Abstract
The peritoneal capillary endothelium is widely considered to be the most influential structure in dictating the rate of small solute transport (SST) during peritoneal dialysis (PD). PD patients are at significant risk of systemic microcirculatory dysfunction. The relationship between peritoneal and systemic microcirculations in patients new to PD has not been well studied. We hypothesised that for patients on PD for less than 6 months, dysfunction in the systemic microcirculation would be reflected in the rate of SST. We recruited 29 patients to a cross-sectional, observational study. Rate of SST was measured using a standard peritoneal equilibration test. Laser Doppler Flowmetry was used to measure response to physical and pharmacological challenge (post-occlusive hyperaemic response and iontophoretic application of vasodilators) in the cutaneous microcirculation. Sidestream Darkfield imaging was used to assess sublingual microvascular density, flow and endothelial barrier properties. We found no moderate or strong correlations between any of the measures of systemic microcirculatory function and rate of SST or albumin clearance. There was however a significant correlation between dialysate interleukin-6 concentrations and both SST (rs = 0.758 p ≤ 0.0001) and albumin clearance (rs = 0.53, p = 0.01). In this study, systemic microvascular dysfunction did not significantly influence the rate of SST even early in patients PD careers. In conclusion, this study demonstrates that intraperitoneal factors particularly inflammation have a far greater impact on rate of SST than systemic factors.
Highlights
The primary function of the microcirculation, which encompasses arterioles, capillaries and venules, is to allow exchange of nutrients and gas transfer across their semipermeable vascular wall
There was a significant correlation between peritoneal albumin clearance and serum IL-6 (Supplemental Figure 2). This is the first study to investigate the relationship between systemic microvascular structure and function and peritoneal solute transport (SST) in a cohort of patients exclusively with a duration of peritoneal dialysis (PD) less than 6 months, examining the relationship between the systemic and peritoneal microcirculations and not the effects on peritoneal microvessels of chronic exposure to dialysate solutions
We found no moderate or strong relationship between endothelial function, microvascular responsiveness, the glycocalyx or microvascular density as assessed in the cutaneous or sublingual microcirculations and rate of SST
Summary
The primary function of the microcirculation, which encompasses arterioles, capillaries and venules, is to allow exchange of nutrients and gas transfer across their semipermeable vascular wall. Excellent agreement between D/PCr4 H for standard PET and fast PET has been shown (r 1⁄4 0.77; p 1⁄4 0.0001).[22] Differences in laboratory creatinine assays are known to influence results,[23] samples taken during the Cardiff PETs were frozen and subsequently reanalysed in the Royal Devon and Exeter clinical biochemistry department (Creatinine Jaffe Gen.[2] by Cobas). Manufacturers of this assay state that no interference is expected at glucose concentrations
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