T

Dwell time, h

FIGURE 4-7 ( Continued)

C, Osmotic equilibrium most likely precedes glucose equilibrium because of both solute sieving and the higher peritoneal reflection coefficient of glucose compared with other dialysate solutes, allowing net transcapillary ultrafiltration to continue at a low rate even after osmotic equilibrium. D, Ultrafiltration can be maximized by measures that delay osmotic equilibrium, which can be accomplished by using hypertonic glucose solutions, larger volumes, or both, during an exchange. More frequent exchanges shorten dwell times and increase the dialysate flow rate and thus avert attaining osmotic equilibrium. Additionally, potential exists for enhancing ultrafiltration by measures that reduce the peritoneal reabsorption rate. (From Mactier and coworkers [13]; with permission.)

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