Patient Transport Functions

If damp-heat accumulates in the Middle-Jiao, the transformation and transportation functions of the Spleen are impaired. Patients may suffer from loss of appetite and have a sticky sensation in the mouth. 

The K/DOQI clinical practice guidelines suggest that the adequacy of PD be assessed by using measured Kt/V and CEj three times in the first 6 months of dialysis (i.e., at months 1, 4, and 6). The reasoning behind this frequency is to accurately establish a baseline creatinine and urea excretion rate. Thereafter the KtA and Clcr should be measured every 4 months, at months 10, 14, and so on. The rationale for this is that it is imperative to detect subtle decreases in residual renal function and noncompliance and to make the necessary alterations to the prescribed PD dose to compensate for them. It is recommended that the first PET be conducted within the first month of treatment. Because solute clearance is dependent on peritoneal membrane transport properties, the guidelines also recommend that a PET be conducted within the first month of treatment. Future PET assessment is only recommended for patients with suspected changes in peritoneal membrane transport function, particularly when usual efforts to increase the PD dose are not successful. 

Alteration in mental status occurring in patients with systanic sepsis always carries a serious prognosis. The mechanisms of impaired brain function are poorly understood and are probably multifactorial. Considerations include hypoxia, ischemia, mitochondrial dysfunction and anaerobic cerebral energy metabolism, blood-brain barrier dysfunction or impaired transporter function, cerebral edema, toxins like ammonia or endotoxins, and last but not least, clinical use of cerebral depressants and sedatives in severely ill patients. In patients with multi-organ failure, clearance of common short-acting sedatives can become prolonged, resulting in severe and protracted alteration of mentation. 

Since the kidneys are the major site of RBP catabolism (as discussed earlier in this chapter), patients with functionally significant renal disease show disordered RBP and vitamin A metabolism. The effects of renal disease on the vitamin A transport system have been explored in some detail in a number of laboratories and clinics throughout the world. 

Twardowski Z, Nolph K, Khanna R et al (1987) Peritoneal equilibration test. Perit Dial Bull 7 138-147 Vychtytil A, Lilay T, Lorenz M et al (1999) Ultrasonography of the catheter tunnel in peritoneal dialysis patients what are the indications Am J Kidney Dis 33 722-727 Warady BA, Alexander SR, Hossli S et al (1996) Peritoneal membrane transport function in children receiving longterm dialysis. J Am Soc Nephrol 7 2385-2391 Warady BA, Herbert D, Sullivan EK et al (1997) Renal transplantation, chronic dialysis and chronic renal insufficiency in children and adolescents. The 1995 annual report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11 49-64... 

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