Molecular size dependence of peritoneal transport.

The nature of the barrier between blood and peritoneal dialysate was studied by determining peritoneal solute transport rates as a function of molecular size using neutral dextrans, polymers with different molecular weights but uniform chemical composition. Transport rates for creatinine, p-aminohippurate (PAH), and neutral dextran (3,000 to 50,000 daltons) were measured during peritoneal dialysis in the awake rabbit using sequential isotonic and hypertonic dialysis solutions. The permeability-area product (PA) for the peritoneum was determined from the dependence of the dialysate concentration on time during the isotonic exchange. The dependence of PA on molecular size showed no additional hindrance by the peritoneum as molecules of larger size were considered. By accounting for convective solute transport during the hypertonic exchange, the solute reflection coefficient (sigma) and PA were simultaneously determined. The values of PA for creatinine and PAH were similar to those determined during the isotonic exchange, and sigma values for creatinine and PAH were 0.18 +/- 0.20 and 0.14 +/- 0.14, respectively. Dextran sigma values (3,000 to 22,000 daltons) were near unity (0.9 to 1.0) and relatively independent of molecular size, suggesting substantial hindrance to convective transport for this size range. This work demonstrates that the paradoxical transport properties of an "open" diffusive yet "tight" convective peritoneal barrier are primarily reflective of the unique structural properties of this biologic tissue and are not related to test solute heterogeneity.