Benefits of switching from a conventional to a low-GDP bicarbonate/lactate-buffered dialysis solution in a rat model.
BACKGROUND
Long-term exposure to standard peritoneal dialysis fluid (PDF) results in alterations in peritoneal morphology and function. Studies investigating the long-term effects on the peritoneum of a low-glucose degradation product (GDP) bicarbonate/lactate-buffered PDF demonstrated its superior biocompatibility. We examined the potential of the low-GDP bicarbonate/lactate-buffered solution to reverse or reduce standard PDF-induced peritoneal alterations.


METHODS
Female Wistar rats received twice daily intraperitoneal infusions with either a lactate-buffered solution with 3.86% glucose at pH 5.5 (Dianeal, referred to as standard PDF), or a low-GDP bicarbonate/lactate-buffered solution with 3.86% glucose at physiologic pH (Physioneal, referred to as bicarbonate/lactate PDF) for different periods of time: (1) 12 weeks Dianeal (N= 9); (2) 12 weeks Physioneal (N= 9); (3) 20 weeks Dianeal (N= 11); (4) 20 weeks Physioneal (N= 10); (5) 12 weeks Dianeal followed by 8 weeks Physioneal (N= 10).


RESULTS
Chronic standard PDF exposure resulted in loss of ultrafiltration capacity, increased VEGF expression and vascular density, higher advanced glycation end product (AGE) accumulation, up-regulation of TGF-beta expression, and development of fibrosis compared to low-GDP bicarbonate/lactate-buffered PDF. The PDF-induced alterations were time-dependent. Crossover from standard PDF to low-GDP bicarbonate/lactate PDF resulted in a less impaired ultrafiltration (UF), less pronounced VEGF expression and neoangiogenesis, and less severe AGE accumulation, TGF-beta expression, and fibrosis compared to continuous standard PDF exposure for 20 weeks.


CONCLUSIONS
Low-GDP bicarbonate/lactate-buffered PDF has the potential to slow down standard PDF-induced peritoneal membrane damage.
Mortier
Siska
S
Renal Unit, University Hospital, Ghent, Belgium; and Baxter R and D Europe, Nivelles, Belgium. siska.mortier@Ugent.be
Faict
Dirk
D
Lameire
Norbert H
NH
De Vriese
An S
AS
D000818:Animals; D001639:Bicarbonates; D015314:Dialysis Solutions / Q000009:adverse effects* / Q000494:pharmacology*; D005260:Female; D006153:Guanosine Diphosphate; D007239:Infections / Q000453:epidemiology; D019344:Lactic Acid; D023421:Models, Animal; D010529:Peritoneal Cavity / Q000502:physiology; D051381:Rats; D017208:Rats, Wistar; D014462:Ultrafiltration; D014781:Viscera / Q000166:cytology / Q000187:drug effects
D001639:Bicarbonates; D015314:Dialysis Solutions; D006153:Guanosine Diphosphate; D019344:Lactic Acid