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Am J Physiol Heart Circ Physiol
2016[Jun]; 310
(11
): H1501-11
PMID26945084
show ga
Clinical and animal studies suggest that peritoneal absorption of fluid and
protein from dialysate to peritoneal tissue, and to blood and lymph circulation,
occurs concomitantly with opposite flows of fluid and protein, i.e., from blood
to dialysate. However, until now a theoretical explanation of this phenomenon has
been lacking. A two-phase distributed model is proposed to explain the
bidirectional, concomitant transport of fluid, albumin and glucose through the
peritoneal transport system (PTS) during peritoneal dialysis. The interstitium of
this tissue is described as an expandable two-phase structure with phase F
(water-rich, colloid-poor region) and phase C (water-poor, colloid-rich region)
with fluid and solute exchange between them. A low fraction of phase F is assumed
in the intact tissue, which can be significantly increased under the influence of
hydrostatic pressure and tissue hydration. The capillary wall is described using
the three-pore model, and the conditions in the peritoneal cavity are assumed
commencing 3 min after the infusion of glucose 3.86% dialysis fluid. Computer
simulations demonstrate that peritoneal absorption of fluid into the tissue,
which occurs via phase F at the rate of 1.8 ml/min, increases substantially the
interstitial pressure and tissue hydration in both phases close to the peritoneal
cavity, whereas the glucose-induced ultrafiltration from blood occurs via phase C
at the rate of 15 ml/min. The proposed model delineating the phenomenon of
concomitant bidirectional transport through PTS is based on a two-phase structure
of the interstitium and provides results in agreement with clinical and
experimental data.
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