Experimental study on long-term exposure to a biocompatible, hypertonic, pyruvate-buffered dialysis solution.
BACKGROUND
Chronic exposure to glucose and glucose degradation products (GDPs) in dialysis solutions is involved in the pathogenesis of peritoneal neoangiogenesis and fibrosis, potentially leading to encapsulating peritoneal sclerosis (EPS). High lactate concentrations may contribute to glucose toxicity by creating a state of pseudohypoxia, which stimulates the formation of various growth factors.


OBJECTIVE
To study the effects of long-term peritoneal exposure to a filter-sterilized pyruvate-buffered solution with a combination of 3 osmotic agents (amino acids, glycerol, glucose: PYRAGG) on peritoneal function and morphology.


METHODS
Rats were exposed daily for a period of 20 weeks to PYRAGG, or to a conventional heat-sterilized solution (LH), or to a filter-sterilized solution (LF), after which a peritoneal function test was done and peritoneal tissue was obtained.


RESULTS
Peritoneal solute and fluid transport characteristics at 20 weeks were similar in all groups. Fibrosis was most pronounced in the LH group compared to the others, suggesting an effect of GDPs. A marked reduction in the number of omental vessels was noted in the PYRAGG group (59% reduction compared to LH). A modest reduction (28%) was found in the LF animals. This points to a marked effect of reduced exposure to glucose.


CONCLUSIONS
PYRAGG was more biocompatible than a filter-sterilized glucose/lactate solution because it did not induce marked peritoneal abnormalities after long-term exposure. This did not lead to altered peritoneal transport characteristics. It is likely that further development of PYRAGG-like solutions will decrease the incidence of EPS.
van Westrhenen
Roos
R
Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Vlijm
Anniek
A
Hiralall
Johan K
JK
Krediet
Raymond T
RT
D000596:Amino Acids; D000818:Animals; D002021:Buffers; D015314:Dialysis Solutions / Q000737:chemistry / Q000494:pharmacology*; D004334:Drug Administration Schedule; D005950:Glucose Solution, Hypertonic / Q000737:chemistry / Q000494:pharmacology*; D005990:Glycerol; D008297:Male; D023421:Models, Animal; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000187:drug effects* / Q000473:pathology; D019289:Pyruvic Acid; D051381:Rats; D017208:Rats, Wistar; D013997:Time Factors
D000596:Amino Acids; D002021:Buffers; D015314:Dialysis Solutions; D005950:Glucose Solution, Hypertonic; D019289:Pyruvic Acid; D005990:Glycerol