Advances in Peritoneal Dialysis

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Title Influence of Osmotic and Oncotic Factors on Gentamicin and Insulin Transport Across the Peritoneal Membrane In Vitro
Author Teresa Grzelak, Katarzyna Wojciechowska, Beata Szary, Krystyna Czyzewska
Glucose or its polymer is usually added to dialysis solution for the development of sufficient ultrafiltration during peritoneal dialysis. The aim of the present study 
was to determine the influence of glucose and icodextrin on the transport of gentamicin and insulin from the mesothelial to the interstitial side of the peritoneal 
membrane. Transfer values are expressed as a coefficient of diffusive permeability, P, in centimeters per second. Each of the molecules was tested in 3 series 
of experiments using rabbit parietal peritoneum, a modified Ussing chamber, and a mathematical model of mass transport. First, transperitoneal transfers of gentamicin (0.040 g/dL) and insulin (0.1 g/dL) were analyzed in control conditions for 120 minutes. Then, transport parameters for gentamicin and insulin were separately determined before (15 – 60 minutes) and after (75 – 120 minutes or 75 – 130 minutes) the application of glucose (1.8 g/dL) or icodextrin (2 g/dL) on the mesothelial side of the peritoneal membrane. Insulin transport was observed to be stable in the control series. Gentamicin transfer was not stable; its passage declined by 52% (p < 0.01) in the control series. The mean transfer parameters were 
7.41 ± 1.40 cm/s (×0.0001) over 15 – 30 minutes and 3.21 ± 0.54 cm/s (×0.0001) over 75 – 130 minutes. Gentamicin transfer declined less in the series with glucose or icodextrin, by 21% (p < 0.04) and 30% (p < 0.05) respectively, than in the control series. For insulin, the mean P (± standard error of the mean) was 0.15 ± 0.02 cm/s (×0.0001) at the first hour of transfer and 0.14 ± 0.02 cm/s (×0.0001) at the second.
Glucose induced a nonsignificant intensification of insulin transport. Icodextrin increased insulin passage by 107% (p < 0.03). Osmotic and oncotic factors 
(glucose and icodextrin) both stabilize the transfer of gentamicin across the peritoneal membrane in vitro. Glucose polymer intensifies insulin transport from the 
mesothelial to the interstitial side of the peritoneum. Similar modifications might be observed in vivo during peritoneal dialysis or continuous intraperitoneal administration of insulin, influencing the efficiency of those treatments.

1 Galach M, Werynski A, Waniewski J, Freida P, Lindholm B. Kinetic analysis of peritoneal fluid and solute 
transport with combination of glucose and icodextrin 
as osmotic agents. Perit Dial Int 2009;29:72–80.
2 Aroeira LS, Aguilera A, Sánchez–Tomero JA, et al. 
Epithelial to mesenchymal transition and peritoneal 
membrane failure in peritoneal dialysis patients: 
pathologic significance and potential therapeutic interventions. J Am Soc Nephrol 2007;18:2004–13.
3 Krediet RT. 30 Years of peritoneal dialysis development: the past and the future. Perit Dial Int 
2007;27(suppl 2):S35–41.
4 Paniagua R, Ventura MD, Avila–Díaz M, et al. Ico Ico--
dextrin improves metabolic and fluid management 
in high and high-average transport diabetic patients. 
Perit Dial Int 2009;9:422–32.
5 Freida P, Galach M, Divino Filho JC, Werynski A, 
Lindholm B. Combination of crystalloid (glucose) 
and colloid (icodextrin) osmotic agents markedly enhances peritoneal fluid and solute transport during the 
long PD dwell. Perit Dial Int 2007;27:267–76.
6 Ranganathan D, Varghese JM, Fassett RG, et al. Optimising intraperitoneal gentamicin dosing in peritoneal 
dialysis patients with peritonitis (GIPD) study. BMC 
Nephrology 2009;10:42.
7 Voges M, Faict D, Lechien G, Taminne M. Stability 
of drug additives in peritoneal dialysis solutions in a 
new container. Perit Dial Int 2004;24:590–5.
8 Li PK, Szeto CC, Piraino B, et al. Peritoneal dialysisrelated infections recommendations: 2010 update. 
Perit Dial Int 2010;30:393–423.
9 Huang CC. Treatment targets for diabetic patients 
on peritoneal dialysis: any evidence? Perit Dial Int 
2007;27(suppl 2):S176–9.
10 Pantsulaia T, Chokhonelidze I, Lomitashvili T. 
Estimate the insulin absorption in diabetic patients on peritoneal dialysis. Georgian Med News 
11 Logtenberg SJ, Kleefstra N, Houweling ST, et al. Improved glycemic control with intraperitoneal versus 
subcutaneous insulin in type 1 diabetes: a randomized 
controlled trial. Diabetes Care 2009;32:1372–7.
12 Renard E, Place J, Cantwell M, Chevassus H, Palerm 
CC. Closed-loop insulin delivery using a subcutaneous glucose sensor and intraperitoneal insulin 
delivery feasibility study testing a new model for the 
artificial pancreas. Diabetes Care 2010;33:121–7.
13 Czyżewska K, Szary B, Waniewski J. Transperitoneal transport of glucose in vitro. Artif Organs 
14 Szary B, Grzelak T, Czyżewska K. Icodextrin peritoneal transport in vitro: effect of sodium deoxycholate, glucose, and methylglyoxal. Artif Organs 
15 Galach M, Waniewski J, Axelsson J, Heimbürger O, 
Werynski A, Lindholm B. Mathematical modeling of 
the glucose–insulin system during peritoneal dialysis 
with glucose-based fluids. ASAIO J 2011;57:41–7.
16 Janicka L, Majdan M, Solski J, Baranowska–Daca E, 
Kimak E. Influence of intraperitoneal gentamicin on 
peritoneal transport in IPD patients. Int Urol Nephrol 
17 Szary B, Czyżewska K. Diffusive permeability of 
rabbit peritoneum for small solutes in vitro: effect of gentamicin and insulin. Int J Artif Organs 
18 Czyżewska K, Szary B. Transperitoneal glucose 
transport. Study of function and results (monograph 
in Polish). Poznań, Poland: Poznań University of 
Medical Science Publishers; 2001.
19 Lin A, Qian J, Li X, et al. Randomized controlled 
trial of icodextrin versus glucose containing 
peritoneal dialysis fluid. Clin J Am Soc Nephrol 
20 Finkelstein F, Healy H, Abu-Alfa A, et al. Superiority of icodextrin compared with 4.25% dextrose 
for peritoneal ultrafiltration. J Am Soc Nephrol 
21 Fine A, Parry D, Ariano R, Dent W. Marked variation 
in peritoneal insulin absorption in peritoneal dialysis. 
Perit Dial Int 2000;20:652–5.

Keywords Peritoneal transport, glucose, icodextrin, gentamicin, insulin
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