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Dr. Nyoman Sutarka - Presentasi PET (BUN-SC 2019) PDF
Dr. Nyoman Sutarka - Presentasi PET (BUN-SC 2019) PDF
( AS SEMIPERMEABLE MEMBRANE)
Nyoman Sutarka
Principles:
• peritoneum (capillary endothelium, matrix,
mesothelium) = semipermeable dialysis membrane
through which solute move from blood to dialysis
solution via diffusion and convection
• Two layers:
parietal
- lines the anterior wall and undersurface of
the diaphragm
- 20% of total Surface Area; blood supply from
abdominal wall
visceral
- covers the abdominal organs
- 80% of total SA; blood supply from
mesenteric aa and portal vv
Anatomy of The Peritoneum
• Highly Vascular
• Semi-permeable/bi-directional
Diffusion Osmosis
• Solute Clearance
diffusive
convective
• Fluid Removal
Factors Influencing Solute Diffusion
• Surface Area
• Peritoneal Permeability
• Solute Characteristics
• Concentration Gradient
• Temperature of Dialysis Solution
• Blood Flow
• Dialysis Solution Volume in 24 hrs.
• Dwell Time
Ultrafiltration during PD
Depends on:
- type of transporter – low transporters have better UF
- concentration and type of osmotic agent in PD fluid:
1. Fluids with glucosis (1,27%, 2,5% a 3,8% ), higher
concentration – higher osmotic pressure and UF
2. Fluid with icodextrin (Extraneal) = glucose polymer with
a large molecule, resorbs only 10-20%, offers longtime
UF, suitable for long night exchanges, 8-12 hours)
- time between exchanges, using glucose-based fluids,
maximal UF obtained after 2-3 hours, using longer
spaces UF dicreases.
Ultrafiltration in different types of PD
solutions
Perspectives - New dialysis solutions protect
peritoneal membrane
Physioneal1 Extraneal2
• GDPs and AGEs • Isosmolar to plasma
• Lactate • No glucose exposure
• Physiologic pH and pCO2 • GDPs and AGEs
• Membrane and immune cell • Membrane and immune cell
function function
Nutrineal2
• No glucose exposure
• No GDPs or AGEs
• Membrane and immune cell
function
Nutrineal
Glucose load
Glycemic control
Protein intake, nutritional status
2.5 L 2.5 L
2 Physioneal 2.5 L Physioneal 2.5 L
1.36% Nutrineal 1.36% Extraneal
Assessement of peritoneal
function
HIGH
AVERAGE
LOW
AVERAGE
LOW
Choice of PD scheme depends of BSA and
type of transport
CAPD – continual ambulatory
peritoneal dialysis
• manual exchanges
NIPD – night intermitent peritoneal
dialysis (cycler)
CCPD – continual cyclic PD
FAKTOR2 YANG MEMPENGARUHI
AKURASI DARI PET
Jika serum glukosa > 300 mg/dl : cek glukosa serum pasien
sebelum tes diulang. Glukosa > 300 dapat mempengaruhi UF
❖ Tes tidak memakai konsentrasi 2,5 %. Jika hasil akan
dibandingkan dengan kurva dari dr. Twardowski, maka
harus digunakan dextrose 2,5 %, jadi ulangi tes.
❖ Rasio D/P tidak sesuai dengan D/D0. Plot rasio dalam grafik
PET. Jika hasilnya dalam 1 standar deviasi, hasilnya masih
dapat diterima.
CORRECTION FACTOR FROM FRESH 2.5% DIANEAL
= .000210526
Do/Do = 1
D2/Do = 0,4980
D4/Do = 0,2900
D4/p = 0,7426
D2/p = 0,5666
Do/p = 0,1026