Lymph Flow from the Peritoneal Cavity in CAPD Patients

Rippe, Bengt; Stelin, Gunnar; Ahlmén, J

doi:10.1007/978-3-662-11784-2_4

Cited by 76 publications

(48 citation statements)

References 12 publications

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“…1 and 3) are in accord with previous sequential, direct measurements (25) and infer that fluid absorption in CAPD is mainly lymphatic. The calculated lymphatic absorption rate in this study is much higher than in prior reports (26,27) which determined the rate of lymphatic flow from the rate of mass transfer to radio-labeled tracer from the peritoneal cavity to the blood. This latter method underestimates lymphatic drainage since a significant proportion of the small quantity of radio-labeled colloid administered remains in the subperitoneal interstitium (5) and after systemic absorption the tracer equilibrates out of the blood volume (28).…”

Section: Discussioncontrasting

confidence: 56%

Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis.

Mactier¹,

Khanna²,

Twardowski³

et al. 1987

J. Clin. Invest.

151

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The contribution of peritoneal cavity lymphatic absorption to ultrafiltration kinetics and solute clearances in continuous ambulatory peritoneal dialysis was evaluated in patients with normal (group 1) and high (group 2) peritoneal permeability X area during 4-h exchanges using 2 liters 2.5% dextrose dialysis solution with 30 g added albumin. Cumulative lymphatic drainage in all continuous ambulatory peritoneal dialysis (CAPD) patients averaged 358±47 ml per 4-h exchange and reduced cumulative net transcapillary ultrafiltration at the end of the exchange by 58±7.2%. The peak ultrafiltration volume was observed before osmotic equilibrium between serum and dialysate was reached and occurred when the net transcapillary ultrafiltration rate had decreased to equal the lymphatic absorption rate. Thereafter the lymphatic absorption rate exceeded the net transcapillary ultrafiltration rate, and intraperitoneal volume decreased. Extrapolated to 4 X 2 liters, 2.5% dextrose, 6-h exchanges per d, lymphatic drainage reduced potential daily net ultrafiltration by 83.2±10.2%, daily urea clearance by 16.9±1.9%, and daily creatinine clearance by 16.5±1.9%. Although lymphatic absorption did not differ between the two groups, lymphatic drainage caused a proportionately greater reduction in net ultrafiltration in group 2 (P < 0.025), because these patients had more rapid dialysate glucose absorption (P < 0.05) and less cumulative transcapillary ultrafiltration (P < 0.01). These findings indicate that cumulative lymphatic drainage significantly reduces net ultrafiltration and solute clearances in CAPD and that ultrafiltration failure in CAPD occurs when daily lymphatic absorption equals or exceeds daily transcapillary ultrafiltration. Reduction of lymphatic absorption may provide a means for future improvement in the efficiency of CAPD.

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Section: Discussioncontrasting

confidence: 56%

Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis.

Mactier¹,

Khanna²,

Twardowski³

et al. 1987

J. Clin. Invest.

151

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“…This volume produces almost no measurable intraperitoneal pressure in the rat. Other groups [ 12] have advocated using the body weight to the 0.7 power: for the 200-gram rat. this results in a volume of 30.2 ml [(200/70.000)0-7 X 2.000 ml].…”

Section: Clinical Implications and Design Of Future Experimentsmentioning

confidence: 99%

“…21. 22] and in humans [11][12][13] has shown that fluid and large solutes are removed from the peritoneal cavity at equivalent rates. While 5-25% of the solution leaving the cavity passes directly into the lymphatics, the remainder is transported directly into the surrounding tissue interstitium.…”

Section: Clinical Implications and Design Of Future Experimentsmentioning

confidence: 99%

Net Ultrafiltration in Peritoneal Dialysis: Role of Direct Fluid Absorption into Peritoneal Tissue

Flessner

1992

Blood Purif

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‘Net ultrafiltration’ in peritoneal dialysis refers to the difference between the osmotically induced ultrafiltration into the peritoneal cavity and the fluid loss from the cavity during dialysis. Recent research has demonstrated that, during a 3- to 4-hour experimental dialysis, 5-25% of the total fluid loss is via lymphatics and the remaining fluid is absorbed directly into the tissue surrounding the peritoneal cavity. The driving force for this convection into tissue is the hydrostatic pressure gradient between the peritoneal cavity and the tissue, which ranges from 2 to 8 mm Hg during the typical 2-liter dialysis in humans. Because the convection from the cavity occurs during periods of a positive net ultrafiltration, the peritoneum and its underlying tissue cannot be represented as a single membrane but function as a composite of ‘tight’ and ‘loose’ membranes. More data on the mechanical properties of the peritoneal tissue space and its response to hydrostatic pressure in the cavity are required before we fully understand fluid transport at the tissue level.

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“…However, the quantity of macromol ecules appearing in the circulation is only 11-24% of the amount lost over a dwell time of 4-8 h [9. 11, 12], It has been suggested that the difference is caused by accumulation of the marker in the peritoneal interstitial space [9,11], The presence of l25I-human serum albumin in the abdominal wall after a single intraperitoneal administration has been dem onstrated in rats by Flessner et al [8. 11].…”

Section: Introductionmentioning

confidence: 99%

“…Several authors have used the appareance rate of radiolabeled tracers (e.g.. l25I-albumin [8][9][10], 125I-fibrinogen [11] and 5lCr-erythrocytes [11]) in the circulation for the calcula tion of lymphatic absorption and calculated a lymphatic absorption rate of about 0.1-0.3 ml/min. However, the quantity of macromol ecules appearing in the circulation is only 11-24% of the amount lost over a dwell time of 4-8 h [9.…”

Section: Introductionmentioning

confidence: 99%

Use of the Disappearance Rate for the Estimation of Lymphatic Absorption during CAPD

et al. 1992

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Several studies are discussed which investigated the usefulness of the disappearance rate of macromolecules from the peritoneal cavity for estimating convective fluid loss from the peritoneal cavity into the peritoneal lymphatic system. It is shown that dextrans are removed from the peritoneal cavity by a size-independent process at a mean rate of 1.37 ± 0.15 ml/min, whereas the clearance from blood to dialysate of dextrans is size-dependent. The fluid removal rate estimated by the difference in bidirectional transport of inulin (1.79 ± 0.38 ml/min; p < 0.0005) was of the same order of magnitude as has been found using the removal rate of macromolecules from the peritoneal cavity. Also, the role of local accumulation of macromolecules was studied during continuous administration of dextrans. No differences were found in the dextran disappearance rate before and after saturation of the peritoneal interstitium with dextran (1.1 ± 0.6 vs. 1.0 ± 0.4 ml/min). During a study using a hypoosmotic solution we calculated a net transcapillary backfiltration of fluid, whereas the dextran removal rate was in the same order of magnitude as found using commercially available dialysate. In our opinion, the disappearance rate of macromolecules is an estimate of convective fluid loss from the peritoneal cavity into the peritoneal lymphatic system.

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Lymph Flow from the Peritoneal Cavity in CAPD Patients

Cited by 76 publications

References 12 publications

Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis.

Contribution of lymphatic absorption to loss of ultrafiltration and solute clearances in continuous ambulatory peritoneal dialysis.

Net Ultrafiltration in Peritoneal Dialysis: Role of Direct Fluid Absorption into Peritoneal Tissue

Use of the Disappearance Rate for the Estimation of Lymphatic Absorption during CAPD

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