Similarities and differences between the effects of amino acids and nitroprusside on peritoneal permeability during CAPD.
OBJECTIVE
Intraperitoneal administration of amino acid based dialysis solutions affects the surface area available for diffusion, with almost no effect on the intrinsic permeability to macromolecules. Intraperitoneally administered nitroprusside affects the vascular surface area and the intrinsic permeability without effect on the peritoneal blood flow. In the present study, these differences were translated into different effects on the radii of the pores in the peritoneal membrane.


METHODS
Effects of amino acid based dialysate and nitroprusside on peritoneal permeability characteristics were evaluated in standard peritoneal permeability analyses with L-arginine-containing amino acid dialysate (10 patients) or with 1.36% glucose dialysate with nitroprusside (10 patients). In each patient a control experiment with 1.36% glucose was performed. Kinetic modeling was done to analyze the effects in terms of the pore theory.


RESULTS
Both interventions increased the mass transfer area coefficients of low molecular weight solutes. This is in accordance with an increase in the unrestricted area over diffusion distance found with modeling. With amino acids almost no effect was found on the protein clearances; the increase in the large-pore radius was only small. Nitroprusside induced a marked increase in protein clearances. This was in accordance with an evident increase in the average large-pore radius.


CONCLUSIONS
Amino acids affect the radii of the small pores and the large pores to the same extent. Nitroprusside influences especially the large pores. Both amino acids and nitroprusside are vasoactive, although the effects on the peritoneal microcirculation are different.
Douma
C E
CE
Department of Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
Imholz
A L
AL
Struijk
D G
DG
Krediet
R T
RT
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007263:Infusions, Parenteral; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009599:Nitroprusside / Q000008:administration & dosage / Q000494:pharmacology*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000378:metabolism*; D010539:Permeability / Q000187:drug effects
D000596:Amino Acids; D009599:Nitroprusside