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BACKGROUND: Ultrafiltration failure (UFF) is a complication of peritoneal dialysis (PD) treatment that occurs especially in long-term patients. Etiological factors include a large effective peritoneal surface area measured as high mass transfer area coefficient (MTAC) of creatinine, a high effective lymphatic absorption rate (ELAR), a large residual volume, or combinations. OBJECTIVE: The prevalence and etiology of UFF were studied and the contribution of transcellular water transport (TCWT) was analyzed. A new definition of UFF and guidelines for the analysis of its etiology were derived from the results. SETTING: Peritoneal dialysis unit in the Academic Medical Center in Amsterdam. DESIGN: Cross-sectional study of standard peritoneal permeability analyses (4-hr dwells, dextran 70 as volume marker) with 1.36% glucose in 68 PD patients. Patients with negative net UF (change in intraperitoneal volume, dIPV 5 mmol/L, indicating normal TCWT. The 3 patients with dNA 5 mmol/L group, but no differences were present for MTAC creatinine, ELAR, residual volume, or glucose absorption. CONCLUSIONS: In addition to known factors, impairment of TCWT can be a cause of UFF. A standardized dwell with 1.36% glucose overestimates UFF. Therefore, 3.86% glucose should be used for identification of patients with UFF, especially because it provides additional information on TCWT. Ultrafiltration failure can be defined as net UF < 400 mL/4 hr with 3.86% glucose during a 4-hour exchange.
Pannekeet et al. (Sat,) studied this question.