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Nephrol Dial Transplant (2004) 19: 917-924
Nephrol Dial Transplant Vol. 19 No. 4 © ERA-EDTA 2004; all rights reserved

Original Article

Peritoneal dialysis with solutions low in glucose degradation products is associated with improved biocompatibility profile towards peritoneal mesothelial cells

Janusz Witowski1, Katarzyna Korybalska1, Krzysztof Ksiazek1, Justyna Wisniewska-Elnur1, Achim Jörres3, Cristina Lage4, Thomas P. Schaub4, Jutta Passlick-Deetjen4, Andrzej Breborowicz1 and the members of the European Balance Trial Group:, Alicja Grzegorzewska2, Andrzej Ksiazek5, Tomasz Liberek6, Monika Lichodziejewska-Niemierko6, Maria Majdan5, Boleslaw Rutkowski6, Tomasz Stompór7 and Wladyslaw Sulowicz7

1Department of Pathophysiology and 2Department of Nephrology, University Medical School, Poznan, Poland, 3Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Berlin, 4Fresenius Medical Care, Bad Homburg, Germany, 5Department of Nephrology, University Medical School, Lublin, 6Department of Nephrology, University Medical School, Gdansk and 7Department of Nephrology, Collegium Medicum, Jagiellonian University, Kraków, Poland

Correspondence and offprint requests to: Dr Janusz Witowski, Department of Pathophysiology, University Medical School, ul. Swiecickiego 6, 60–781 Poznan, Poland. Email: jwitow{at}amp.edu.pl

Background. In vitro experiments point to a better biocompatibility profile of new pH-neutral peritoneal dialysis fluids (PDFs) containing low levels of glucose degradation products (GDPs). The present study examines the impact on human peritoneal mesothelial cells (HPMCs) of equilibrated dialysates obtained during dialysis with either conventional or new PDFs.

Methods. Peritoneal dialysate was collected from 17 patients participating in a randomized, controlled, cross-over trial comparing a pH-neutral low-GDP solution (Balance) to a conventional solution (S-PDF). All patients were treated sequentially for 3 months with both PDFs. At the end of each treatment phase, peritoneal effluent was drained after a timed 10 h dwell. Samples of dialysate were then mixed with standard culture medium and added to in vitro cultures of HPMCs from healthy donors. Cells were assessed for proliferation, viability and cytokine release.

Results. Proliferation and viability of HPMCs were better preserved in the presence of effluent obtained during dialysis with Balance (P<0.046 and P<0.035, respectively). The proliferative response of HPMCs correlated with the concentration of fibronectin in dialysates (P = 0.0024). Effluent drained following a 3 month dialysis with Balance contained significantly increased levels of fibronectin (P = 0.004) and CA125 antigen (P = 0.0004) compared with S-PDF. There was no significant difference in constitutive and stimulated cytokine (IL-6, MCP-1, VEGF) synthesis by HPMCs treated with either Balance- or S-PDF-derived effluents.

Conclusions. These results suggest that therapy with new pH-neutral low-GDP solutions contribute to an intraperitoneal milieu that improves mesothelial cell proliferation and viability. It may positively impact on the preservation of the peritoneal membrane integrity during long-term dialysis.

Keywords: biocompatibility; glucose degradation products; peritoneal dialysis; peritoneal mesothelial cells


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