Nephrology Dialysis Transplantation, Vol 12, Issue 8 1652-1660, Copyright © 1997 by Oxford University Press
J Plum, A Fussholler, G Schoenicke, T Busch, C Erren, C Fieseler, J Kirchgessner, J Passlick-Deetjen and B Grabensee
Background: Increasing evidence suggests that
conventional PD solutions are detrimental to host defence mechanisms of
peritoneal cells. We tested a new amino-acid-based and bicarbonate-buffered
PD solution under in vivo and in
vitro conditions. Method: During a
prospective cross-over randomized intraindividual study 10 CAPD patients
were investigated with three different solutions: Amino/Bic, 1% amino acid,
34 mmol/l bicarbonate; Glu/Bic, 1.5% glucose, 34 mmol/l bicarbonate; and
Glu/Lac, 1.5% glucose, 35 mmol/l lactate. A PET was performed and transport
properties (clearance, D/P ratio, MTAC) were calculated. Prostanoid and
cytokine concentrations were measured in serum and the 6 h effluent. Using
an in vitro model, mononuclear leukocytes of healthy
donors were also incubated with the test fluid. In
vivo results. Peritoneal clearance and MTAC of small solutes
(creatinine, urea) were not significantly altered by amino acids or
bicarbonate. Peritoneal permeability and transperitoneal excretion of
higher-weight protein molecules ({beta}2-microglobulin, albumin, IgG)
were increased with Amino/Bic compared to Glu/Lac (P<0.05) (D/P
ratio albumin: Amino/Bic, 0.027±0.003; Glu/Bic,
0.023±0.003; Glu/Lac, 0.022±0.002). Application of
Amino/Bic was accompanied by an increased effluent concentration of Il-6,
Il-8, TNF&agr; PGE2, and 6-keto-PGR1a (P<0.05). Dialysate
nitrite/nitrate and cGMP concentrations (as indicators of NO generation)
did not differ between the solutions. In vitro
results. Both bicarbonate fluids demonstrated a better preservation of the
mitochondrial dehydrogenases activity (MTT assay) compared to Glu/Lac (P
<0.01) (Amino/Bic: 80.6±3.2%; Glu/Bic:
86.0±1.8%; Glu/Lac, 64.9±2.3%, referred to RPMI as
control). Constitutive and LPS stimulated release of Il-1{beta} and Il-6
was less suppressed with both bicarbonate fluids (P<0.05) LPS-stim.
Il-6 release: Amino.Bic, 33.0±6.6%; Glu/Bic,
65.5±10.3%; Glu/Lac, 1.5±0.7% referred to RPMI).
Conclusion: Application of an amino-acid/bicarbonate
solution resulted in a small but significant increase in peritoneal
permeability. Also increased concentrations of various
cytokines/prostanoids were measured in the effluent. According to
in vitro testing with mononuclear phagocytes both
bicarbonate-buffered fluids were to the same extent less inhibitory to
certain cell functions than lactate-buffered solution.
Keywords: peritoneal dialysis fluids; peritoneal
transport; bicarbonate; lactate; cytokines; prostanoids
ORIGINAL ARTICLES
In vivo and in vivo effects of amino-acid-based and bicarbonate-buffered peritoneal dialysis solutions with regard to peritoneal transport and cytokines/prostanoids dialysate concentrations
Department of Nephrology and Rheumatology, Heinrich-Heine University Duesseldorf, Moorenstrasse 5, 40225 Dusseldorf, Germany; Corresponding author
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