Inflammation and Metabolism in Peritoneal Dialysis – Factors Associated with Peritoneal Function, Peritonitis and Dialysis Solutions

..................................................................................................................... 10 Introduction ............................................................................................................... 12 Review of the literature .............................................................................................. 13 1. Principles of peritoneal dialysis ........................................................................ 13 2. Techniques of peritoneal dialysis ..................................................................... 13 3. Outcome of peritoneal dialysis ......................................................................... 13 4. Assessing peritoneal clearances and function .................................................. 15 5. Soluble factors in the dialysate ......................................................................... 17 6. Dialysis solutions ............................................................................................. 19 6.1. Glucose as osmotic agent ........................................................................ 19 6.2. Icodextrin as osmotic agent ..................................................................... 20 6.3. Amino acids as osmotic agent ................................................................. 20 7. Outcome of peritoneal dialysis patients ............................................................ 21 8. Assessing the insulin sensitivity ....................................................................... 22 9. Insulin sensitivity and substrate oxidation in peritoneal dialysis patients ......... 23 Aims of the study....................................................................................................... 24 Materials and methods ............................................................................................... 25 1. Subjects ................................................................................................................ 25 Part 1. Influence of dialysis adequacy, characteristics of the peritoneal membrane and peritonitis on inflammatory and fibrotic parameters in the dialysate .... 25 1.1. Association of dialysis adequacy and characteristics of the peritoneal membrane with soluble factors in the dialysate, and their changes during a one-year follow-up .......................................................................... 25 1.2. Inflammatory parameters during and after peritonitis and their association with the outcome of peritonitis ..................................................................... 25 Part 2. Influence of glucose-free dialysis solutions on host defence and on metabolism ............................................................................................................ 26 2. Study designs ........................................................................................................ 26