title: Improved in vitro biocompatibility of bicarbonate-buffered peritoneal dialysis fluid.
abstract: BACKGROUND
  Conventional peritoneal dialysis fluids (PDFs) have been shown to damage the mesothelial layer and are associated with the development of peritoneal fibrosis and neoangiogenesis. New-generation PDFs have therefore been developed with physiological pH and reduced levels of glucose degradation products (GDPs), precursors of advanced glycation end products (AGEs). In this work, we evaluated and compared the improved biocompatibility of two new-generation PDFs (Balance and bicaVera) using mesothelial cell biology; we also compared them to a standard PDF (stay.safe) (all PDFs by Fresenius Medical Care, Fresnes, France).
  
  
  METHODS
  stay.safe, Balance, and bicaVera were tested for their effect on human peritoneal mesothelial cell (HPMC) viability by measuring cell proliferation and apoptosis, and oncosis induction. The formation of AGEs was evaluated by immunoassay. Transforming growth factor beta-1 and vascular endothelial growth factor (VEGF) were immunoassayed in HPMC supernatants exposed to the above PDFs.
  
  
  RESULTS
  At 15 g/L glucose concentration, HPMC exposure to bicaVera resulted in higher cell proliferation compared to Balance (p < 0.001) and stay.safe (p < 0.001). Compared to the lactate-buffered PDFs (Balance and stay.safe), oncosis was significantly lower in cells exposed to bicaVera (p < 0.05). bicaVera, containing lower amounts of GDPs, generated less AGE formation (p < 0.05) and VEGF production (p < 0.05) than either Balance or stay.safe.
  
  
  CONCLUSIONS
  New-generation PDFs with physiological pH and lower GDP levels, especially if bicarbonate-buffered (bicaVera), have fewer in vitro toxic effects on mesothelial cells and may contribute to peritoneal preservation, thus improving long-term treatment of PD patients.
authors.affiliation: Institut National de la Transfusion Sanguine, UFR Médecine, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Grossin
authors.forename: Marie-Paule
authors.initials: MP
authors.lastname: Wautier
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Wautier
authors.forename: Pierre
authors.initials: P
authors.lastname: Gane
authors.forename: Redouane
authors.initials: R
authors.lastname: Taamma
authors.forename: Eric
authors.initials: E
authors.lastname: Boulanger
mesh_terms: D001639:Bicarbonates; D002021:Buffers; D002478:Cells, Cultured; D004847:Epithelial Cells; D015312:Hemodialysis Solutions; D006801:Humans; D007773:Lactates; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000166:cytology
chemical_list: D001639:Bicarbonates; D002021:Buffers; D015312:Hemodialysis Solutions; D007773:Lactates