Glucose Polymer as an Osmotic Agent in CAPD

  • C. D. Mistry
  • R. Gokal
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 260)


Ultrafiltration in peritoneal dialysis is primarily an osmotically driven phenomenon achieved by means of dialysis solution made hypertonic to plasma by addition of osmotic agents. This traditional practice stemmed from early experimental work demonstrating changes in volumes of both hypo- and hypertonic solutions in the peritoneal cavity in accordance with the laws of osmosis (1,2). This seemed to confirm the “semipermeable” nature of the peritoneal membrane. Since small molecular weight solutes generate greater osmolality per unit mass, the use of crystalloids was considered as the most appropriate osmotic agents. However, amongst many of the solutes evaluated (3), only glucose proved to be safe as well as effective (4).


Peritoneal Dialysis Osmotic Agent Peritoneal Membrane Glucose Polymer Metabolic Side Effect 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Wegner, G.: Chirurgische Bemerkungen über die Peritonealhöhle, mit besonderer Berücksichtigung der Ovariotome. Arch. Klin. Chir. 20:51 (1877) .Google Scholar
  2. 2.
    Putman, J.: The living peritoneum as a dialysing membrane. Am. J. Physiol. 63:548 (1923) .Google Scholar
  3. 3.
    Cunningham, R.S.: Studies on absorption from serous cavities III. The effect of dextrose upon the peritoneal mesothelium. Am. J. Physiol. 53:458 (1920).Google Scholar
  4. 4.
    Palmer, R.A., Quinton, W.E., Gray, J.F.: Prolonged peritoneal dialysis for chronic renal failure. Lancet 1:700 (1964).PubMedGoogle Scholar
  5. 5.
    Popovich, R., Moncrief, J., Denchard, J., Bomar, J.B., Pyle, W.K.: The defination of a novel portable/ wearable equilibrium dialysis technique. Trans. Am. Soc. Artif. Int. Organs 5:64 (1976).Google Scholar
  6. 6.
    Pyle, W.K., Popovich, R.P., Moncrief, J.W.: Mass transfer evaluation in peritoneal dialysis. In: Moncrief, J.W., Popovich, R.P. eds. CAPD update. Masson N.Y., p. 35 (1981).Google Scholar
  7. 7.
    Hain, H., Kessel, M.: Aspect of new solutions for peritoneal dialysis. Nephrol. Dial. Transplant. 2:67 (1987) .PubMedGoogle Scholar
  8. 8.
    Duwe, A.K., Vas, S.I., Weatherhead, J.W.: Effect of the composition of peritoneal dialysis fluid on chemiluminescence , phagocytosis and bacterial activity in vitro. Infect. Immunity 33:130 (1981).Google Scholar
  9. 9.
    Ota, K., Mineshima, M., Watanabe, N., Naganuma, S.: Functional deterioration of the peritoneum: Does it occur in the absence of peritonitis? Nephrol. Dial. Transplant. 2:30 (1987).PubMedGoogle Scholar
  10. 10.
    Raja, R.M., Kramer, M.S., Manchanda, R., Lazaro, N., Rosenbaum, J.L.: Peritoneal dialysis with fructose dialysate — Prevention of hyperglycemia and hyperosmolality. Ann. Intern. Med. 79:511 (1973).PubMedGoogle Scholar
  11. 11.
    Bazzato, G., Coli, U., Landinis, S., Fracasso, A., Morachiello, P., Righetto, F., Scanferla, F.: Xylitol and low dosage of insulin: new perspectives for diabetic uraemic patients on CAPD. Perit. Dial. Bull. 2:161 (1982).Google Scholar
  12. 12.
    Raja, R.M., Moros, J.G., Kramer, M.S., Rosenbaum, J.L.: Hyperosmotic coma complicating peritoneal dialysis with sorbitol dialysate. Ann. Intern. Med. 73: 993 (1970).PubMedGoogle Scholar
  13. 13.
    Twardowski, Z.J., Khanna, R., Nolph, K.D.: Osmotic agents and ultrafiltration in peritoneal dialysis. Nephron 42:93 (1986) .PubMedCrossRefGoogle Scholar
  14. 14.
    Daniels, F.H., Leonard, E.F., Cortell, S.: Glucose and glycerol compared as osmotic agents for peritoneal dialysis. Kidney Int. 25:20 (1984).PubMedCrossRefGoogle Scholar
  15. 15.
    Heaton, A., Ward, M.K., Johnston, D.G., Nicholson, D.V., Alberti, K.G.M.M., Kerr, D.N.S.: Short term studies on the use of glycerol as an osmotic agent for continuous ambulatory dialysis in end stage renal failure. Clin. Science 67:121 (1984).Google Scholar
  16. 16.
    Heaton, A., Ward, K.D., Johnston, D.G., Alberti, K.G.M.M., Kerr, D.N.S.: Evaluation of glycerol as an osmotic agent for continuous ambulatory peritoneal dialysis in end stage renal failure. Clin. Science70:23 (1986).Google Scholar
  17. 17.
    Matthys, E., Dolkart, R., Lameire, N.: Potential hazards with the use of glycerol dialysate in diabetic CAPD patients. Perit. Dial. Bull. 7:16 (1987).Google Scholar
  18. 18.
    Matthys, E., Dolkart, R., Lameire, N.: Extended use of a glycerol containing dialysate in the treatment of diabetic CAPD patients. Perit. Dial. Bull. 7:10 (1987).Google Scholar
  19. 19.
    Oreopoulos, D.G., Crassweller, P., Kartirtzoglou, A., Ogilvie, R., Zellerman, G. , Rodella, H., Vas, S.I.: Amino acids as an osmotic agent in continuous peritoneal dialysis. In: Legrain M. (ed.) Continuous Ambulatory Peritoneal Dialysis. Excerpta Medica, Amsterdam, p. 335 (1979).Google Scholar
  20. 20.
    William, P.F., Marliss, E.B., Anderson, G.H., Oren, A., Stein, A.N., Khanna, R., Pettit, J., Brandes, L., Rodella, H., Mupas, L., Dombros, N. , Oreopoulos, D.G.: Amino acid absorption following intraperitoneal administration in CAPD patients. Perit. Dial. Bull. 2: 124 (1982).Google Scholar
  21. 21.
    Oren, A., Wu, G., Anderson, G.H., Marliss, E., Khanna, R., Pettit, J., Mupas, L., Rodella, H., Brandes L., Roncari, D., Kakis, G., Harrison, J., McNeill, K., Oreopoulos, D.G.: Effective use of amino acids dialysate over 4 weeks in CAPD patients. Perit. Dial. Bull. 3:66 (1983).Google Scholar
  22. 22.
    Dombros, N., Prutis, K., Tong, M., Anderson, H., Harrison, J., Sombolos, K., Digenis, G., Oreopoulos, D.G.: Six-month overnight intraperitoneal amino acid in CAPD patients: No effect on nutritional status. Nephrol. Dial. Transplant. 3:556 (1988).Google Scholar
  23. 23.
    Jirka, J., Kotkova, E.: Peritoneal dialysis by isooncotic dextran solution in anaesthetized dogs. Intraperitoneal fluid volumes and peritoneal concentration in the irrigation fluid. Proc. EDTA 4:141 (1967).Google Scholar
  24. 24.
    Gjessing, J.: Use of dextran as a dialysing fluid in peritoneal dialysis. Acta Med. Scand. 185:237 (1969).PubMedCrossRefGoogle Scholar
  25. 25.
    Twardowski, Z.J., Moore, H., McGary, T., Poskuta, M., Hirszel, P., Stathakis, C: Polymer as osmotic agents in peritoneal dialysis. Perit. Dial. Bull. 4:125 (1984) .Google Scholar
  26. 26.
    Kiil, F.: Mechanisms of osmosis. Kidney Int. 21:303 (1982).PubMedCrossRefGoogle Scholar
  27. 27.
    Herbert, S.C., Schafer, J.A., Andreoli, T.E.: Principles of membrane transport, In: Brenner, B.M., Rector FC (eds). The Kidney 2nd ed. vol I. Philadelphia, Saunders, W.B., p. 116 (1981).Google Scholar
  28. 28.
    Bibby, R.J., Davies, D., Mallick, N.P., Atherton, S.T., Wright, D.M, Rickett, R., Milner, J.: Intravenous infusion of a dextrin caloreen in human subjects: metabolic studies. Br. J. Nutr. 38:341 (1977).PubMedCrossRefGoogle Scholar
  29. 29.
    Weser, E., Sleisenger, M.H.: Metabolism of circulating disaccharides in man and in the rat. J. Clin. Invest. 46:499 (1967).PubMedCrossRefGoogle Scholar
  30. 30.
    Mistry, C.D., Gokal, R. , Mallick, N.P.: Glucose Polymer as an osmotic agent in CAPD. In: Maher, J.F., Winchester, J.F. (eds). Frontiers in Peritoneal Dialysis. Field Rich & Assoc. New York, p. 241 (1986).Google Scholar
  31. 31.
    Mistry, CD., Mallick, N.P., Gokal, R. : Ultrafiltration with an isosmotic solution during long peritoneal dialysis exchanges. Lancet ii:178 (1987).CrossRefGoogle Scholar
  32. 32.
    Mistry, C.D., Turner, K. , Uttley, L., Gokal, R. : Can UF occur with hypoosmolar solutions across the peritoneum? Perit. Dial. Bull. 7: 53 (1987) .Google Scholar
  33. 33.
    Mistry, C.D., Gokal, R.: The use of Glucose Polymer in CAPD: a 7 day study. Perit. Dial. Bull. 7:54 (1987).Google Scholar

Copyright information

© Plenum Press, New York 1989

Authors and Affiliations

  • C. D. Mistry
    • 1
  • R. Gokal
    • 1
  1. 1.Manchester Royal InfirmaryManchesterEngland

Personalised recommendations