BIOCOMPATIBILITY AND TOLERABILITY OF A PURELY BICARBONATE-BUFFERED PERITONEAL DIALYSIS SOLUTION

Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions; however, until now, the effect of purely bicarbonate-buffered solutions has not been intens...

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Bibliographic Details
Published in:	Peritoneal dialysis international Vol. 29; no. 6; pp. 647 - 655
Main Authors:	WEISS, Lars, STEGMAYR, Bernd, VAN HAMERSVELT, Henk W, JOHANSSON, Ann C, HYLANDER, Britta, MAYR, Michael, NILSSON, Per-Henrik, ANDERSSON, Per O, DE LOS RIOS, Tatiana, MALMSTEN, Gudrun, TEJDE, Mattias, HADIMERI, Henrik, SIEGERT, Carl E, AHLMEN, Jarl, LARSSON, Rutger, INGMAN, Bo, SIMONSEN, Ole
Format:	Journal Article
Language:	English
Published:	Milton, ON Multimed Inc 2009 Multimed
Subjects:	Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Bicarbonates Biological and medical sciences Buffers Cross-Over Studies Emergency and intensive care: renal failure. Dialysis management Female Hemodialysis Solutions Humans Intensive care medicine Kidney - physiopathology Male Medical sciences MEDICIN MEDICINE Middle Aged Pain Measurement Peritoneal Dialysis Peritoneum - physiology Prospective Studies Single-Blind Method Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Kidney disease Urinary system disease Renal function residual renal function Dialysis fluid peritoneal dialysis fluids Malignant tumor cancer antigen 125 Buffer solution Peritoneal dialysis purely bicarbonate buffered Hydrogencarbonates Peritoneal fluid Extrarenal dialysis Renal failure Biocompatibility Cancer
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Summary:	Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions; however, until now, the effect of purely bicarbonate-buffered solutions has not been intensively studied in vivo. This study was an open label, prospective, crossover multicenter trial to investigate the biocompatibility of a purely bicarbonate-buffered solution (bicPDF) by measuring biocompatibility parameters such as cancer antigen 125 (CA125) in peritoneal effluent. 55 patients were enrolled in the study. After a 2-week run-in phase, 53 patients could be randomized into 2 groups, starting with either standard lactate-buffered peritoneal dialysis fluid (SPDF) for 12 weeks (phase 1) and then switching to bicPDF for 12 weeks (phase 2), or vice versa. Overnight peritoneal effluents were collected at baseline and at the end of phases 1 and 2 and were tested for CA125, hyaluronic acid, vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), interleukin 6 (IL-6), interferon gamma (IFNgamma), and transforming growth factor-beta(1) (TGF-beta1). Total ultrafiltration and residual renal function were also assessed. At the end of the study, pain during fluid exchange and dwell was evaluated using special questionnaires. 34 patients completed the study; 27 of them provided data for analysis of the biocompatibility parameters. CA125 levels in overnight effluent were significantly higher with bicPDF (61.9 +/- 33.2 U/L) than with SPDF (18.6 +/- 18.2 U/L, p < 0.001). Hyaluronic acid levels were significantly lower after the use of bicPDF (185.0 +/- 119.6 ng/mL) than after SPDF (257.4 +/- 174.0 ng/mL, p = 0.013). Both TNF-alpha and TGF-beta1 showed higher levels with the use of bicPDF than with SPDF. No differences were observed for IL-6, VEGF, or IFNgamma levels. We observed an improvement in the glomerular filtration rate with the use of bicPDF but no differences were observed for total fluid loss. Pain scores could be analyzed in 23 patients: there was no difference between the solutions. The use of a purely bicarbonate-buffered low-glucose degradation product solution significantly changes most of the peritoneal effluent markers measured, suggesting an improvement in peritoneal membrane integrity. Additionally, it seems to have a positive effect on residual renal function.
ISSN:	0896-8608 1718-4304 1718-4304
DOI:	10.1177/089686080902900610