Pharmacological Reduction of Lymphatic Absorption from the Peritoneal Cavity Increases Net Ultrafiltration and Solute Clearances in Peritoneal Dialysis

Nephron ◽  
1988 ◽  
Vol 50 (3) ◽  
pp. 229-232 ◽  
Author(s):  
Robert A. Mactier ◽  
Ramesh Khanna ◽  
Harold Moore ◽  
Zbylut J. Twardowski ◽  
Karl D. Nolph
Keyword(s):  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Lymphatic Absorption

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 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

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).

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.

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.

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.

Klebsiella pneumoniae Renal Abscess and Peritonitis in a Peritoneal Dialysis Patient: A Novel Route of Infection

2017 ◽  
Vol 37 (6) ◽  
pp. 654-656
Author(s):  
Miten J. Dhruve ◽  
Joanne M. Bargman
Keyword(s):  
Peritoneal Dialysis ◽  
Klebsiella Pneumoniae ◽  
Renal Biopsy ◽  
Peritoneal Cavity ◽  
Successful Treatment ◽  
Dialysis Patient ◽  
Peritoneal Dialysis Patient ◽  
Renal Abscess ◽  
Biopsy Site ◽  
Route Of Infection

We present a peritoneal dialysis (PD) patient who had a renal biopsy performed during an episode of urosepsis and subsequently presented with a renal abscess at the biopsy site along with concurrent peritonitis. Microbiology from the PD effluent and from the renal abscess were both positive for Klebsiella pneumoniae. We propose that the PD peritonitis was the result of seeding of the peritoneal cavity with bacteria from the renal abscess. Successful treatment was achieved through drainage of the abscess and intraperitoneal antibiotics.

Peritoneal Dialysis

2019 ◽  
Author(s):  
Karlien François ◽  
Joanne M. Bargman
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Peritoneal Cavity ◽  
Fluid Overload ◽  
Kidney Injury ◽  
Dialysis Fluid ◽  
Keywords Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage ◽  
Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos,  8 figures, 4 tables, and 73 references.  Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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