Pathways for Fluid Loss from the Peritoneal Cavity

Shockley, Ty R.; Ofsthun, Norma J.

doi:10.1159/000170038

Cited by 37 publications

(17 citation statements)

References 12 publications

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“…The relative contribution of these two components of peritoneal absorptive flow (which both are considered to be bulk flows [19,27]) is controversial [6,7,[18][19][20]36], However, the simultaneous estimation of the peritoneal bulk absorptive flow (as estimated by Ke) and the direct lymphatic absorption (as estimated by KPP) may yield an approxi mate estimate of the order of magnitude of absorption into adjacent tissues (as absorp tion into tissue approximately should equal the difference between KP and KPP).…”

Section: Relative Importance O F Lymphatic Absorption and Absorption mentioning

confidence: 99%

“…However, several studies have shown that the plasma appearance rate of a macromolecular marker is on average only about 10-20% of its disappearance rate from the peritoneal dialysate (in clinically stable CAPD patients [8][9][10] as well as in animals [11][12][13][14][15]). Furthermore, studies in animals have demonstrated that a major part of the lost marker accumulates inside the tissues ad jacent to the peritoneal cavity, mainly in the liver, diaphragm and anterior abdominal wall [13,[15][16][17], The direct lymphatic and non lymphatic (convective absorption into tis sues) absorption of fluid in peritoneal dialysis has recently been reviewed [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Lymphatic Absorption in CAPD Patients with Loss of Ultrafiltration Capacity

Heimbürger¹,

Waniewski²,

Weryński³

et al. 1995

Blood Purif

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During continuous ambulatory peritoneal dialysis (CAPD) treatment, loss of ultrafiltration capacity (UFC) is a common complication that can be associated with increased peritoneal fluid absorption rate. The aim of the present study was to investigate the relative importance of lymphatic absorption for total peritoneal fluid absorption in patients with permanent loss of UFC associated with a high peritoneal absorption rate (K_E, ml/min; high-K_E group, n = 4). Clinically stable CAPD patients (n = 23) as well as patients with loss of UFC associated with increased diffusive mass transport coefficients (K_BD, ml/min; high-K_BD group, n = 8) served as control groups. The patients were investigated with a 6-hour dwell study with 3.86% glucose solution. The total fluid absorption rate was estimated by the disappearance rate (K_E) of ¹³¹I-radioiodinated human serum albumin (RISA) from the peritoneal cavity, and the lymphatic absorption rate was estimated by the rate of RISA appearance in plasma (K_PP, ml/min). The values of K_E and K_PP in the high-K_E group (4.65 ± 0.93 and 0.42 ± 0.31 ml/min, respectively) were markedly higher than in the clinically stable CAPD patients (1.77 ± 0.60 and 0.15 ± 0.06 ml/min, respectively; both p < 0.001 vs. the high-K_E group). In the high-K_BD group, K_E was lower (2.19 ± 0.38 ml/min, p < 0.001) compared to the high-K_E group, whereas K_PP was similar (0.26 ± 0.09 ml/min, NS). The fraction of K_E which could be accounted for by K_PP was on average only 9 + 5% in the high-K_E group and did not differ from the fractions in the clinically stable patients or in the high-K_BD group (9 ± 5 and 12 ± 4%, respectively). In 5 patients in whom plasma RISA activity was measured for 24 h from the beginning of the 6-hour dwell study, a continuous increase of the RISA level in plasma was observed during this time period. We conclude that although K_PP was increased in patients with UFC loss associated with high K_E, it accounted for only a minor part of K_E. Furthermore, the relatively slow but prolonged appearance of RISA in plasma indicates that the interstitial compartment may serve as a reservoir of macromolecules which are slowly absorbed by local lymphatics. The present study supports previous findings that direct lymphatic absorption is only of relatively minor importance for the fluid absorption in peritoneal dialysis.

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Section: Relative Importance O F Lymphatic Absorption and Absorption mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lymphatic Absorption in CAPD Patients with Loss of Ultrafiltration Capacity

Heimbürger¹,

Waniewski²,

Weryński³

et al. 1995

Blood Purif

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“…However, at the same time fluid disappears from the abdominal cavity back to the circula tion. Controversy exists whether this fluid reabsorption from the abdominal cavity dur ing a dwell with a hypertonic solution is main ly caused by absorption into the lymphatic system or by transcapillary backfiltration due to colloid-osmotic pressure within peritoneal capillaries in combination with a small lym phatic uptake of fluid [1], The basis of this controversy is the disagreement in the inter pretation of the disappearance of intraperitoneally administered macromolecular markers that are used to calculate intraperitoneal fluid kinetics.…”

Section: Introductionmentioning

confidence: 99%

Fluid Kinetics in CAPD Patients during Dialysis with a Bicarbonate-Based Hypoosmolar Solution

Struijk¹,

Krediet²,

Imholz³

et al. 1996

Blood Purif

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The magnitude of transcapillary backfïltration by the colloid-osmotic pressure within the peritoneal capillaries compared to the effective lymphatic absorption was investigated in continuous ambulatory peritoneal dialysis patients. This was done during a 4-hour dwell period, using a hypoosmolar dialysis fluid (280 mosm/kg H₂O) in 8 patients and compared to 5 of these patients using a 1.36% glucose (GS; 324 mosm/kg H₂O). The low molecular weight solute transport did not differ between the two solutions. The intraperitoneal dextran 70 concentration increased during the dwell with the hypoosmolar dialysis fluid (from 770 to 945 mg/l; p = 0.000002) and decreased with the GS (from 859 to 719 mg/l; p = 0.007). With the GS the transcapillary ultrafiltration was directed towards the abdominal cavity during the dwell period. With the hypoosmolar fluid, the transcapillary ultrafiltration was continuously directed towards the circulation. In this solution, the magnitude of transcapillary backfiltration due to colloid-osmotic pressure within the peritoneal capillaries was 0.4 ± 0.1 ml/min. In conclusion, intraperitoneal markers can be used in continuous ambulatory peritoneal dialysis patients for determination of effective lymphatic absorption and transcapillary fluid passage in both transport directions.

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“…The fluid absorption from the peritoneal cavity is due to two separate mechanisms: (i) direct lymphatic absorption via lymphatic stomata mainly in the diaphragm, and to a lesser extent, through visceral lymphatic pathway; and (ii) fluid absorption into the peritoneal tissue interstitium, where the fluid is absorbed into the capillary due to the Starling forces, whereas the macromolecules are absorbed slowly into local lymphatics together with a fraction of the fluid (16). Fluid absorption from the peritoneal cavity adversely affects the efficacy of PD by reducing the potential for net fluid removal by 40–50%, and by reducing small solute clearances by 15–20% (17). The rate of fluid absorption has been shown to increase with time on dialysis (18).…”

Section: Discussionmentioning

confidence: 99%

Ultrafiltration Capacity and Peritoneal Fluid Kinetics in Continuous Ambulatory Peritoneal Dialysis Patients

Tian

Cheng

2007

Artificial Organs

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Volume control is critical for peritoneal dialysis. Although peritoneal equilibration test (PET) has been used to clarify the peritoneal membrane characteristics, it is not able to adequately predict peritoneal fluid removal and optimize appropriately the dwell time. In the present study, we applied computer simulation and performed a more detailed evaluation of the fluid kinetics in patients with different ultrafiltration (UF) capacity. Patients who used three to four exchanges of 2.27% glucose dialysate per day (poor UF capacity group), and patients who used three to four exchanges of 1.36% glucose dialysate per day (good UF capacity group) to achieve adequate amount of peritoneal fluid removal were included in the present analysis. All included patients were asked to record appropriately their dialysis exchanges for the assessment of their peritoneal fluid transport characteristics. Seventeen continuous ambulatory peritoneal dialysis patients were selected in the present study, nine in poor UF capacity group and eight in good UF capacity group. Patients in poor UF capacity group had significantly higher daily glucose exposure, higher dialysate-to-plasma ratio of creatinine (D/P creatinine) values, and higher peritoneal fluid absorption rate, K(e), as compared to patients with good UF capacity. Our results suggest that patients with poor UF capacity have significant higher peritoneal small solute transport rate, and more importantly, higher peritoneal fluid absorption rate as compared to patients with good UF capacity.

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Pathways for Fluid Loss from the Peritoneal Cavity

Cited by 37 publications

References 12 publications

Lymphatic Absorption in CAPD Patients with Loss of Ultrafiltration Capacity

Lymphatic Absorption in CAPD Patients with Loss of Ultrafiltration Capacity

Fluid Kinetics in CAPD Patients during Dialysis with a Bicarbonate-Based Hypoosmolar Solution

Ultrafiltration Capacity and Peritoneal Fluid Kinetics in Continuous Ambulatory Peritoneal Dialysis Patients

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