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Neuropeptide Release Augments Serum Albumin Loss and Reduces Ultrafiltration in Peritoneal Dialysis

Journal article
Authors Nicola Cavallini
Dick Delbro
Gunnar Tobin
Magnus Braide
Published in Peritoneal dialysis international
Volume 32
Issue 2
Pages 168-176
ISSN 0896-8608
Publication year 2012
Published at Institute of Neuroscience and Physiology, Department of Pharmacology
Institute of Biomedicine, Department of Medical Biochemistry and Cell Biology
Pages 168-176
Language en
Links dx.doi.org/10.3747/pdi.2010.00254
Keywords Inflammation, peritoneal membrane, ultrafiltration
Subject categories Clinical Medicine

Abstract

BACKGROUND: The triggers of the acute local inflammatory response to peritoneal dialysis (PD) fluid exposure remain unknown. In the present study, we investigated the effects of neurogenic inflammation and mast cell degranulation on water and solute transport in experimental PD. METHODS: Single 2-hour dwells in rats with PD catheters were studied. Histamine and the neuropeptides substance P and calcitonin gene-related peptide (CGRP) were measured in PD fluid samples by ELISA. Radiolabeled albumin (125I and 131I respectively) was used as an intraperitoneal (IP) and intravascular tracer. Glucose and urea concentrations were measured in plasma and PD fluid. The effects of varying the volume and osmolarity of a lactate-buffered PD fluid were compared and related to the effects of pharmacologicintervention. RESULTS: Application of 20 mL 3.9% glucose PD fluid induced an IP histamine release during the first 30 minutes, blockable by the mast cell stabilizer doxantrazole and the substance P neurokinin-1 receptor (NK1R)-blocker spantide. Histamine release was also inhibited at a reduced PD volume (14 mL), but was not affected by normalizing the PD fluid osmolarity. Blockade of NK1R also reduced plasma albumin leakage to the peritoneal cavity. Inhibition of CGRP receptors by CGRP8-37 improved osmotic (transcapillary) and net ultrafiltration and reduced the dialysate urea concentration. Neuropeptide release was not clearly related to activation of the TrpV1 receptor, the classic trigger of neurogenic inflammation. CONCLUSIONS: Neuropeptide release exaggerated albumin loss and reduced ultrafiltration in this rat PD model. Intervention aimed at the neuropeptide action substantially improved PD efficiency.

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