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membrane/fibre matrix model can explain how osmotic fluid flow can occur from the peritoneal tissue to the peri- toneal cavity against a glucose concentration gradient, and against a hydrostatic pressure gradient, at the same time as fluid and macromolecules move from the peritoneal cavity to the peritoneal tissue, by hydrostatic pressure driven flow. Concerning the 'glycocalyx (fibre matrix) hypothesis', it may be regarded as a 'soft' hypothesis since it is hard to test experimentally. Actually, the pore theory and the fibre ma- trix theory are mathematically similar, and there is no way of actually distinguishing between the two models. In fact, the bimodal ('small pore'/'large pore') solute selectivity of the TPM can be accurately described by the presence of a dense, but heterogeneous, fibre matrix filling out all spaces in between the endothelial cells of the capillary barrier. In this commentary I shall first review the key features of the TPM and how these have contributed to a deeper understanding of the physiology of peritoneal exchange. Especially I will discuss the puzzling discrepancy between the clearance of tracer macromolecules from the peritoneal cavity into the tissues (KE) and the net reabsorption of fluid from the peritoneal cavity to plasma. Second, arguments will be raised that the endothelial glycocalyx does not sat- isfy the criteria for being a highly size-selective barrier in the TPM.

Free water transport, small pore transport and the osmotic pressure gradient three-pore model of peritoneal transport