Is the Peritoneum a Significant Transport Barrier in Peritoneal Dialysis?

Objectives The anatomic peritoneum is often considered equivalent to the barrier between the dialysate and the blood, and is also called “the peritoneal membrane.” Our hypothesis is that the normal peritoneum is not a significant barrier to solute or water flow. The goal of this study was to explore the effects of alteration of the anatomic peritoneum on the transperitoneal transport of water and solute. Design In vivo transport experiments were carried out in control and treated rats. Treatments consisted of frequent mixing of the peritoneal solution versus no mixing, drying the peritoneum prior to the experiment, or selective removal of the entire peritoneum. Transport experiments were carried out via a plastic chamber affixed to the parietal peritoneum. After measuring solute transport or osmotically induced filtration, the tissue underlying the chamber was collected and stained for histology. Results Mixing the chamber solution every 5 minutes versus no mixing over 90 minutes did not result in a significant change in the mass transfer coefficient for mannitol (MTCmannitol, n = 14, p > 0.25). Drying the peritoneum prior to the transport experiment did not significantly alter the MTC of albumin or mannitol (n = 17, p > 0.6; n = 19, p > 0.1, respectively). Manual drying did not remove or significantly alter the apparent peritoneal coating on the surface of the mesothelium. Removal of the entire peritoneum did not significantly alter the osmotically induced volume flux from the tissue, nor did it change the MTCmannitol (n = 9, p > 0.9; n = 9, p > 0.4, respectively). Conclusions Mixing of the solution directly over the tissue, manual drying of the peritoneum, or removal of the entire peritoneum does not result in significant alterations in transport. We conclude that the anatomic peritoneum is relatively unimportant as a physical transport barrier in peritoneal dialysis.