Document Detail

Plasma appearance rate of intraperitoneal macromolecular tracer underestimates peritoneal lymph flow.
MedLine Citation:
PMID:  18985995     Owner:  NLM     Status:  MEDLINE    
The magnitude of peritoneal lymph flow is an issue of great controversy in peritoneal dialysis (PD) research. Because no single lymphatic duct drains the entire peritoneal cavity, peritoneal lymph flow is indirectly measured as lymphatic removal of intraperitoneal macromolecular tracer. In rats, the peritoneal clearance (K) of such a tracer is 5 times the approximately 8 microL/min determined from the tracer appearance rate in blood (Cl). The fractional contribution of tissues bordering the peritoneal cavity to the overall Cl was determined to be diaphragm, 55%; viscera, 30%; and abdominal wall, 15%. The present study determines whether direct measurement of visceral peritoneal lymph flow matches the 30% (approximately 2.5 microL/min) contribution of the visceral peritoneal lymph flow as measured indirectly by the Cl method. The mesenteric lymph duct that exclusively drains lymph from the gut, liver, and mesentery was cannulated in 15 rats, and lymph flow from the duct was collected at hourly intervals up to 6 hours under near-normal physiologic conditions and under conditions of simulated PD. Changes in mesenteric lymph flow that resulted from a challenge with 3 mL intravenous saline were captured using real-time video. We observed no significant differences between the hourly lymph volumes collected over 6 hours in naïve animals (n = 5, p > 0.05). Under conditions of simulated PD with dialysis fluid in the peritoneal cavity, the mesenteric duct lymph flow averaged 8.67 +/- 1.41 microL/min (n = 10). That flow is similar to reported data on total peritoneal Cl in rats; and 4 times the 2.5 microL/min visceral peritoneal contribution to the total peritoneal Cl. The intravenous saline challenge significantly increased mesenteric lymph duct output to 30.9 +/- 1.6 microL/min (n = 5, p < 0.01) and reduced the lymph-to-plasma concentration ratio (L/P) by 43%. The reflection coefficient for total proteins (sigma(prot)) across the intestinal capillaries as calculated from the filtration rate-dependent L/P ratio when the transcapillary fluid escape rate and the mesenteric lymph flow were both high was more than 0.87. We concluded that (A) under near-normal physiologic conditions, the mesenteric lymph duct flow is steady, but quite low; (B) under conditions of simulated PD, the mesenteric lymph duct flow increases significantly from the physiologic norm; (C) mesenteric lymph duct flow is sensitive to the peritoneal fill volume; (D) during simulated PD, the fractional visceral peritoneal lymph flow measured indirectly from plasma appearance of intraperitoneal tracer underestimates the directly measured mesenteric duct lymph flow; and (E) the increased transcapillary fluid escape rate is rapidly buffered by augmentation of mesenteric lymph duct output.
El Rasheid Zakaria; Chester J Mays; Paul J Matheson; Ryan T Hurt; Richard N Garrison
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis     Volume:  24     ISSN:  1197-8554     ISO Abbreviation:  Adv Perit Dial     Publication Date:  2008  
Date Detail:
Created Date:  2008-11-06     Completed Date:  2008-12-19     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9104803     Medline TA:  Adv Perit Dial     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  16-21     Citation Subset:  IM    
Department of Physiology and Biophysics, University of Louisville, Louisville, Kentucky 40292, USA.
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MeSH Terms
Biological Transport
Lymph / physiology
Lymphatic System / physiology*
Mesentery / physiology
Peritoneal Dialysis*
Peritoneum / physiology*
Radiopharmaceuticals / diagnostic use*,  pharmacokinetics
Rats, Sprague-Dawley
Serum Albumin, Radio-Iodinated / diagnostic use*,  pharmacokinetics
Grant Support
5R01 HL076160-04/HL/NHLBI NIH HHS; R01 HL076160-04/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Radiopharmaceuticals; 0/Serum Albumin, Radio-Iodinated

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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