as a volume marker to calculate fluid kinetics. Serum and dialysate samples were taken for determination of urea, creatinine, and sodium. After calculation of the initial transcapillary ultrafiltration (TCUF) rate, it was possible to calculate the contribution of aquaporin-mediated (AQP-mediated) water transport to ultrafiltration for icodextrin and 3.86% glucose and the part of L(p)S (the product of the peritoneal surface area and the hydraulic permeability) caused by AQP. In children, the transport parameters were similar for the two solutions, except for TCUF, which was lower for icodextrin (0.9 ml/min per 1.73 m(2)) as compared with 3.86% glucose (4 ml/min per 1.73 m(2)). Transport parameters were similar in children and adults for glucose, but with icodextrin, TCUF and marker clearance were significantly lower in children. AQP-mediated water flow was 83 versus 50% with glucose (child versus adult; P < 0.01) and 18 versus 7% with icodextrin (P < 0.01). Data indicate that transport parameters in children using icodextrin are similar to glucose except for TCUF. Differences are explained by the absence of crystalloid osmosis and that TCUF was determined after a 4-h dwell. Comparison of transport parameters and peritoneal membrane characteristics between children and adults reveal that there seem to be differences in the amount and functionality of AQP. However, there are no differences in clinical efficacy of this transport pathway because the absolute flow through the AQP is identical in both groups using 3.86% glucose.

Adult↗