Clinical Investigation

Kidney International (1989) 35, 1234–1244; doi:10.1038/ki.1989.115

Simulations of peritoneal solute transport during CAPD. Application of two-pore formalism

Bengt Rippe1 and Gunnar Stelin2

  1. 1Department of Physiology, University of Göteborg, Göteborg, Sweden
  2. 2Department of Nephrology, Sahlgrenska Hospital, Göteborg, Sweden

Correspondence: Bengt Rippe MD, Department of Nephrology, Sahlgrenska Hospital, S-413/45 Göteborg, Sweden.

Received 28 March 1988; Revised 25 October 1988; Accepted 20 December 1988.

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Abstract

Simulations of peritoneal solute transport during CAPD. Application of two-pore formalism. Blood peritoneal clearances of various endogenous solutes in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) were evaluated according to recent developments of the two-pore theory of membrane permeability, using a non-linear transport formalism for the analysis. Based on results obtained from these calculations and taking lymphatic drainage into account, transport from peritoneal cavity to the blood was also simulated. With respect to solute transport the data were compatible with a functional blood-peritoneal barrier consisting of a two-pore membrane containing a large number of paracellular "small pores" of radius 40 to 55 Å and a small number of "large pores" of radius 200 to 300 Å. Solutes smaller than 25 Å in radius were found to be permeating across the peritoneal membrane mainly by means of diffusion across the small pores, whereas solutes larger than 40 Å were calculated to reach the peritoneal cavity exclusively by unidirectional convection across the large pores. In addition, water was simulated to be transported through transcellular "ultrapores" (radius less than 8 Å) not accessible to hydrophilic solute permeation. Small solute absorption from the peritoneal cavity was found to occur by diffusion across small pores. Molecules larger than 25 to 30 Å in radius (molecular weight above 25,000) were simulated to be absorbed from the peritoneal cavity exclusively via non-size-selective lymphatic drainage.

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References

  1. Grotte G: Passage of dextran molecules across the blood-lymph barrier. Acta Chir Scand(Suppl) 211:1, 1956
  2. Taylor AE, Granger DN: Exchange of macromolecules across the microcirculation, in Handbook of Physiology, sect 2, The cardiovascular system, edited by Renkin EM Michel CC, American Physiological Society, 1984, p. 465
  3. Rippe B, Haraldsson B: A technique for assessing capillary permeability from transvascular protein flux data obtained at low filtration rates. Acta Physiol Scand 127:263–265, 1986
  4. Rippe B, Haraldsson B: Fluid and protein fluxes across small and large pores in the microvasculature. Application of two-pore equations. Acta Physiol Scand 131:411–428, 1987 | PubMed | ISI | ChemPort |
  5. Patlak CS, Goldstein DA, Hoffman JF: The flow of solute and solvent across two-membrane system. J Theor Biol 5:425–442, 1963
  6. Rippe B, Stelin G, Ahlmén J: Lymph flow from the peritoneal cavity in CAPD patients, in Frontiers in peritoneal dialysis, edited by Maher JF Winchester JF, New York, Field, Rich and Assoc. Inc, 1986, p. 24
  7. Mactier RA, Khanna R, Twardowski Z, Moore H, Nolph KD: Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances incontinuous ambulatory peritoneal dialysis. J Clin Invest: 80:1311–1316, 1987
  8. Rippe B, Stelin G, Ahlmén J: Basal permeability of the peritoneal membrane during continuous ambulatory peritoneal dialysis (CAPD), in Advances in peritoneal dialysis. Proc of the 2nd Int Symp on Peritoneal Dialysis, edited by Gahl GM Kessel M Nolph KD, Amsterdam, Excerpta Medica, 1981, p. 5
  9. Rippe B, Kamiya A, Folkow B: Transcapillary passage of albumin, effects of tissue cooling and of increases in filtration and plasma colloid osmotic pressures. Acta Physiol Scand 105:171–187, 1979 | PubMed |
  10. Renkin EM: Capillary transport of macromolecules: Pores and other endothelial pathways. J Appl Physiol 58:315–325, 1985 | PubMed | ISI | ChemPort |
  11. Blumenkrantz MJ, Gahl GM, Kopple JD, Kadmar AV, Jones MR, Kessel M, Coburn JW: Protein losses during peritoneal dialysis. Kidney Int 19:593–602, 1981 | PubMed | ISI | ChemPort |
  12. Young GA, Brownjohn AM, Parsons FM: Protein losses in patients receiving continuous ambulatory peritoneal dialysis. Nephron 45:196–201, 1987 | PubMed | ISI | ChemPort |
  13. Krediet RT, Zuyderhoudt FMJ, Boeschoten EW, Arisl: Peritoneal permeability to proteins in diabetic and non-diabetic continuous ambulatory peritoneal dialysis patients. Nephron 42:133–140, 1986 | PubMed | ISI | ChemPort |
  14. Farrell PC: Kinetic modeling: Applications in renal and related diseases. Kidney Int 24:487–495, 1983
  15. Garred LJ, Canaud B, Farrell PC: A simple kinetic model for assessing peritoneal mass transfer in chronic ambulatory peritoneal dialysis. ASAIO 6:131–137, 1983
  16. Kedem O, Katchalsky A: Thermodynamic analysis of the permeability of biological membranes to nonelectrolyte. Biochim Biophys Acta 27:229–246, 1958 | Article | PubMed | ISI | ChemPort |
  17. Drake R, Davis E: A corrected equation for the calculation of reflection coefficients. Microvasc Res 15:259, 1978
  18. Henderson L: Ultrafiltration with peritoneal dialysis, in Peritoneal Dialysis, edited by Nolph KD, Dordrecht, Martinus Nijhoff Publishers, 1985, p. 159
  19. Taylor AE: Capillary fluid filtration: Starling forces and lymph flow. Circ Res 49:557–575, 1981 | PubMed | ISI | ChemPort |
  20. Rippe B: A simple method for assessing peritoneal membrane permeability in CAPD patients. (abstract) Perit Dialysis Bull 6(1):87, 1985
  21. Pyle WK, Moncrief JW, Popovich RP: Peritoneal transport evaluation in CAPD, in CAPD update, edited by Moncrief JW Popovich RP, New York, Masson Publishing, 1980, p. 35
  22. Nolph K, Popovich RP, Ghods AJ, Twardowski Z: Determinants of low clearances of small solutes during peritoneal dialysis. Kidney Int 13:117–123, 1978 | PubMed | ChemPort |
  23. Rubin J: Comments on dialysis solution, antibiotic transport, poisoning and novel uses of peritoneal dialysis, in Peritoneal Dialysis, edited by Nolph KD Dordrecht, Martinus Nijhoff Publishers, 1985, p. 297
  24. Rubin J, Reed V, Adair C, Bower J, Klein E: Effect of intraperitoneal insulin on solute kinetics in CAPD: Insulin kinetics in CAPD. Am J Med Sci 291(2):81–87, 1986
  25. Wideröe TE, Smeby LC, Berg KJ, Jörstad S, Svarts TM: Intraperitoneal (125I) insulin absorption during intermittent and continuous peritoneal dialysis. Kidney Int 23:22–28, 1983
  26. Dulaney JT, Hatch FE Jr: Peritoneal dialysis and loss of proteins: A review. Kidney Int 26:253–262, 1984 | PubMed | ISI | ChemPort |
  27. Lindholm B, Werynski A, Bergström J: Kinetics of peritoneal dialysis with glycerol and glucose as osmotic agents. ASAIO 10:19–27, 1987
  28. Curry FE: Mechanisms and thermodynamics of transcapillary exchange, in Handbook of Physiology, sect. 2, vol. IV, edited by Renkin EM Michel CC, Bethesda, Maryland, American Physiological Society, 1984, p. 309
  29. Rippe B, Perry MA, Granger DN: Permselectivity of peritoneal membrane. Microvasc Res 29:89–102, 1985 | PubMed |
  30. Nolph KD, Miller FN, Pyle WK, Popovich RP, Sorkin MI: An hypothesis to explain the ultrafiltration characteristics of peritoneal dialysis. Kidney Int 20:543–548, 1981
  31. Curry FE, Mason JC, Michel CC: Osmotic reflection coefficients of capillary walls to low molecular weight hydrophilic solutes measured in single perfused capillaries of the frog mesentery. J Physiol (London) 261:319–336, 1976
  32. Aune S: Peritoneal permeability. The exchange of water and solutes between blood and peritoneal cavity. Universitetsforlaget, Oslo, 1970
  33. Hirszel P, Chakrobarti EK, Bennet RR, Maher JF: Permse-lectivity of the peritoneum to neutral dextrans. Trans Am Soc Artif Intern Organs 30:625–628, 1984
  34. Arthurson G: Permeability of the peritoneal membrane. (abstract) 6th Eur Conf Microcirculation, Aalborg, 1970, Basel, Karger, p. 197, 1971
  35. Flessner MF, Dedrick RL, Schultz JS: A distributed model of peritoneal-plasma transport: Analysis of experimental data in the rat. Am J Physiol 248:F413–424, 1985
  36. Flessner MF, Fenstermacher JD, Dedrick RL, Blasberg RG: A distributed model of peritoneal-plasma transport: Tissue concentration gradients. Am J Physiol 248:F425–F435, 1985 | PubMed |
  37. Flessner MF, Dedrick RL, Schultz JS: Exchange of macro-molecules between peritoneal cavity and plasma. Am J Physiol 248:H15–H25, 1985
  38. Haraldsson B, Rippe B: Restricted diffusion of CrEDTA and cyanocobalamin in rat hindquarters. Acta Physiol Scand 127:359–372, 1986 | PubMed | ChemPort |
  39. Twardowski Z, Kisazek A, Majdan M, Janicka L, Bochens-ka-Nowacka E, Sokolowska G, Gutka A, Zbikowska A: Kinetics of continuous ambulatory peritoneal dialysis (CAPD) with four exchanges per day. Clin Nephrol 15(3):119–130, 1981
  40. Flessner MF, Parker RJ, Sieber SM: Peritoneal lymphatic uptake of fibrinogen and erythrocytes in the rat. Am J Physiol 244:H89–H96, 1983 | PubMed |
  41. Rippe B, Haraldsson B: How are macromolecules transported across the capillary wall? News in Physiol Sci 2:135–138, 1987

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