The kinetics of ultrafiltration during peritoneal dialysis: The role of lymphatics

Nolph, Karl D.; Mactier, Robert; Khanna, Ramesh; Twardowski, Zbylut J.; Moore, Harold L.; McGary, Terry J.

doi:10.1038/ki.1987.195

Cited by 101 publications

(40 citation statements)

References 22 publications

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“…This is most readily achieved with automated PD via the use of a cycler. Since glucose is absorbed into the bloodstream during the period of dwell [14], the osmotic gradient dissipates over time, leading to a decrease in the rate of ultrafiltration [11]. The rate of absorption of glucose is dependent upon the transport characteristics of the peritoneum, a patient-specific factor that is readily determinable using the standardized peritoneal equilibration test [15].…”

Section: Determinants Of Ultrafiltration With Pdmentioning

confidence: 99%

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Peritoneal Ultrafiltration for Chronic Congestive Heart Failure: Rationale, Evidence and Future

Mehrotra

Khanna

2001

Cardiology

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Peritoneal dialysis (PD) was the first dialytic therapy used to achieve euvolemia in individuals with refractory congestive heart failure. PD remains a viable therapy for the short-term management of refractory congestive heart failure, and fluid removal rates comparable to those obtained with the continuous extracorporeal therapies can be achieved. However, with advances in extracorporeal therapies, the role of PD in these situations is limited to those individuals in whom vascular access cannot be obtained or if extracorporeal therapies are not available. On the other hand, PD is the ultrafiltration therapy of choice for the long-term ambulatory management of individuals with refractory congestive heart failure, either as a palliative therapy or as a bridge to definitive surgery or transplantation. A reduction in hospitalization rates and an improvement in functional capacity can be expected under such circumstances; however, survival is unlikely to be affected.

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Section: Determinants Of Ultrafiltration With Pdmentioning

confidence: 99%

“…1) [11]. Only one of these three processes, the transcapillary ultrafiltration, is potentially modifiable; the other two, diffusive reabsorption and lymphatic absorption, occur at a constant rate.…”

Section: Determinants Of Ultrafiltration With Pdmentioning

confidence: 99%

Peritoneal Ultrafiltration for Chronic Congestive Heart Failure: Rationale, Evidence and Future

Mehrotra

Khanna

2001

Cardiology

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“…We have shown that injecting a bolus of isotonic saline intraperitoneally or subcutaneously can be rapidly detected by the system as a significant rise in unbound fluid injected into the peritoneal cavity and document the rate of clearance. To further assess the performance of this technique in a living animal subjected to a subtle physiological challenge, we administered a bolus of hypertonic saline intraperitoneally, which would be expected to lead an additional rise in unbound fluid due to osmotic-induced, intracellular dehydration (12). Administering a hypertonic intraperitoneal saline challenge to the rats was manifested as a significant increase in %fluid compared with the same volume of isotonic saline, representing an increase in unbound fluid.…”

Section: Discussionmentioning

confidence: 99%

“…Administering a hypertonic intraperitoneal saline challenge to the rats was manifested as a significant increase in %fluid compared with the same volume of isotonic saline, representing an increase in unbound fluid. Since intraperitoneal injection of hypertonic saline as well as other hyperosmotic agents in the rat lead to rapid increases in plasma osmolarity (3), blood pressure (6), and fluid in the lymph system and peritoneal cavity (12,19), we assume that the rise in %fluid is representation of the transient increase in fluid of vascular, peritoneal, and lymphatic compartments. This is likely due to free water exchange via aquaporins in the peritoneal membrane (16,18).…”

Section: Discussionmentioning

confidence: 99%

A noninvasive method to study regulation of extracellular fluid volume in rats using nuclear magnetic resonance

Gordon

Phillips

Johnstone

2016

American Journal of Physiology-Renal Physiology

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Gordon CJ, Phillips PM, Johnstone AF. A noninvasive method to study regulation of extraceullular fluid volume in rats using nuclear magnetic resonance. Am J Physiol Renal Physiol 310: F426-F431, 2016. First published December 23, 2015 doi:10.1152/ajprenal.00405.2015.-Timedomain nuclear magnetic resonance (TD-NMR)-based measurement of body composition of rodents is an effective method to quickly and repeatedly measure proportions of fat, lean, and fluid without anesthesia. TD-NMR provides a measure of free water in a living animal, termed %fluid, and is a measure of unbound water in the vascular and extracellular spaces. We hypothesized that injecting a bolus of fluid into the peritoneal cavity would lead to an abrupt increase in %fluid and the rate of clearance monitored with TD-NMR would provide a noninvasive assessment of the free water homeostasis in an awake rat. Several strains of laboratory rats were injected intraperitoneally with 10 ml/kg isotonic or hypertonic saline and %fluid was monitored repeatedly with a Bruker "Minispec" TD-NMR body composition system. Following isotonic saline, %fluid increased immediately by 0.5% followed by a recovery over ϳ6 h. Injecting hypertonic (3 times normal saline) resulted in a significantly greater rise in %fluid and longer recovery. Intraperitoneal and subcutaneous fluid injection led to similar rates of clearance. The Wistar-Kyoto rat strain displayed significantly slower recovery to fluid loads compared with LongEvans and Sprague-Dawley strains. Rats exercised chronically showed significant increases in %fluid, but the rate of clearance of fluid was similar to that of sedentary animals. We conclude that this technique could be used to study vascular and extracellular volume homeostasis noninvasively in rats. fluid homeostasis; rodent; noninvasive; unanesthetized; deydration NONINVASIVE MEASUREMENT OF body composition of laboratory rodents is becoming an increasingly popular method to measure body fat as well as other components of body composition without the need for anesthesia or terminating the animal. Magnetic resonance-based systems are used to rapidly measure body composition in awake animals (10, 11). Time-domain nuclear magnetic resonance (TD-NMR) measures the percentages of fat, lean, and fluid of unanesthetized mice and rats (5). The %fluid parameter is a measure of water in a liquid, unbound state and does not include water that is bound in tissue. Hence, %fluid measured by TD-NMR is primarily a measure of unbound fluid in blood and other extracellular fluid compartments. TD-NMR measures of %fluid of rats and mice are typically 7-8% (5).We speculated that the TD-NMR measure of %fluid could be used to study the homeostatic regulation of free water in an awake rodent. That is, if a bolus of saline were to be injected into a mouse or rat, one should be able to measure an abrupt increase in the %fluid. The magnitude of the rise in fluid volume and the rate of clearance of the excess could reflect the capacity of homeostatic processes involved in regulating e...

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“…For the calculations, the principles of Nolph et al (8) were applied, adapted by Krediet et al (9). Transport parameters were calculated according to previously described formulas (7).…”

Section: Calculationsmentioning

confidence: 99%

Peritoneal Transport Characteristics with Glucose Polymer–Based Dialysis Fluid in Children

Rusthoven¹,

Krediet²,

Willems³

et al. 2004

Journal of the American Society of Nephrology

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Abstract. Scarce data are available on the use of glucose polymer-based dialysate in children. The effects of glucose polymer-based dialysate on peritoneal fluid kinetics and solute transport were studied in pediatric patients who were on chronic peritoneal dialysis, and a comparison was made with previously published results in adult patients. In nine children, two peritoneal equilibration tests were performed using 3.86% glucose and 7.5% icodextrin as a test solution. Dextran 70 was added as a volume marker to calculate fluid kinetics. Serum and dialysate samples were taken for determination of urea, creatinine, and sodium. After calculation of the initial transcapillary ultrafiltration (TCUF) rate, it was possible to calculate the contribution of aquaporin-mediated (AQP-mediated) water transport to ultrafiltration for icodextrin and 3.86% glucose and the part of L p S (the product of the peritoneal surface area and the hydraulic permeability) caused by AQP. In children, the transport parameters were similar for the two solutions, except for TCUF, which was lower for icodextrin (0.9 ml/min per 1.73 m 2 ) as compared with 3.86% glucose (4 ml/min per 1.73 m 2 ). Transport parameters were similar in children and adults for glucose, but with icodextrin, TCUF and marker clearance were significantly lower in children. AQPmediated water flow was 83 versus 50% with glucose (child versus adult; P Ͻ 0.01) and 18 versus 7% with icodextrin (P Ͻ 0.01). Data indicate that transport parameters in children using icodextrin are similar to glucose except for TCUF. Differences are explained by the absence of crystalloid osmosis and that TCUF was determined after a 4-h dwell. Comparison of transport parameters and peritoneal membrane characteristics between children and adults reveal that there seem to be differences in the amount and functionality of AQP. However, there are no differences in clinical efficacy of this transport pathway because the absolute flow through the AQP is identical in both groups using 3.86% glucose.Icodextrin contains glucose polymers as osmotic agent instead of glucose in the conventional peritoneal dialysis (PD) solutions. The effectiveness of icodextrin as a colloid osmotic agent has been very well established in adult patients (1-4). The solution is especially indicated in situations in which a high exposure to glucose should be avoided, such as in patients with exchanges with a long dwell time and in patients with ultrafiltration failure (5).Until now, very little has been published about the use of glucose polymer-based dialysate in children. It was demonstrated that 7.5% icodextrin is capable of inducing sustained net ultrafiltration during long-term dwell in children and that the metabolism of icodextrin is similar compared with adults (6). The aim of the present study was to compare a 7.5% icodextrin-based dialysis solution with a 3.86% glucose solution with regard to peritoneal fluid kinetics and solute transport in a pediatric PD population. In addition, the results obtained in children were c...

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The kinetics of ultrafiltration during peritoneal dialysis: The role of lymphatics

Cited by 101 publications

References 22 publications

Peritoneal Ultrafiltration for Chronic Congestive Heart Failure: Rationale, Evidence and Future

Peritoneal Ultrafiltration for Chronic Congestive Heart Failure: Rationale, Evidence and Future

A noninvasive method to study regulation of extracellular fluid volume in rats using nuclear magnetic resonance

Peritoneal Transport Characteristics with Glucose Polymer–Based Dialysis Fluid in Children

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