The peritoneal microcirculation in peritoneal dialysis.
This paper deals with the peritoneal microcirculation and with peritoneal exchange occurring in peritoneal dialysis (PD). The capillary wall is a major barrier to solute and water exchange across the peritoneal membrane. There is a bimodal size-selectivity of solute transport between blood and the peritoneal cavity, through pores of radius approximately 40-50 A as well as through a very low number of large pores of radius approximately 250 A. Furthermore, during glucose-induced osmosis during PD, nearly 40% of the total osmotic water flow occurs through molecular water channels, termed "aquaporin-1." This causes an inequality between 1 - sigma and the sieving coefficient for small solutes, which is a key feature of the "three-pore model" of peritoneal transport. The peritoneal interstitium, coupled in series with the capillary walls, markedly modifies small-solute transport and makes large-solute transport asymmetric. Thus, although severely restricted in the blood-to-peritoneal direction, the absorption of large solutes from the peritoneal cavity occurs at a high clearance rate ( approximately 1 mL/min), largely independent of molecular radius. True absorption of macromolecules to the blood via lymphatics, however, seems to be occurring at a rate of approximately 0.2 mL/min. Several controversial issues regarding transcapillary and transperitoneal exchange mechanisms are discussed in this paper.
Rippe
B
B
Department of Nephrology, University Hospital of Lund, Lund, Sweden. Bengt.Rippe@njur.lu.se
Rosengren
B I
BI
Venturoli
D
D
D020346:Aquaporins / Q000378:metabolism; D001692:Biological Transport / Q000502:physiology; D001825:Body Fluid Compartments / Q000502:physiology; D004730:Endothelium, Vascular / Q000378:metabolism / Q000502:physiology; D006801:Humans; D008833:Microcirculation; D009995:Osmosis / Q000502:physiology; D010529:Peritoneal Cavity / Q000098:blood supply*; D010530:Peritoneal Dialysis; D014882:Water-Electrolyte Balance / Q000502:physiology
D020346:Aquaporins