Limitation of small-solute exchange across the visceral peritoneum: Effects of vibration

Objective: To evaluate the importance of the peritoneal membrane diffusion resistances to small solutes prevailing outside the capillaries in the visceral versus the parietal peritoneum during acute peritoneal dialysis (PD). Design: Experimental study in anesthetized Wistar rats undergoing PD in a single exchange (120 min) using 1.36% Dianeal as dialysis fluid. Vibration, using a standard laboratory shaker at 10 Hz, was used to induce dialysate mixing and reduce the impact of 'unstirred layers' in intact and eviscerated rats. Nonvibrated rats served as controls. Measurements: The mass transfer area coefficient (PS) for chromium 51-ethylenediamine tetraacetic acid (⁵¹Cr-EDTA), continuously infused intravenously, the plasma-to-peritoneal clearance (Cl→D) of radioiodinated (¹²⁵I) serum albumin (human) (RISA), as well as the total clearance out of the peritoneal cavity (CI) of Evans blue labeled albumin, given as an intraperitoneal volume marker, and the portion of this CI reaching the plasma per unit time (Cl→P) were assessed. Results: In intact rats there was a marked increase in PS for ⁵¹Cr-EDTA, from 0.297 ± 0.036 mL/min to 0.642 ± 0.122 mL/min (n = 7, p < 0.01), and a moderate increase in Cl and Cl→D, from 37.6 ± 1.3 μL/min to 63.3 ± 9.0 μL/min and from 6.04 ± 0.51 μL/min to 9.54 ± 0.93 μL/min (n = 7, p < 0.05), respectively, upon vibration. However, the plasma absorption clearance of albumin (Cl→P) was unchanged after vibration. Furthermore, in eviscerated rats, vibration caused no significant changes in either of the exchange parameters measured. Conclusion: In conclusion, the visceral peritoneal transport of small solutes is normally limited by the presence of diffusion resistances outside the capillaries, which may be markedly reduced by 'stirring' of the dialysate by vibration. Normally, the parietal, rather than the visceral, peritoneum is the major site for small-solute mass transfer in stationary animals. However, the visceral peritoneum apparently becomes increasingly important after stirring. The moderate increases in transperitoneal clearances of macromolecules occurring upon vibration, which were quite unexpected, indicate that vibration may also increase the dialysate/peritoneal membrane contact and/or cause some recruitment of capillaries.