Effects of a 4 Hour Exposure to Conventional Peritoneal Dialysis Fluids on the Murine Hepatic Microcirculation

Peritoneal dialysis (PD) is associated with structural and functional changes in the peritoneal and liver vasculature limiting its efficacy. Our objective was to examine the impact of high osmolar PD solutions and a 4hr dwell time on the liver microcirculation. Mice were given TNF 500ng or normal saline 50 μl (NS) IP, then 30 min later 2 ml of PD solution was injected. The hepatic microcirculation was examined by intravital microscopy. The PD fluids were a glucose‐based, bicarbonate buffered Physioneal, icodextrin‐based lactate and bicarbonate buffered Extraneal and dextrose‐based, lactate buffered Dianeal, compared to lactated Ringer's. In TNF‐treated mice, Dianeal and Extraneal caused an increase in leukocyte rolling, compared to NS (P>0.004). Adhesion was higher with TNF compared to NS in all groups (P>0.05); however, there was no significant difference between PD solutions. Comparing the 4 hr to a 1 hr dwell, Physioneal only was associated with a 6‐fold increase in adhesion (0.8±0.3 vs 5.2±0.7, P<0.001) and a decrease in leukocyte rolling (8.5±2.1 vs 3.2±0.8, P<0.04) with peritoneal TNF exposure. With a clinically relevant exposure time, TNF, combined with a glucose based, bicarbonate buffered PD solution, induced an increase in leukocyte adhesion in the hepatic microcirculation. Replacement with icodextrin may alleviate the effects of high glucose and cytokine stimulation.