Wang T, Cheng H H, Heimbürger O, Waniewski J, Bergström J, Lindholm B
Divisions of Baxter Novum and Renal Medicine, Huddinge University Hospital, Karolinska Institute, Huddinge, Sweden.
Kidney Int. 2000 Apr;57(4):1704-12. doi: 10.1046/j.1523-1755.2000.00015.x.
Peritonitis is a common clinical problem and contributes to the high rate of technique failure in continuous ambulatory peritoneal dialysis treatment. The present study investigated the effect of peritonitis on peritoneal fluid and solute transport characteristics using glucose and polyglucose (icodextrin) solutions.
A four-hour dwell was performed in 32 Sprague-Dawley rats (8 rats in each group), with 131I albumin as an intraperitoneal volume marker. Peritonitis was induced by an intraperitoneal injection of 2 mL lipopolysaccharide (100 microg/mL phosphate-buffered saline) four hours before the dwell. Each rat was intraperitoneally infused with 25 mL of 3.86% glucose [glucose solution control group (Gcon) and glucose solution peritonitis group (Gpts)] or 7.5% icodextrin solution [icodextrin solution control group (Pgcon) and icodextrin peritonitis group (PGpts)].
Net ultrafiltration was significantly lower (by 44%) in the Gpts as compared with the Gcon group, but was significantly higher (by 138%) in the PGpts as compared with the PGcon group. The peritoneal fluid absorption rate, including the direct lymphatic absorption rate, was significantly increased (by 78%) in the Gpts group as compared with the Gcon group. However, the total fluid absorption did not differ between the PGpts and the PGcon groups. The dialysate osmolality decreased much faster in the Gpts group as compared with the Gcon group, resulting in significantly lower (by 9%) transcapillary ultrafiltration in the Gpts group. In contrast, the dialysate osmolality increased faster in the PGpts group as compared with the PGcon group, resulting in higher (by 40%) transcapillary ultrafiltration in the PGpts group. The in vitro increase in dialysate osmolality was also higher in the PGpts group as compared with the PGcon group. The solute diffusive transport rates were, in general, increased in the two peritonitis groups as compared with their respective control groups.
Our results suggest the following: (1) Peritonitis results in decreased net ultrafiltration using glucose solution caused by (a) decreased transcapillary ultrafiltration and (b) increased peritoneal fluid absorption. (2) Ultrafiltration induced by the icodextrin solution appears to be related to the increase in dialysate osmolality (mainly because of the degradation of icodextrin). (3) Peritonitis results in increased degradation of icodextrin and a faster increase in dialysate osmolality and therefore better ultrafiltration, whereas the fluid absorption rate does not change. (4) Peritonitis results in increased peritoneal diffusive permeability.
腹膜炎是常见的临床问题，也是持续性非卧床腹膜透析治疗中技术失败率高的原因之一。本研究使用葡萄糖和聚葡萄糖（艾考糊精）溶液，探讨腹膜炎对腹膜液及溶质转运特性的影响。
对32只Sprague-Dawley大鼠（每组8只）进行4小时留腹，以131I白蛋白作为腹腔容积标志物。留腹前4小时腹腔注射2 mL脂多糖（100 μg/mL磷酸盐缓冲盐水）诱导腹膜炎。每只大鼠腹腔内注入25 mL 3.86%葡萄糖[葡萄糖溶液对照组（Gcon）和葡萄糖溶液腹膜炎组（Gpts）]或7.5%艾考糊精溶液[艾考糊精溶液对照组（Pgcon）和艾考糊精腹膜炎组（PGpts）]。
与Gcon组相比，Gpts组的净超滤显著降低（降低44%），但与Pgcon组相比，PGpts组的净超滤显著升高（升高138%）。与Gcon组相比，Gpts组的腹膜液吸收率，包括直接淋巴吸收率，显著增加（增加78%）。然而，PGpts组和Pgcon组的总液体吸收无差异。与Gcon组相比，Gpts组透析液渗透压下降更快，导致Gpts组的跨毛细血管超滤显著降低（降低9%）。相反，与Pgcon组相比，PGpts组透析液渗透压升高更快，导致PGpts组的跨毛细血管超滤更高（升高40%）。与Pgcon组相比，PGpts组透析液渗透压的体外升高也更高。与各自的对照组相比，两个腹膜炎组的溶质扩散转运速率总体上有所增加。
我们的结果表明：（1）腹膜炎导致使用葡萄糖溶液时净超滤降低，原因是（a）跨毛细血管超滤降低和（b）腹膜液吸收增加。（2）艾考糊精溶液诱导的超滤似乎与透析液渗透压升高有关（主要是由于艾考糊精的降解）。（3）腹膜炎导致艾考糊精降解增加，透析液渗透压升高更快，因此超滤效果更好，而液体吸收率不变。（4）腹膜炎导致腹膜扩散通透性增加。
