Division of Kidney and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
2Department of Pathology, Jikei University School of Medicine, Tokyo, Japan 3Divisions of Renal Medicine and Baxter Novum, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden
It is well known that peritoneal solute transport rate (PSTR) increases during peritonitis in peritoneal dialysis (PD) patients. However, there was great concern recently over the possibility that long-term PD itself increases PSTR. An increasing number of studies report that an increased PSTR may have a negative impact on both the technique survival and the patient survival in PD patients. Furthermore, it was reported that encapsulating peritoneal sclerosis, which is a serious complication for PD patients, is related to high PSTR.
Several factors such as increases in the peritoneal contact area, tissue diffusivity, capillary surface area, and capillary permeability could conceivably explain an increase in PSTR. The contact area between the dialysate and the peritoneum is the first barrier to solute transport between the underlying microvessels and the dialysis solution. The wall of microvessels is considered to be the main functional barrier to the peritoneal solute transport as demonstrated by Flessner et al. It is conceivable that increasing vascular surface area could be caused by both increase of the amount and dilatation of peritoneal perfused capillary.
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