Effect of Phosphatidylcholine on Peritoneal Transport and Lymphatic Absorption in a CAPD Patient with Sclerosing Peritonitis

The three-pore model of peritoneal transport treats the capillary membrane as a primary barrier determining the amount of solute that transports to the interstitium and the peritoneal cavity. According to the three-pore model, the principal peritoneal exchange route for water and water-soluble substances is a protein-restrictive pore pathway of radius 40–55 A, accounting for approximately 99% of the total exchange (pore) area and approximately 90% of the total peritoneal ultrafiltration (UF) coefficient (LpS). For their passage through the peritoneal membrane proteins are confined to so-called “large pores” of radius approximately 250 Å, which are extremely few in number (0.01% of the total pore population) and more or less nonrestrictive with respect to protein transport. The third pathway of the three-pore model accounts for only about 2% of the total LpS and is permeable to water but impermeable to solutes, a so-called “water-only” (transcellular?) pathway. In contrast to the classical Pyle-Popovich (P&P) model, the three-pore model can predict with reasonable accuracy not only the transport of water and “small solutes” (molecular radius 2.3–15 Å) and “intermediatesize” solutes (radius 15–36 Å), but also the transport of albumin (radius 36 Å) and larger molecules across the peritoneal membrane. The model operates with reflection coefficientsa (a's) for small solutes <0.1. These are approximately one order of magnitude lower than the & sigma's In the P&P model. Furthermore, the peritoneal LPS is one order of magnitude higher than In the P&P model. As a consequence, the major portion of the “fluid loss” from the peritoneal cavity In continuous ambulatory peritoneal dialysis (CAPD) can be explained by the operation of the so-called Starling forces (the transcapillary hydrostatic pressure gradient opposed by the plasma colloid osmotic pressure as multiplled by the LpS), and to a much lesser extent by lymphatic absorption (L). Furthermore, In contrast to the P&P model, the three-pore model can with reasonable accuracy predict the UF profiles produced when glucose Is substituted by high molecular weight solutes as osmotic agents In CAPO.

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Alterations of peritoneal transport characteristics in dialysis patients with ultrafiltration failure: tissue and capillary components

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfy313 ◽

2018 ◽

Vol 34 (5) ◽

pp. 864-870 ◽

Cited By ~ 4

Author(s):

Joanna Stachowska-Pietka ◽

Jan Poleszczuk ◽

Michael F Flessner ◽

Bengt Lindholm ◽

Jacek Waniewski

Keyword(s):

Transport Properties ◽

Capillary Wall ◽

Lymphatic Absorption ◽

Distributed Approach ◽

Peritoneal Transport ◽

Peritoneal Tissue ◽

Ultrafiltration Failure ◽

Spatially Distributed ◽

Transport Barriers ◽

The Individual

AbstractBackgroundUltrafiltration failure (UFF) in peritoneal dialysis (PD) patients is due to altered peritoneal transport properties leading to reduced capacity to remove excess water. Here, with the aim to establish the role of local alterations of the two major transport barriers, peritoneal tissue and capillary wall, we investigate changes in overall peritoneal transport characteristics in UFF patients in relation to corresponding local alterations of peritoneal tissue and capillary wall transport properties.MethodsSix-hour dwell studies using 3.86% glucose solutions and radioisotopically labelled serum albumin added to dialysate as a volume marker were analysed in 31 continuous ambulatory PD patients, 20 with normal ultrafiltration (NUF) and 11 with UFF. For each patient, the physiologically based parameters were evaluated for both transport barriers using the spatially distributed approach based on the individual intraperitoneal profiles of volume and concentrations of glucose, sodium, urea and creatinine.ResultsUFF patients as compared with NUF patients had increased solute diffusivity in both barriers, peritoneal tissue and capillary wall, decreased tissue hydraulic conductivity and increased local lymphatic absorption and functional decrease in the fraction of the ultra-small pores. This resulted in altered distribution of fluid and solutes in the peritoneal tissue, and decreased penetration depths of fluid and solutes into the tissue in UFF patients.ConclusionsMathematical modelling using a spatially distributed approach for the description of clinical data suggests that alterations both in the capillary wall and in the tissue barrier contribute to UFF through their effect on transport and distribution of solutes and fluid within the tissue.

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Sclerosing Peritonitis Presenting 2 Years after Renal Transplantation in a Former CAPD Patient

Renal Failure ◽

10.3109/0886022x.2011.552147 ◽

2011 ◽

Vol 33 (2) ◽

pp. 246-248 ◽

Cited By ~ 5

Author(s):

Konstantinos N. Adamidis ◽

Christos A. Zachariou ◽

Maria-Emmanouela Kopaka ◽

Evangelia E. Charitaki ◽

Vasileios Drakopoulos ◽

...

Keyword(s):

Renal Transplantation ◽

Sclerosing Peritonitis ◽

Capd Patient

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The First Peritonitis Episode Alters the Natural Course of Peritoneal Membrane Characteristics in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2014.00277 ◽

2015 ◽

Vol 35 (3) ◽

pp. 324-332 ◽

Cited By ~ 18

Author(s):

Anouk T.N. van Diepen ◽

Sadie van Esch ◽

Dirk G. Struijk ◽

Raymond T. Krediet

Keyword(s):

Peritoneal Dialysis ◽

Free Water ◽

Glucose Absorption ◽

Natural Course ◽

Control Group ◽

Peritoneal Membrane ◽

Transport Parameters ◽

Lymphatic Absorption ◽

Peritoneal Transport ◽

The Impact

ObjectiveLittle or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of peritoneal transport before and after infection.ParticipantsWe analyzed prospectively collected data from 541 incident peritoneal dialysis (PD) patients, aged > 18 years, between 1990 and 2010. Standard Peritoneal Permeability Analyses (SPA) within the year before and within the year after (but not within 30 days) the first peritonitis were compared. In a control group without peritonitis, SPAs within the first and second year of PD were compared.Main outcome measurementsSPA data included the mass transfer area coefficient of creatinine, glucose absorption and peritoneal clearances of β–2-microglobulin (b2m), albumin, IgG and α–2-macroglobulin (a2m). From these clearances, the restriction coefficient to macromolecules (RC) was calculated. Also, parameters of fluid transport were determined: transcapillary ultrafiltration rate (TCUFR), lymphatic absorption (ELAR), and free water transport. Crude and adjusted linear mixed models were used to compare the slopes of peritoneal transport parameters in the peritonitis group to the control group. Adjustments were made for age, sex and diabetes.ResultsOf 541 patients, 367 experienced a first peritonitis episode within a median time of 12 months after the start of PD. Of these, 92 peritonitis episodes were preceded and followed by a SPA within one year. Forty-five patients without peritonitis were included in the control group. Logistic reasons (peritonitis group: 48% vs control group: 83%) and switch to hemodialysis (peritonitis group: 22% vs control group: 3%) were the main causes of missing SPA data post-peritonitis and post-control. When comparing the slopes of peritoneal transport parameters in the peritonitis group and the control group, a first peritonitis episode was associated with faster small solute transport (glucose absorption, p = 0.03) and a concomitant lower TCUFR ( p = 0.03). In addition, a discreet decrease in macromolecular transport was seen in the peritonitis group: mean difference in post- and pre-peritonitis values: IgG: -8 μL/min ( p = 0.01), a2m: -4 μL/min ( p = 0.02), albumin: -10 μL/min (p = 0.04). Accordingly, the RC to macromolecules increased after peritonitis: 0.09, p = 0.04.ConclusionsThe very first peritonitis episode alters the natural course of peritoneal membrane characteristics. The most likely explanation might be that cured peritoneal infection later causes long-lasting alterations in peritoneal transport state.

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The Standard Peritoneal Permeability Analysis in the Rabbit: A Longitudinal Model for Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089901900110 ◽

1999 ◽

Vol 19 (1) ◽

pp. 56-64 ◽

Cited By ~ 6

Author(s):

Machteld M. Zweers ◽

Caroline E. Douma ◽

Dirk R. De Waart ◽

Anton B. Van Der Wardt ◽

Marja M. Ho-Dac-Pannekeet ◽

...

Keyword(s):

Molecular Weight ◽

Peritoneal Dialysis ◽

Normal Values ◽

Rabbit Model ◽

Low Molecular Weight ◽

Transport Parameters ◽

Lymphatic Absorption ◽

Intraindividual Variation ◽

Peritoneal Transport ◽

Peritoneal Permeability

Objective The development of an experimental peritoneal dialysis (PD) model in rabbits to investigate peritoneal transport characteristics during a longitudinal follow-up and to assess normal values of these peritoneal transport parameters. Design Peritoneal transport parameters were determined in conscious, unrestrained rabbits by standard peritoneal permeability analysis adjusted for rabbits (SPAR). In this test a 1-hour dwell with 3.86% glucose dialysate is used. Dextran 70 (1 g/L) was added to the dialysate to allow calculation of fluid kinetics. Dialysate samples were taken before, 10, and 40 minutes after instillation and at the end of the dwell. Blood was drawn at the end of the dwell. Experimental Animals Eighteen female New Zealand White rabbits (2565 g) were included for catheter implantation. SPARs were performed in 15 animals; the other 3 were excluded due to complications. Main Outcome The mass transfer area coefficients (MTACs) of the low molecular weight solutes urea (MTACurea) and creatinine (MTACcr) were calculated. The clearances of albumin (Clalb) and IgG (ClIgG), glucose absorption, and fluid transport were computed. Coefficients of intraindividual variation (Vc) were calculated for these parameters. Results The main complications were catheter obstruction and/or dislocation. Five rabbits underwent uncomplicated PD during a 4-week period. Fifteen SPARs in 15 stable rabbits were performed and analyzed to obtain normal values. Means and standard deviations of the transport parameters were as follows: MTACurea 2.24 ± 0.57 mL/min, MTACcr 1.61 ± 0.30 mL/min, Clalb 52.9 ± 17.2 μL/min, ClIgG 44.5 ± 22.9 μL/min. The transcapillary ultrafiltration rate was 0.66 ± 0.13 mL/min and the lymphatic absorption rate 0.47 ± 0.26 mL/min. The parameters of solute transport were upscaled to those in humans using two different methods. MTACs of low molecular weight solutes in rabbits and patients were of the same order of magnitude, but the clearance of albumin was approximately four times higher in rabbits than in patients, and that of IgG eight times. In all rabbits sieving of sodium was observed. The dialysate/plasma (D/P) of sodium decreased to a minimum at 40 min ( p < 0.003 vs the initial value), followed by a rise to 60 min. The minimal value was 0.884 ± 0.002. The coefficients of variation calculated on 7 rabbits that underwent two or more SPARs were similar to those assessed from the patient data. This indicates stability of the model and reproducibility of the SPAR. Conclusion The conscious rabbit model for PD can be used for repeated studies on peritoneal transport.

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The Time Course of Peritoneal Transport Kinetics in Continuous Ambulatory Peritoneal Dialysis Patients Who Develop Sclerosing Peritonitis

American Journal of Kidney Diseases ◽

10.1016/s0272-6386(89)80036-8 ◽

1989 ◽

Vol 13 (4) ◽

pp. 299-307 ◽

Cited By ~ 59

Author(s):

Raymond T. Krediet ◽

Dirk G. Struijk ◽

Elisabeth W. Boeschoten ◽

Gerardus C.M. Koomen ◽

Jacqueline M.L. Stouthard ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Time Course ◽

Transport Kinetics ◽

Dialysis Patients ◽

Sclerosing Peritonitis ◽

Peritoneal Transport

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Scanning Electron Microscopy of Staphylococcus Epidermidis Adherence to Continuous Ambulatory Peritoneal Dialysis Catheters

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100119429 ◽

1985 ◽

Vol 43 ◽

pp. 520-521

Author(s):

William J. Lamoreaux ◽

David L. Smalley ◽

Larry M. Baddour ◽

Alfred P. Kraus

Keyword(s):

Electron Microscopy ◽

Scanning Electron Microscopy ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Staphylococcus Epidermidis ◽

Sterile Saline ◽

Intravascular Devices ◽

Capd Patient ◽

Scanning Electron

Infections associated with the use of intravascular devices have been documented and have been reported to be related to duration of catheter usage. Recently, Eaton et al. reported that Staphylococcus epidermidis may attach to silastic catheters used in continuous ambulatory peritoneal dialysis (CAPD) treatment. The following study presents findings using scanning electron microscopy (SEM) of S. epidermidis adherence to silastic catheters in an in vitro model. In addition, sections of polyvinyl chloride (PVC) dialysis bags were also evaluated by SEM.The S. epidermidis strain RP62A which had been obtained in a previous outbreak of coagulase-negative staphylococcal sepsis at local hospitals was used in these experiments. The strain produced surface slime on exposure to glucose, whereas a nonadherent variant RP62A-NA, which was also used in these studies, failed to produce slime. Strains were grown overnight on blood agar plates at 37°C, harvested from the surface and resuspended in sterile saline (0.85%), centrifuged (3,000 rpm for 10 minutes) and then washed twice in 0.1 M phosphate-buffered saline at pH 7.0. Organisms were resuspended at a concentration of ca. 106 CFU/ml in: a) sterile unused dianeal at 4.25% dextrose, b) sterile unused dianeal at 1.5% dextrose, c) sterile used dialysate previously containing 4.25% dextrose taken from a CAPD patient, and d) sterile used dialysate previously containing 1.5% dextrose taken from a CAPD patient.

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