Hyperosmolality, acetate, and lactate: Dilatory factors during peritoneal dialysis

Abstract

Factors that alter peritoneal blood flow may influence the clearance of solutes during peritoneal dialysis. Arteriolar vasodilation, for instance, could increase the delivery of solutes to the capillaries and venules leading to an increase in solute transport into the peritoneal cavity. This study was designed to identify the vasoactive effects of several major components of McGaw and Dianeal peritoneal dialysis solutions to understand how the composition of these solutions may alter in vivo blood flow in the peritoneum. Because the major differences between these solutions and Krebs solution are a high osmolality, a high dextrose concentrations, and an acetate or lactate buffer system, we investigated the effects of these components. Rats were anesthetized with the combination of urethane and chloralose. The cremaster muscles, with the nerve and blood supplies from the rat still intact, was placed in a specially designed tissue chamber that was filled with Krebs solutions. A port permitted microscopic observations of the blood vessels. In vivo television microscopy observations was used to quantitate changes in small arteriole diameters induced by changes in the composition of the solution bathing the cremaster or by the addition of nitroprusside. Hyperosmolality produced by the addition of dextrose, sucrose, or sodium chloride to the Krebs solution induced a submaximal dilation of the small arterioles of the cremaster. The rate of dilation differed depending on the substance used to increase osmolality. A normal osmolality acetate (74 mM) or lactate (45 mM) solution produced a slow, submaximal dilation of the cremaster arterioles. Hyperosmolar acetate (37 or 74 mM) or lactate (45 mM) solutions produced a rapid, maximal dilation of these vessels. Because the rate of dilation and maximal effect produced by the commercial dialysis solutions were similar to these same parameters produced by the high-osmolality acetate or lactate solutions, the dilatory effects of McGaw and Dianeal solutions appear to be due to the combinations of high osmolality and the buffer anion acetate or lactate.