Clinical and physiological effects of a new, less toxic and less acidic fluid for peritoneal dialysis.
OBJECTIVE
To report our first clinical experience with a new continuous ambulatory peritoneal dialysis (CAPD) fluid (PD-Bio), which is nearly devoid of glucose degradation products and has a higher pH (6.3) than conventional peritoneal dialysis (PD) solutions, and to discuss in general terms some acute and long-term effects of conventional acidic solutions containing glucose degradation products.


METHODS
1) Pilot study on 4 patients investigated using a modified peritoneal equilibration test (PET) and cytobiology parameters. 2) Computer simulation study, assuming that conventional acidic solutions cause vasodilatation and recruitment of capillary surface area initially (during 0-60 minutes) in a PD dwell.


METHODS
Four stable CAPD patients were chosen in an open cross-over study. After a period of three months using conventional PD fluid, the patients were switched to three months on the new PD fluid.


RESULTS
Cancer antigen 125 increased significantly, and patients with discomfort/infusion pain during the control period improved during the period with the new fluid. No significant changes were observed in mass-transfer coefficients or drained volumes with the new solution. PH in the effluent dialysis was, however, higher for PD-Bio at all times during a two-hour dwell. In the computer simulation study, a less acidic solution caused an initially lower rate of glucose dissipation and improved ultrafiltration (UF) after a four-hour dwell, as compared to a conventional PD solution.


CONCLUSIONS
A new, differently produced, less toxic and less acidic PD fluid (PD-Bio) seems to be better tolerated than a conventional acidic solution with respect to discomfort/infusion pain. Theoretically, neutralized solutions should show slightly improved UF profiles over conventional acidic solutions, according to the computer simulation analysis. Furthermore, it is speculated that a neutral, less acidic, less toxic fluid would cause less interstitial-mesothelial alterations and less impairment of UF capacity than conventional solutions during long-term CAPD.
Rippe
B
B
Department of Nephrology, University Hospital of Lund, Sweden.
Simonsen
O
O
Wieslander
A
A
Landgren
C
C
D018394:CA-125 Antigen / Q000032:analysis; D002455:Cell Division / Q000187:drug effects; D002478:Cells, Cultured; D002986:Clinical Trials as Topic; D003198:Computer Simulation; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000009:adverse effects / Q000494:pharmacology; D005947:Glucose / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007375:Interleukin-1 / Q000096:biosynthesis; D007963:Leukocytes, Mononuclear / Q000187:drug effects / Q000378:metabolism; D008070:Lipopolysaccharides / Q000494:pharmacology; D010146:Pain / Q000209:etiology; D010531:Peritoneal Dialysis, Continuous Ambulatory; D010537:Peritoneum / Q000378:metabolism; D010865:Pilot Projects
D018394:CA-125 Antigen; D015314:Dialysis Solutions; D007375:Interleukin-1; D008070:Lipopolysaccharides; D005947:Glucose