Symposium on Continuous Ambulatory Peritoneal Dialysis

Kidney International (1983) 23, 35–39; doi:10.1038/ki.1983.7

The influence of solution composition on protein loss during peritoneal dialysis

Frederick N Miller1, Karl D Nolph1, Michael I Sorkin1 and Hans J Gloor1

1Dalton Research Center and the Departments of Pharmacology and Medicine, University of Missouri, Columbia, Missouri

Correspondence: Dr F N Miller, Departments of Physiology and Biophysics, School of Medicine, Health Science Center, University of Louisville, Louisville, Kentucky 40232, USA

Received 1 July 1982.

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Abstract

A number of recent studies in man [1–3] and rats [1, 4, 5] has investigated the influence of the composition of commercial peritoneal dialysis solutions on the microcirculation and on the removal of solutes during peritoneal dialysis. One of those studies [3] demonstrated that dialysis with a normal osmolality Krebs solution greatly enhanced the concentration of protein in the drainage solution in comparison to that obtained with commercial, 1.5% dextrose solutions. We proposed that these results represented an effect of osmolality on interstitial movement of protein [6]. Since protein movement in the interstitium probably occurs through water channels in the gel-like matrix of the interstitium [7, 8], a change to a high osmolality dialysis solution could dehydrate the interstitium. This would increase the resistance to protein movement and thus decrease the loss of protein in the dialysate. During the first few exchanges, the high osmolality of commercial dialysis solutions could also pull residual protein out of the interstitium because it produced a generalized dehydration of the interstitial tissues. This would lead to large concentrations of protein in the drainage solution during the first few exchanges and then a progressive fall in dialysate protein with subsequent exchanges. An alternative hypothesis to explain such results would be that there is simply a washout of residual protein from the peritoneal cavity or from tissue spaces within the cavity.

The following studies were designed to test which of these two hypotheses, an increased resistance to protein movement through dehydration of the interstitial tissue or a washout of residual protein already present in the peritoneal cavity, could explain our previous findings [3].

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References

  1. Miller FN, Nolph KD, Harris PD, Rubin J, Wiegman DL, Joshua IG, Twardowski ZB, Ghods AJ: Microvascular and clinical effects of altered peritoneal dialysis solutions. Kidney Int 15:630–639, 1979
  2. Nolph KD, Rubin J, Wiegman DL, Harris PD, Miller FN: Peritoneal clearances with three types of commercially available peritoneal dialysis solutions. Effects of pH adjustment and intraperitoneal nitroprusside. Nephron 24:35–40, 1979
  3. Rubin J, Nolph KD, Arfania D, Joshua IG, Miller FN, Wiegman DL, Harris PD: Clinical studies with a nonvasoactive peritoneal dialysis solution. J Lab Clin Med 93:910–915, 1979
  4. Miller FN, Wiegman DL, Joshua IG, Nolph KD, Rubin J: Effects of vasodilators and peritoneal dialysis solutions on the microcirculation of the rat. Proc Soc Exp Biol Med 161:605–608, 1979
  5. Jauchem JR, Miller FN, Harris PD, Wiegman DL, Joshua IG: Interaction of acetate, lacetate, and osmolality on contraction of mesenteric arteries. Microcirculation 1:37–54, 1981
  6. Miller FN: The peritoneal microcirculation, in Peritoneal Dialysis, edited by Nolph KD. The Hague, Martinus Nijhoff Publishers B.V., 1981, pp. 42–78
  7. Watson PD, Grodins FS: An analysis of the effects of the interstitital matrix on plasma-lymph transport. Microvasc Res 16:19–41, 1978 | PubMed |
  8. Wiederhielm CA: The interstitial space, in Biomechanics, It's Foundations and Objectives, edited by Fung YC, Perrone N, Anliker M. Englewood Cliffs, Prentice Hall, 1972, pp. 273–286
  9. Brown P, Nolph KD: Chemical measurement of inulin concentration in peritoneal dialysis solution. Clin Chim Acta 76:103–112, 1977 | Article | PubMed | ChemPort |
  10. Henry RJ, Sobel C, Segalone M: Turbidometric determination of proteins with sulfosalicyclic and tricholoroacetic acids. Proc Soc Exp Biol Med 92:748–751, 1956 | PubMed | ISI | ChemPort |
  11. Brown EA, Klinger AS, Goffinet J, Finkelstein FP: Effect of hypertonic dialysate and vasodilators on peritoneal dialysis clearances in the rat. Kidney Int 13:271–277, 1978 | PubMed |
  12. Chadwick CS, Fothergill JE: Fluorochromes and their conjugation with proteins. Fluorescent Protein Tracing, edited by Nairyn RC. Edinburgh, E. and S. Livingstone, Ltd, 1962, pp. 4–30
  13. Kramer CY: Extension of multiple range tests to group means with unequal numbers of replications. Biometrics 133:307–310, 1956
  14. Henderson LW, Nolph KD: Altered permeability of the peritoneal membrane after using hypertonic peritoneal dialysis fluid. J Clin Invest 48:992–1001, 1969
  15. Nolph KD, Twardowski ZJ, Popovich RP, Rubin J: Equilibration of peritoneal dialysis solutions during long-dwell exchanges. J Lab Clin Med 93:246–256, 1979
  16. Blumenkrantz MJ, Gahl GM, Kopple JD, Kamdar MR, Kessel JM, Coburn JW: Protein losses during peritoneal dialysis. Kidney Int 19:593–602, 1981 | PubMed | ISI | ChemPort |
  17. Miller FN, Nolph KD, Joshua IG, Wiegman DL, Harris PD, Anderson DB: Hyperosmolality, acetate and lactate: Dilatory factors during peritoneal dialysis. Kidney Int 20:397–402, 1981 | PubMed |

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