Peritoneal physicochemical transport mechanisms: Hypotheses,models and controversies

This study answers criticisms by Waniewski et al. of the recent paper by Wolf on peritoneal transport kinetic models. Their criticisms centre on the accuracy of the data used for model fits, the hypothesis presented, which involves changes in glucose membrane parameters at high peritoneal glucose concentration and on the necessary techniques required to achieve accurate model parameter estimation. In response, this article shows that (1) the mean values previously captured from graphical depictions of Heimburger et al. are not different than those captured from the recent Waniewski et al. graphs, (2) a much simpler hypothesis is proposed, which centres on intraperitoneal pressure-induced lymph flow during the dialysis dwell and (3) the finding that the new model predictions, with only two constant parameter values, as estimated by the Powell algorithm, give a closer fit than the Waniewski model, which uses many time-varying parameters. The current findings again bring into question of the validity of their vasodilation hypothesis, leading to transient changes in capillary surface area during the dwell.