Alterations of peritoneal transport characteristics in dialysis patients with ultrafiltration failure: tissue and capillary components

Abstract

Background Ultrafiltration failure (UFF) in peritoneal dialysis (PD) patients is due to altered peritoneal transport properties leading to reduced capacity to remove excess water. Here, with the aim to establish the role of local alterations of the two major transport barriers, peritoneal tissue and capillary wall, we investigate changes in overall peritoneal transport characteristics in UFF patients in relation to corresponding local alterations of peritoneal tissue and capillary wall transport properties. Methods Six-hour dwell studies using 3.86% glucose solutions and radioisotopically labelled serum albumin added to dialysate as a volume marker were analysed in 31 continuous ambulatory PD patients, 20 with normal ultrafiltration (NUF) and 11 with UFF. For each patient, the physiologically based parameters were evaluated for both transport barriers using the spatially distributed approach based on the individual intraperitoneal profiles of volume and concentrations of glucose, sodium, urea and creatinine. Results UFF patients as compared with NUF patients had increased solute diffusivity in both barriers, peritoneal tissue and capillary wall, decreased tissue hydraulic conductivity and increased local lymphatic absorption and functional decrease in the fraction of the ultra-small pores. This resulted in altered distribution of fluid and solutes in the peritoneal tissue, and decreased penetration depths of fluid and solutes into the tissue in UFF patients. Conclusions Mathematical modelling using a spatially distributed approach for the description of clinical data suggests that alterations both in the capillary wall and in the tissue barrier contribute to UFF through their effect on transport and distribution of solutes and fluid within the tissue.

Proteomic Research in Peritoneal Dialysis

“…Although the relative abundance of primarily IgG-derived glycans was not associated with several inflammation markers or PET-creatinine and PET-UF, no such association was tested for the abundance of pro-inflammatory, agalactosylated glycated IgG. In keeping with the relevance of preserving residual kidney function in maintaining euvolemia and delaying the occurrence of UF failure, both highly correlated with PD patient survival [77][78][79], it would be of great interest to investigate if the decline of residual kidney function and UF failure correlates with the pro-inflammatory and anti-inflammatory IgG N-glycosylation pattern in both diabetic and non-diabetic PD patients.…”

Long Peritoneal Dialysis Dwells With Icodextrin: Kinetics of Transperitoneal Fluid and Polyglucose Transport

“…One may expect higher concentration of amylase in interstitial fluid than in dialysate so the osmolality of interstitial fluid may differ from that of dialysate. According to the distributed model, the sodium dip measured for glucose-based hypertonic fluids occurs also in the interstitial fluid, not only in dialysate, and this observation suggests the importance of the processes inside the tissue in contact with peritoneal dialysate (Stachowska-Pietka et al, 2012, 2019). The conjecture about the role of interstitium in the process of osmotic fluid transport induced by polyglucose is hypothetical and will need further theoretical, experimental, and clinical studies to be confirmed.…”

Dipeptidyl peptidase 4 promotes peritoneal fibrosis and its inhibitions prevent failure of peritoneal dialysis

“…Previous study has demonstrated that an increase in the number of blood vessels in the peritoneal tissues of PD patients was commonly observed and more pronounced in those of PD patients with peritoneal membrane ultrafiltration failure 44 . Consistent with the previous study 44 , our study demonstrated a progressive increase in submesothelial thickening (i.e., through EMT process), in number of blood vessels and in a unique vasculopathy after CG-treated F344 PF.…”