An exploratory study of the relationship between systemic microcirculatory function and small solute transport in incident peritoneal dialysis patients

Williams, Jennifer, Gilchrist, Mark, Strain, William David, Fraser, Donald ORCID: https://orcid.org/0000-0003-0102-9342 and Shore, Angela 2022. An exploratory study of the relationship between systemic microcirculatory function and small solute transport in incident peritoneal dialysis patients. Peritoneal Dialysis International 42 (5) , pp. 513-521. 10.1177/08968608211047332

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Abstract

Background: The peritoneal capillary endothelium is widely considered to be the most influential structure in dictating the rate of small solute transport (SST) during peritoneal dialysis (PD). PD patients are at significant risk of systemic microcirculatory dysfunction. The relationship between peritoneal and systemic microcirculations in patients new to PD has not been well studied. We hypothesised that for patients on PD for less than 6 months, dysfunction in the systemic microcirculation would be reflected in the rate of SST. Methods: We recruited 29 patients to a cross-sectional, observational study. Rate of SST was measured using a standard peritoneal equilibration test. Laser Doppler Flowmetry was used to measure response to physical and pharmacological challenge (post-occlusive hyperaemic response and iontophoretic application of vasodilators) in the cutaneous microcirculation. Sidestream Darkfield imaging was used to assess sublingual microvascular density, flow and endothelial barrier properties. Results: We found no moderate or strong correlations between any of the measures of systemic microcirculatory function and rate of SST or albumin clearance. There was however a significant correlation between dialysate interleukin-6 concentrations and both SST (rs = 0.758 p ≤ 0.0001) and albumin clearance (rs = 0.53, p = 0.01). Conclusions: In this study, systemic microvascular dysfunction did not significantly influence the rate of SST even early in patients PD careers. In conclusion, this study demonstrates that intraperitoneal factors particularly inflammation have a far greater impact on rate of SST than systemic factors.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/)
Publisher:	SAGE
ISSN:	0896-8608
Date of First Compliant Deposit:	26 January 2022
Date of Acceptance:	28 October 2021
Last Modified:	23 May 2023 23:28
URI:	https://orca.cardiff.ac.uk/id/eprint/146940

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