Clinical Investigation

Kidney International (1992) 41, 1668–1675; doi:10.1038/ki.1992.240

Indirect measurement of lymphatic absorption in CAPD patients is not influenced by trapping

Dirk G Struijk, Gerardus C M Koomen, Raymond T Krediet and Lambertus Arisz

Renal Unit, Departments of Medicine and Clinical Chemistry, Academic Medical Center, University of Amsterdam, Amsterdam, and Foundation of Home Dialysis, Midden-West Nederland, Utrecht, The Netherlands

Correspondence: Dirk G Struijk MD, Dialysis Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

Received 8 July 1991; Revised 23 January 1992; Accepted 27 January 1992.

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Abstract

Indirect measurement of lymphatic absorption in CAPD patients is not influenced by trapping. The disappearance rate of intraperitoneally administered macromolecules is often used to calculate lymphatic absorption during CAPD. The possible contribution of local accumulation (trapping) of such solutes in the tissues surrounding the peritoneal cavity, leading to overestimation of lymphatic flow, was investigated in eight CAPD patients. They were studied twice during a four hour dwell, glucose 1.36%, to which polydisperse neutral dextran 70 1 g/liter had been added for measurement of lymphatic flow. After the test on day 1 dextran 130 mg/kg was given intravenously and also dextran 1 g/liter was added to every following dialysis bag until the second test on day 3. This was done to saturate the tissues surrounding the peritoneal cavity and thereby to create a steady state condition. In one patient the dextran administration was continued until a third study was done on day 5. Dextran in serum during day 3 was 1.3 plusminus 0.5 g/liter (mean plusminus SD). No difference in peritoneal clearance of dextran was found between day 1 and day 3 (1.11 plusminus 0.56 versus 0.97 plusminus 0.41 ml/min). Also no difference was found between day 1 (0.32), day 3 (0.62), and day 5 (0.42 ml/min). Trapping would have influenced the first but not the second test, as the second time all tissues were saturated with dextran. As the dextran absorption rate remained the same, this indicates that trapping is of no importance and that lymphatic absorption can be measured by the disappearance of a macromolecular marker.

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References

  1. Daugirdas JT, Ing TS, Ghandhi VC, Hano JE, Chen WT, Yuan L: Kinetics of peritoneal fluid absorption in patients with chronic renal failure. J Lab Clin Med 95:351–361, 1980 | PubMed | ISI | ChemPort |
  2. Nolph KD, Mactier RA, Khanna R, Twardowski ZJ, Moore H, McGary T: The kinetics of ultrafiltration during peritoneal dialysis: The role of lymphatics. Kidney Int 32:219–226, 1987 | PubMed | ChemPort |
  3. Mactier RA, Khanna R, Twardowski Z, Moore H, Nolph KD: Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis. J Clin Invest 80:1311–1316, 1987 | PubMed | ISI | ChemPort |
  4. Rippe B, Stelin G, Ahlmen 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, 1986, pp. 24–30
  5. Krediet RT, Koomen GCM, Koopman MG, Hoek FJ, Struijk DG, Boeschoten EW, Arisz L: The peritoneal transport of serum proteins and neutral dextran in CAPD patients. Kidney Int 35:1064–1072, 1989 | PubMed |
  6. Rippe B, Stelin G: Simulations of peritoneal solute transport during CAPD. Application of two-pore formalism. Kidney Int 35:1234–1244, 1989 | PubMed | ISI | ChemPort |
  7. Krediet RT, Struijk DG, Koomen GCM, Hoek FJ, Arisz L: The disappearance of macromolecules from the peritoneal cavity during CAPD is not dependent on molecular size. Perit Dial Int 10:147–152, 1990 | PubMed |
  8. Henriksen JH, Lassen NA, Parving HH, Winkler K: Filtration as the main transport mechanism of protein exchange between plasma and the peritoneal cavity in hepatic cirrhosis. Scand J Clin Lab Invest 40:503–513, 1980
  9. Flessner MF, Dedrick RL, Schultz JS: Exchange of macro-molecules between peritoneal cavity and plasma. Am J Physiol 248:H15–H25, 1985
  10. Hirszel P, Donohue TS, Chakrabarti E, Montcalm E, Maher JF: The role of the capillary wall in restricting diffusion of macromolecules. Nephron 49:58–61, 1988 | PubMed |
  11. Mactier R, Khanna R, Twardowski Z, Nolph KD: Estimation of lymphatic absorption and intraperitoneal volume during hypertonic peritoneal dialysis. (Letter) ASAIO Trans 34:82–83, 1988
  12. Flessner MF, Dedrick RL, Rippe B: Letter. ASAIO Trans 35:178–180, 1989
  13. Nolph KD, Khanna R, Mactier R, Twardowski ZJ: Letter. ASAIO Trans 35:180–181, 1989
  14. De Paepe M, Belpaire F, Schelstraete K, Lameire N: Comparison of different volume markers in peritoneal dialysis. Lab Clin Med 111:421–429, 1988
  15. Krediet RT, Struijk DG, Boeschoten EW, Hoek FJ, Arisz L: Measurement of intraperitoneal fluid kinetics in CAPD patients by means of autologous haemoglobin. Neth J Med 33:281–290, 1988
  16. Krediet RT, Struijk DG, Koomen GCM, Arisz L: Peritoneal fluid kinetics during CAPD measured with intraperitoneal dextran 70. ASAIO Trans 37:662–667, 1991 | PubMed | ChemPort |
  17. Spencer PC, Farrell PC: Solute and water transfer kinetics in CAPD, in Continuous Ambulatory Peritoneal Dialysis, edited by Gokal R, London, Churchill Livingstone, 1986, pp. 38–55
  18. Abernethy NJ, Chin W, Hay JB, Rodela H, Oreopoulos D, Johnston MG: Lymphatic removal of dialysate from the peritoneal cavity of anesthetized sheep. Kidney Int 40:174–181, 1991
  19. Flessner MF, Parker RJ, Sieber SM: Peritoneal lymphatic uptake of fibrinogen and erythrocytes in the rat. Am J Physiol 244:H89–H96, 1983 | PubMed |
  20. Flessner MF, Fenstermacher JD, Blasberg RG, Dedrick RL: Peritoneal absorption of macromolecules studied by quantitative autoradiography. Am J Physiol 248:H26–H32, 1985
  21. Renck H, Ljungström HG, Hedin H, Richter W: Prevention of dextran-induced anaphylactic reactions by hapten inhibition. Acta Chir Scan 149:355–360, 1983
  22. Brown P, Nolph KD: Chemical measurements of inulin concentrations in peritoneal dialysis solution. Clin Chim Acta 76:103–112, 1977 | Article | PubMed | ChemPort |
  23. Koomen GCM, Krediet RT, Leegwater AJC, Struijk DG, Arisz L, Hoek FJ: A fast and reliable method for the measurement of intraperitoneal dextran 70, used to calculate lymphatic absorption, in Advances in Continuous Ambulatory Peritoneal Dialysis, edited by Khanna R, Nolph KD, Prowant B, Twardowski ZJ, Oreopoulos DG, Toronto, University of Toronto Press, 1991, pp. 10–14
  24. Garred LJ, Canaud B, Farrell PC: A simple kinetic model for assessing peritoneal mass transfer in chronic ambulatory peritoneal dialysis. ASAIO J 6:131–137, 1983
  25. Krediet RT, Boeschoten EW, Zuyderhoudt FMJ, Strackee J, Arisz L: Simple assessment of the efficacy of peritoneal transport in continuous ambulatory peritoneal dialysis patients. Blood Purif 4:194–203, 1986 | PubMed | ChemPort |
  26. Krediet RT, Zuyderhoudt FMJ, Boeschoten EW, Arisz L: Alterations in the peritoneal transport of water and solutes during peritonitis in continuous ambulatory peritoneal dialysis patients. Eur J Clin Invest 17:43–52, 1987 | PubMed | ISI | ChemPort |
  27. Schluchter MD: Unbalanced repeated measures models with structured covariance matrices, in BMDP Statistical Software Manual, edited by Dixon WJ, Berkely, University of California Press, 1990, vol 2, pp. 1207–1244
  28. Esperanca MJ, Collins DL: Peritoneal dialysis efficiency in relation to body weight. J Pediatric Surg 1:162–169, 1966
  29. Rubin J, Clawson M, Planch A, Jones Q: Measurements of peritoneal surface area in man and rat. Am J Med Sci 295:453–458, 1988 | PubMed | ChemPort |
  30. Baron MA: Structure of the intestinal peritoneum in man. Am J Anat 69:439–496, 1941
  31. Williams PL, Warwick R, Dyson M, Bannister LH: Gray's Anatomy, Edinburgh, Churchill Livingstone, 1989, 37th edition, p. 1336
  32. Di Fiore MSH: Atlas of Human Histology, Philadelphia, Lea & Febiger, 1981
  33. Armitrage P, Berry G: Statistical Methods in Medical Research, Oxford, Blackwell Scientific Publications, 1987, 2nd edition, pp. 179–185
  34. Struijk DG, Krediet RT, Koomen GCM, Boeschoten EW, vd Reijden HJ, Arisz L: Indirect measurement of lymphatic absorption with inulin in continuous ambulatory peritoneal dialysis (CAPD) patients. Perit Dial Int 10:141–145, 1990 | PubMed |
  35. Mactier RA, Khanna R, Twardowski ZJ, Moore H, Nolph KD: Influence of phosphatidylcholine on lymphatic absorption during peritoneal dialysis in the rat. Perit Dial Int 8:179–186, 1988
  36. Mactier RA, Khanna R: Absorption of fluid and solutes from the peritoneal cavity. Trans Am Soc Artif Intern Organs 35:122–131, 1989
  37. Bergonzoni G, Paties C, Vassallo G, Zangrandi A, Poisetti PG, Ballocchi S, Fontana F, Scarpioni L: Dextran deposits in tissues of patients undergoing haemodialysis. Nephrol Dial Transplant 5:54–58, 1990
  38. Terry R, Yuile CL, Golodetz A, Philips CE, White RR: Metabolism of dextran—A plasma expander. J Lab Clin Med 42:6–15, 1953
  39. Arisz L: Glomerulaire Proteinuric, Thesis, University of Groningen, 1973, pp. 160–170
  40. Kastrup EW: Drug Facts and Comparisons. St. Louis, J.B. Lippincott Company, 1989, p. 264
  41. Mactier RA, Khanna R, Twardowski Z, Nolph KD: Net ultrafiltration in peritoneal dialysis equals cumulative transcapillary ultrafiltration minus lymphatic absorption during the dwell time. (Letter) Clin Nephrol 28:209, 1987

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