Clearance of Tracer Albumin from Peritoneal Cavity to Plasma at Low Intraperitoneal Volumes and Hydrostatic Pressures

1998 ◽  
Vol 18 (5) ◽  
pp. 497-504 ◽  
Author(s):  
Qing Zhu ◽  
Ola Carlsson ◽  
Bengt Rippe
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Volume ◽  
Free Fluid ◽  
Annual Conference ◽  
Lymphatic Absorption ◽  
Tissue Samples ◽  
Essentially Normal ◽  
Peritoneal Tissue ◽  
Tracer Distribution

Objective To assess the clearance of radiolabeled tracer albumin (RISA) from peritoneal cavity to plasma (CI → P) in rats under essentially “normal” conditions, that is, when intraperitoneal hydrostatic pressure (IPP) is subatmospheric and the intraperitoneal (IP) “free” fluid volume (IPV) is low. Methods A volume of 0.3 mL of RISA was injected IP into anesthetized Wistar rats (wt = 300 g) when the IPV was approximately 2 mL (normal) or the IPV was approximately 10 mL, and IPP was either -1.8 mmHg (normal) or +1.5 mmHg (produced by an external cuff). Plasma samples (25 μL) were obtained repeatedly during the dwell, which lasted 30 300 min, after which the peritoneal cavity was opened to recover the IPV and residuallP RISA activity. The CI → P was assessed as the mass transfer of RISA into plasma, occurring per unit time,-divided by the calculated mean IP RISA concentration (CD). The interstitial RISA space was measured as the mass of RISA accumulated, per unit tissue weight, in peritoneal tissue samples divided by the CD. Results A markedly lower CI → P (2.47 ± 0.67 μL/min), as well as total RISA clearance out of the peritoneal cavity (CI), was found under “normal” conditions (an IPV of approximately 2 mL and an IPP of approximately -1.8 mmHg) compared to the situation during peritoneal dialysis (an IPV of approximately 20 mL and an IPP of +1 mmHg). Furthermore, the interstitial RISA space increased linearly over time even at negative IPPs and at an unchanging peritoneal interstitial fluid volume. At a low (normal) IPV the CI → P did not increase significantly with elevating IPP, and increased only marginally when tracer distribution was improved by artificial vibration of the rats. However the CI → P increased when larger volumes were infused to increase the totallPV. Conclusions It is concluded that the CI → P and CI at low IPPs and IPVs are not as high as during peritoneal dialysis. Increases in CI → P were, however, coupled to increases in IPV. This highlights the importance of the IPV per se and of a sufficient IP tracer distribution for direct lymphatic absorption to be efficient. This study was presented in part at the XVIth Annual Conference on Peritoneal Dialysis, Denver, Colorado, U.S.A., 1997 (33).

Transport of tracer albumin from peritoneum to plasma: role of diaphragmatic, visceral, and parietal lymphatics

1996 ◽  
Vol 270 (5) ◽  
pp. H1549-H1556 ◽  
Author(s):  
E. R. Zakaria ◽  
O. Simonsen ◽  
A. Rippe ◽  
B. Rippe
Keyword(s):  
Peritoneal Dialysis ◽  
Steady State ◽  
Peritoneal Cavity ◽  
Anterior Abdominal Wall ◽  
Membrane Surface ◽  
Peritoneal Membrane ◽  
Lymphatic Absorption ◽  
Capillary Walls ◽  
Lymphatic Pathways

Using a technique to acutely seal off various parts of the peritoneal membrane surface, with or without evisceration, we investigated the role of diaphragmatic, visceral, and parietal peritoneal lymphatic pathways in the drainage of 125I-labeled albumin (RISA) from the peritoneal cavity to the plasma during acute peritoneal dialysis in artificially ventilated rats. The total RISA clearance out of the peritoneal cavity (Cl) as well as the portion of this Cl reaching the plasma per unit time (Cl⇢ P) were assessed. Under non-steady-state conditions, the Cl was fivefold higher than the Cl⇢ P. Evisceration caused a 25-30% reduction in both Cl⇢ P and Cl. Sealing of the diaphragm, however, reduced the Cl⇢ P by 55% without affecting the Cl. A further reduction in the Cl⇢ P was obtained by combining sealing of the diaphragm with evisceration, which again markedly reduced the Cl. However, the greatest reduction in the Cl was obtained when the peritoneal surfaces of the anterior abdominal wall were sealed off in eviscerated rats. The discrepancy between the Cl and the Cl⇢ P can be explained by the local entrance of fluid and macromolecules into periabdominal tissues, where fluid is rapidly absorbed through the capillary walls via the Starling forces, while macromolecules are accumulating due to their very slow uptake by tissue lymphatics under non-steady-state conditions. Of the portion of the total Cl that rapidly entered the plasma, conceivably by lymphatic absorption, 55% could be ascribed to diaphragmatic lymphatics 30% to visceral lymphatics, and only some 10-15% to parietal lymphatics.

scholarly journals Concomitant bidirectional transport during peritoneal dialysis can be explained by a structured interstitium

2016 ◽  
Vol 310 (11) ◽  
pp. H1501-H1511 ◽  
Author(s):  
Joanna Stachowska-Pietka ◽  
Jacek Waniewski ◽  
Michael F. Flessner ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Phase Structure ◽  
Animal Studies ◽  
Theoretical Explanation ◽  
Distributed Model ◽  
Two Phase ◽  
Tissue Hydration ◽  
Peritoneal Tissue ◽  
Bidirectional Transport

Clinical and animal studies suggest that peritoneal absorption of fluid and protein from dialysate to peritoneal tissue, and to blood and lymph circulation, occurs concomitantly with opposite flows of fluid and protein, i.e., from blood to dialysate. However, until now a theoretical explanation of this phenomenon has been lacking. A two-phase distributed model is proposed to explain the bidirectional, concomitant transport of fluid, albumin and glucose through the peritoneal transport system (PTS) during peritoneal dialysis. The interstitium of this tissue is described as an expandable two-phase structure with phase F (water-rich, colloid-poor region) and phase C (water-poor, colloid-rich region) with fluid and solute exchange between them. A low fraction of phase F is assumed in the intact tissue, which can be significantly increased under the influence of hydrostatic pressure and tissue hydration. The capillary wall is described using the three-pore model, and the conditions in the peritoneal cavity are assumed commencing 3 min after the infusion of glucose 3.86% dialysis fluid. Computer simulations demonstrate that peritoneal absorption of fluid into the tissue, which occurs via phase F at the rate of 1.8 ml/min, increases substantially the interstitial pressure and tissue hydration in both phases close to the peritoneal cavity, whereas the glucose-induced ultrafiltration from blood occurs via phase C at the rate of 15 ml/min. The proposed model delineating the phenomenon of concomitant bidirectional transport through PTS is based on a two-phase structure of the interstitium and provides results in agreement with clinical and experimental data.

scholarly journals Role of peritoneal cavity lymphatic absorption in peritoneal dialysis

1987 ◽  
Vol 32 (2) ◽  
pp. 165-172 ◽  
Author(s):  
Robert A. Mactier ◽  
Ramesh Khanna ◽  
Zbylut J. Twardowski ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Lymphatic Absorption

The Disappearance of Macromolecules from the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis (CAPD) is Not Dependent on Molecular Size

1990 ◽  
Vol 10 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Raymond T. Krediet ◽  
Dirk G. Struijk ◽  
Gerardus C. M. Koomen ◽  
Fransiscus J. Hoek ◽  
Lambertus Arisz
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Serum Proteins ◽  
Molecular Size ◽  
Gel Permeation Chromatography ◽  
Lymphatic Absorption ◽  
Clearance Ratio ◽  
Dextran 70 ◽  
Dextran Clearance

The transport of macromolecules from the circulation to the peritoneal cavity is a size-selective restricted process, while the transport of these solutes from the peritoneal cavity is probably mainly by lymphatic absorption. If so, it should be independent of molecular size. Therefore, we studied with a clearance technique the disappearance of intra peritoneally administered inulin and polydisperse dextran 70 in nine continuous ambulatory peritoneal dialysis (CAPD) patients and compared the results with the simultaneously measured appearance clearance of serum proteins. Using gel permeation chromatography 18 dextran fractions with different molecular radii could be analyzed. Inulin clearance (2.94 mL/min) was higher than total dextran clearance (1.30 mL/min). The maximal dextran concentration in all dialysate samples was found in the 50.4 Å fraction. The clearances of the dextran fractions were the same for different molecular sizes. All disappearance clearances were higher than the appearance clearances: the protein/dextran clearance ratio ranged from 0.15 for albumin/36 Å to 0.04 for alpha2-macroglobulin/91 Å. This confirms that the appearance of a macromolecule, but not its disappearance is dependent on molecular size. It is concluded that the disappearance of macromolecules from the peritoneal cavity is mainly a size independent convective process, possibly by lymphatic uptake. This implies that total dextran 70 clearance can be used for measurement of lymphatic absorption in CAPD patients.

Technical Aspects in Studying Peritoneal Morphology in Animal Models of Peritoneal Dialysis

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 40-44 ◽  
Author(s):  
Soner Duman ◽  
Sait Şen
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Wall ◽  
Histological Examination ◽  
Anterior Abdominal Wall ◽  
Anterior Wall ◽  
Abdominal Muscle ◽  
Tissue Samples ◽  
Peritoneal Tissue ◽  
Significant Difference ◽  
Peritonitis Model

Objective Peritoneal biopsies are considered useful for gaining a better understanding of the pathophysiology of the peritoneum during experimental peritoneal dialysis (PD). Different peritoneal tissue samples (i.e., abdominal wall, liver, diaphragm, intestine, and omentum) may be used, but there can be artifacts due to peritoneal tissue processing. Aim To investigate differences in peritoneal membranes from different parts of the peritoneum, and also 2 different fixatives, in experimental PD and a peritonitis model in rats. Methods Peritoneal tissues from the anterior abdominal wall, liver, omentum, and intestine were taken from each of 3 groups of animals: sham, experimental PD, and peritonitis model. Tissue samples were immediately fixed with 4% formaldehyde and routinely processed for histological examination. Two parietal peritoneal tissue samples according to longitudinal and horizontal sections of anterior wall inner abdominal muscle were also taken. All samples were immediately fixed with 4% formaldehyde and B5 fixative (B5), and then routinely processed for histological examination. Results In all groups, histopathological findings were more commonly seen in the abdominal wall samples. There were no changes observed in peritoneal membranes other than those of anterior abdominal wall samples from both sham and PD model rats. However, there was a significant difference between anterior and posterior facets of liver in the peritonitis model. Furthermore, the antimesenteric site of intestinal peritoneum was less affected than the mesenteric site. There were no significant histopathological differences between B5 and 4% formaldehyde fixation ( p > 0.05). Conclusion Our results suggest that peritoneum obtained from the anterior abdominal wall is the most affected area and therefore the most suitable site to investigate peritoneal changes in the experimental rat PD model. There were no significant differences between fixation with 4% formaldehyde and B5 solution. Abdominal wall samples should be of the same direction of inner abdominal muscle, that is, horizontal sectioning should be used for measurements of the submesothelial area.

Role of Diaphragmatic, Visceral, and Parietal Pathways in Peritoneal Fluid Absorption in Rat Peritoneal Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 80-84 ◽  
Author(s):  
Kazuo Kumano ◽  
Kimitoshi Go ◽  
Me He ◽  
Tadasu Sakai
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Absorption Rate ◽  
Ringer Solution ◽  
Fluid Loss ◽  
Fluid Absorption ◽  
Lymphatic Absorption ◽  
Major Route ◽  
Lymphatic Pathway

Assessment was made of the contribution of lymphatic and non lymphatic fluid absorption to net fluid loss from the peritoneal cavity. Diaphragmatic, visceral, and parietal pathways in lymphatics and nonlymphatics were examined using a rat model with adhesion of the diaphragm to the liver, evisceration, these two procedures in combination, and without treatment. In each of these cases, six rats were used, each dialyzed for 180 min with Krebs–Ringer solution. The peritoneal net fluid absorption rate (PNFAR) was determined based on the disappearance of 1251-bovine serum albumin (BSA) from the peritoneal cavity and the lymphatic absorption rate (LAR), was based on the appearance of this albumin in the blood. Seventy-eight percent of net fluid loss occurred via the non lymphatic pathway, primarily through parietal and visceral absorption, and the remaining 22% through the lymphatics, the main pathway being the subdiaphragmatic lymphatics. Nonlymphatic fluid absorption would thus appear to be a major route of fluid loss from the peritoneal cavity in rat peritoneal dialysis.

Methods for Estimation of Peritoneal Dialysate Volume and Reabsorption Rate Using Macromolecular Markers

1994 ◽  
Vol 14 (1) ◽  
pp. 8-16 ◽  
Author(s):  
Jacek Waniewski ◽  
Olof Heimbürger ◽  
Min Sun Park ◽  
Andrzej Werynski ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Cavity ◽  
Lymphatic Absorption ◽  
Physiological Mechanisms ◽  
Peritoneal Dialysate ◽  
Practical Applications ◽  
Peritoneal Tissue ◽  
Simplified Method ◽  
Correct Estimation ◽  
The Impact ◽  
Dialysate Volume

Reabsorption of fluid and solutes from the peritoneal cavity poses several problems for the correct estimation of peritoneal dialysate volume and ultrafiltration rate with macromolecular volume markers. Although physiological mechanisms of peritoneal reabsorption (direct lymphatic absorption vs reabsorption to the peritoneal tissue) are being currently discussed, many experimental and clinical studies have demonstrated that peritoneal reabsorption of the marker is mainly a bulk “backflow” out of the peritoneal cavity. Theoretical bases for the estimation of peritoneal dialysate volume and cumulative ultrafiltration of fluid including the correction for peritoneal reabsorption are reviewed. A widely applied simplified method which, however, neglects the impact of ultrafiltration on marker concentration is also discussed. The systematic errors involved in the application of the simplified method are usually less than 10% in the standard conditions; however, in specific cases they may be much higher. Therefore, the correct method is suggested for practical applications.

Influence of Phosphatidylcholine on Lymphatic Absorption during Peritoneal Dialysis in the Rat

1988 ◽  
Vol 8 (3) ◽  
pp. 179-186 ◽  
Author(s):  
Robert A. Mactier ◽  
Ramesh Khanna ◽  
Zbylut J. Twardowski ◽  
Harold Moore ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Dwell Time ◽  
Solute Concentration ◽  
Lymphatic Absorption ◽  
India Ink ◽  
Dialysis Solution ◽  
Alternative Means ◽  
And Control ◽  
Concentration Ratios

The mechanism whereby i.p. administration of phosphatidylcholine increases net ultrafiltration and solute clearances after long-dwell exchanges is not established. We performed 4-h exchanges in rats using 4.25% dextrose dialysis solution with and without the addition of 50 mgl L phosphatidylcholine. Net ultrafiltration was enhanced in the treated rats (p < 0.005) by a reduction in cumulative lymphatic absorption (p < 0.01) and without a concurrent increase in total net transcapillary ultrafiltration during the dwell time. Likewise, urea and phosphate clearances with i.p. phosphatidylcholine were enhanced mainly by the increase in the drain volume since serum to dialysate solute concentration ratios did not differ significantly between the treated and control rats. Thus, phosphatidylcholine increases net ultrafiltration and solute clearances in the rat by decreasing lymphatic absorption and without increasing transperitoneal transport of water and solutes into the peritoneal cavity. The uptake of the india ink by the lymphatics of rats who received dialysis exchanges without phosphatidylcholine and the lack of uptake in rats treated with phosphatidylcholine are supported by this observation. Reduction in lymphatic absorption with the addition of phosphatidylcholine to the infused dialysis solution offers an alternative means of enhancing the efficiency of long-dwell peritoneal dialysis.

Indirect Measurement of Lymphatic Absorption with Inulin in Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients

1990 ◽  
Vol 10 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Dirk G. Struijk ◽  
Raymond T. Krediet ◽  
Gerardus C. M. Koomen ◽  
Elisabeth W. Boeschoten ◽  
Hendrik J. Vd Reijden ◽  
...  
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Lymphatic Drainage ◽  
Indirect Measurement ◽  
Lymphatic Absorption ◽  
Lymphatic Flow ◽  
Peritoneal Tissue ◽  
The Difference ◽  
Local Accumulation

To elucidate the importance of possible trapping of macromolecules in peritoneal tissue on the calculation of peritoneal lymphatic drainage, we compared the transport of inulin administered i.v. and i.p. in nine continuous ambulatory peritoneal dialysis (CAPD) patients on two separate days. In the intraperitoneal study inulin (5 g) was added to the dialysate and in the intravenous study inulin (5 g) was given i.v. 3 h before the test. No differences were found in the mass transfer area coefficients (MTC) of urea, creatinine, and glucose between the two tests. The MTC after inulin i.p. was 3.2 ± 0.7 mLlmin (mean ± SD) and after inulin i.v. 1.8 ± 0.5 (p < 10-5). As the difference in transport kinetics between i.v. and i.p. administration is likely to be caused by lymphatic absorption, a mean lymphatic flow of 1.4 mLlmin could be calculated. This value corresponds to the data obtained with macromolecules. Our results therefore favor the hypothesis that no local accumulation of macromolecules in the peritoneal tissues takes place and that their disappearance from the peritoneal cavity represents lymphatic absorption.

scholarly journals P1158DOES THE PERITONEUM SWELLS OR SHRINK DURING PERITONEAL DIALYSIS?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jacek Waniewski ◽  
Joanna Stachowska-Pietka ◽  
Roman Cherniha ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Elastic Modulus ◽  
Hydrostatic Pressure ◽  
Reflection Coefficient ◽  
Connective Tissue ◽  
Osmotic Pressure ◽  
Interstitial Fluid ◽  
Fluid Volume ◽  
Free Fluid ◽  
Dialysis Fluid

Abstract Background and Aims The width of the peritoneum (composed mainly of connective tissue and relatively free of vasculature) is increased in patients on peritoneal dialysis compared to healthy subjects. We investigated to what extent increased intraperitoneal (ip) hydrostatic and osmotic pressures following the infusion of dialysis fluid will change hydration status and width of the peritoneum. Method Using linear theory of poroelasticty, clinical data on transport parameters and experimental data on elastic characteristics of the interstitium, the relative change of the width of the poroelastic layer subject to the combined effect of external hydrostatic and effective osmotic pressures (that is, ideal osmotic pressure multiplied by reflection coefficient for osmotic agent) can be described as a function of effective pressure and elastic modulus of the layer: Lmod/L0 = 1/(1-deltaP*/lambda*), where L0 is initial thickness of the tissue, Lmod is modified thickness of the layer, deltaP* is change in effective combined pressure, and lambda* is the elastic modulus of the poroelastic material. The same formula describes also the change in fractional free fluid volume ratio, thetaF. The elastic modulus of the connective tissue was assumed to be 110 mmHg, as measured for the subcutaneous layer of the tip of mouse tail by Swartz et al (J Biomech, 1999), and reflection coefficient for glucose in the interstitium of 0.0035 as estimated by Stachowska-Pietka et al (NDT, 2019) from clinical data for patients on peritoneal dialysis. Results The ip hydrostatic pressure increases by 2-3 mmHg to 15 mmHg at rest depending on infused volume of dialysis fluid (and posture, body weight and location in abdominal cavity), and may increase to 100 mmHg during activities as coughing, whereas the osmotic pressure of glucose 3.86% dialysis fluid is around 400 mmHg above the osmotic pressure of plasma and interstitial fluid (in equilibrium with plasma). However, due to the low reflection coefficient of interstitium, the effective osmotic pressure of dialysis fluid minus the physiological value of interstitial osmotic pressure is only 1.4 mmHg, and is quickly decreasing with dwell time. Therefore, hydrostatic pressure is the dominant factor for interstitial hydration. Assuming ip pressure of 15 mmHg, the stretch of the peritoneum increases its equilibrium width (at 0 mmHg and isotonic interstitial fluid) by 15%. During physical activities peritoneum may transiently thicken even more. Conclusion The peritoneum becomes overhydrated after infusion of dialysis fluid, which increases interstitial hydrostatic pressure; the thickness and fractional free fluid volume of the peritoneum increase by 15% although transiently higher increases may occur following activities that increase intraperitoneal pressure. The mechanical changes in the peritoneum may contribute to the biological changes in cells present there, as fibroblasts and mesothelial cells. The swelling of the peritoneum is in agreement with the increase in the fractional free fluid volume of the intramuscular interstitium behind the peritoneum as reported by Zakaria et al (Am J Physiol Heart Circ Physiol, 1999).

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