NDT Advance Access originally published online on April 5, 2008
Nephrology Dialysis Transplantation 2008 23(7):2142-2146; doi:10.1093/ndt/gfn055
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Distributed model of peritoneal transport: implications of the endothelial glycocalyx
University of Mississippi Medical Center, Jackson, MS, USA
Correspondence and offprint requests to: Michael Flessner, Department of Medicine/Nephrology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216-4505, USA. Tel: +1-601-984-5670; Fax: +1-601-984-5765; E-mail: mflessner@medicine.umsmed.edu
Keywords: mathematical model; microcirculation; osmosis; pathophysiology; peritoneal dialysis
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Mathematical prediction of clinical events versus physiological research |
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This commentary discusses the conceptual and mathematical modelling of solute and water transport across the peritoneum and attempts to put a ‘new’ physiologic entity, the endothelial glycocalyx, into perspective. In the clinic, concepts analogous to the membrane barrier in haemodialysis are used to form simplified mathematical schemes to provide rapid estimation of the transport. In contrast, fundamental research on the pathophysiology of the peritoneal barrier demands models that include important elements of the anatomy that have been demonstrated to influence solute and water transport. If potentially critical elements in the barrier, such as the cell-interstitial matrix, are neglected, their importance will never be realized. In this brief article, the potential importance of the endothelial glycocalyx to our understanding of the pathophysiologic changes in the peritoneum is explored.
Peritoneal barrier
The peritoneal barrier is a complex structure made up of blood vessels surrounded by cells and interstitial matrix, which links the cells within
Osmosis across the endothelial barrier
Water flow from the interstitium
Mathematical models of the transport system
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Inadequacies of the membrane models in basic research of the peritoneum |
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Glycocalyx within the endothelium and the distributed model |
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Structure of the glycocalyx
Endothelial permeability and the glycocalyx
Glycocalyx and revision of starling's law
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Possible impact of adding the glycocalyx to the capillary lumen within the distributed model |
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