Objective: To observe the effect of various peritoneal dialysates on the ultrastructure of the peritoneal mesothelium.
Methods: Continuous ambulatory peritoneal dialysis mice model was made by injecting domestic lactate, acetate, and American Baxter dialysates intraperitoneally. The diaphragmatic peritoneum of the mice was taken at 10th day and 21th day respectively after injection.
Results: After 10 day experiment, the mesothelial ultrastructure of Baxter group was normal, but some pathological changes occurred in the peritoneal mesothelium of both domestic lactate and acetate groups. And the injury of the peritoneal mesothelium was progressing with times, e.g. adhesion and exfoliation of the microvilli, shrinkage of the mesothelial cells and even fibrous adhesion. The extent of effects on the mesothelial cells varied in three groups, the least is Baxter group. After 21 day experiments, the diameters of the stomata were (6.96 +/- 2.46) microns and (6.98 +/- 2.16) microns in both domestic lactate and acetate dialysates groups respectively, which were much greater than those in physiological condition (1.47 +/- 0.88) microns (P < 0.01). The distribution density of the lymphatic stomata were significantly increased in acetate and lactate dialysate groups compared with the control group (P < 0.01). But little effects on the lymphatic stomata were showed after using Baxter dialysate. After discontinuing experiment for 10 days, the impairment of the peritoneal mesothelium recovered in Baxter group and improved to varying degrees in both domestic dialysate groups. The lymphatic stomata were still abnormal in both domestic dialysate groups.
Conclusions: Our findings indicate that lactate and acetate dialysates are more like to elicit peritoneal fibrosis and the increase of distribution density and the enlargement of the lymphatic stomata can significantly enhance their absorption effects and increase their reabsorption quantity of dialysate from the peritoneal cavity during peritoneal dialysis. These changes of the lymphatic stomata and their lymphatic reabsorption are thought to be associated with deterioration of peritoneal function, and to cause ultrafiltration failure in the patients on long-term continuous ambulatory peritoneal dialysis (CAPD) therapy.