The mechanisms responsible for the problem status of high transporters are diverse. High transporters have increased protein losses that may play a role in the presence of hypoalbuminemia and malnutrition. On the other hand, high transport induces increased glucose absorption, which may in turn be responsible for anorexia and increased atherogenesis--issues not discussed here, but clearly of major importance. And finally, the impaired ultrafiltration present in the high transporter leads to fluid overload, which is one of the driving forces for ventricular hypertrophy, hypertension, and increased cardiovascular risk--cardiovascular events being most prevalent cause of death in dialysis patients. All of the factors previously discussed--and others--may preclude some high transporters from being good candidates for peritoneal dialysis. Yet many others may still do well if the prescription is individually tailored to the particular patient.

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