Role of surfactant in peritoneal dialysis

Hills, B. A. (2000) Role of surfactant in peritoneal dialysis. Peritoneal Dialysis International, 20 5: 503-515.

Author Hills, B. A.
Title Role of surfactant in peritoneal dialysis
Journal name Peritoneal Dialysis International   Check publisher's open access policy
ISSN 0896-8608
Publication date 2000
Sub-type Critical review of research, literature review, critical commentary
Volume 20
Issue 5
Start page 503
End page 515
Total pages 13
Place of publication Toronto, Canada
Publisher Multimed
Collection year 2000
Language eng
Subject C1
321012 Nephrology and Urology
730115 Urogenital system and disorders
1103 Clinical Sciences
Abstract Evidence is reviewed that demonstrates how the mesothelial cell in the normal peritoneum and comparable serosal cavities secretes surface-active phospholipid (SAPL) as a means of protecting itself and the membrane it forms with its neighbors. It is shown how SAPL, if adsorbed (reversibly bound) to mesothelium, can impart excellent lubricity, antiwear and release (antistick) properties, while impeding surgical adhesion formation. More-speculative benefits include acting as a deterrent to fibrosis and as a barrier to both protein leakage and pathogen invasion by spanning cell junctions. Such spanning would also pin down cell corners, impeding peeling as the first step in exfoliation encountered in prolonged continuous ambulatory peritoneal dialysis (CAPD). The molecular mechanism underlying each of these possible functions is adsorption. Morphological and hydrophobicity studies are discussed as validation for such an adsorbed lining and how it can be fortified by administering exogenous SAPL. Any role for SAPL in ultrafiltration is much more controversial. However, a surfactant lining can explain the very high permeability of the membrane to lipid-soluble drugs, implying that it is a barrier to water-soluble solutes. The clinical and animal evidence is conflicting but would seem to be best explained by a role for the barrier in promoting semipermeability, and hence the osmotic driving force for water transmission. Thus, adsorption of exogenous SAPL in CAPD patients with low ultrafiltration seems to restore this barrier function. The future direction for surfactant in CAPD would seem to rest with the physical chemists in producing formulations that optimize adsorption, probably involving a compromise between water solubility and surface activity of the phospholipids selected. It might even warrant using the interdialytic interval for re-adsorbing SAPL without the problem of dilution by a large volume of dialysate.
Keyword Urology & Nephrology
Lymphatic Absorption
Capd Patients
Improves Ultrafiltration
Sclerosing Peritonitis
Boundary Lubrication
Articular Surface
Lamellar Bodies
Lung Surfactant
Release Agent
Q-Index Code C1

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collection: School of Medicine Publications
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 33 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Tue, 10 Jun 2008, 13:15:11 EST