The biocompatibility of neutral pH, low-GDP peritoneal dialysis solutions: benefit at bench, bedside, or both?
For patients on peritoneal dialysis (PD), the development of peritonitis, the decline of residual kidney function, and the loss of peritoneal membrane function are central events that affect both patient and technique survival. The use of glucose as the osmotic agent in conventional PD solutions may increase the susceptibility to each of these events. However, its use may also be associated with systemic metabolic perturbations and, in turn, an increase in cardiovascular morbidity. Both in vitro and in vivo evidence suggest that both the local peritoneal and systemic toxicity induced by the use of glucose may be in part mediated by the presence of glucose degradation products (GDPs) coupled with the hyperosmolarity, reduced pH, and use of lactate as the buffer in conventional PD solutions. Therefore, the use of neutral pH, low-GDP (NpHL(GDP)), bicarbonate-buffered PD solutions may represent a promising strategy to attenuate some of these adverse effects. However, the impact of these novel solutions on clinical outcomes remains largely unknown. In this review, we will highlight evidence regarding the biocompatibility of NpHL(GDP) PD solutions, review the utility of current biomarkers in the evaluation of biocompatibility, and discuss the clinical outcome data with these solutions.
Division of Nephrology, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada.
Jeffrey
J
Perl
Sharon J
SJ
Nessim
Joanne M
JM
Bargman
D001672:Biocompatible Materials; D015415:Biomarkers / Q000032:analysis; D018394:CA-125 Antigen / Q000032:analysis; D015314:Dialysis Solutions / Q000009:adverse effects / Q000032:analysis*; D005947:Glucose / Q000009:adverse effects / Q000032:analysis; D017127:Glycation End Products, Advanced / Q000009:adverse effects / Q000032:analysis; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015850:Interleukin-6 / Q000032:analysis; D007668:Kidney / Q000503:physiopathology; D019344:Lactic Acid / Q000032:analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D010537:Peritoneum / Q000503:physiopathology; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control; D042461:Vascular Endothelial Growth Factor A / Q000032:analysis
D001672:Biocompatible Materials; D015415:Biomarkers; D018394:CA-125 Antigen; D015314:Dialysis Solutions; D017127:Glycation End Products, Advanced; C508600:IL6 protein, human; D015850:Interleukin-6; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D019344:Lactic Acid; D005947:Glucose