Effects of Interperitoneal Vasodilators on Peritoneal Clearances and Effects of Peritoneal Dialysis Solutions on the Microcirculation of the Rat on the Peritoneal Clearances in Man

摘要

This work includes studies of the effects of vasoactive substances on peritoneal clearances in humans and on the peritoneal microcirculation in the rat. The goal is to relate microcirculatory and transport phenomena. Major findings are: (1) Commercial solutions are vasodilatory, particularly to arterioles. (2) Nitroprusside added to solutions increases clearances and protein losses, but does not cause greater arteriolar dilation than solutions themselves. (3) Effects of nitroprusside may relate primarily to greater venodilation and to direct alterations in venular permeability. (4) Hyperosmolality and nonbicarbonate anions, lactate and acetate, are the vasodilatory components of dialysis solutions. (5) The component responsible for transient vasoconstriction in parietal peritoneum is unknown. (6) Raising the pH in solutions to the physiologic range does not alter their vasoactivity nor clinical clearances. (7) Solutions containing bicarbonate and with a physiologic pH, PCO2 and osmolality are non-vasoactive. In clinical studies, however, they have increased protein losses. An interstitial hydration hypothesis has been presented. (8) Preliminary studies suggest more rapid solute transport in uremics than in psoriasis patients. (9) Clearances do not correlate with age, sex or blood pressure. (10) Clearances and responses to nitroprusside have remained stable over 1 year in patients on CAPD. (11) Several hypothesis have been developed to explain all findings to date.