Benefits of switching from a conventional to a low-GDP bicarbonate/lactate-buffered dialysis solution in a rat model

• Published in: Kidney international Vol. 67; no. 4; pp. 1559 - 1565
• Main Authors: Mortier, Siska, Faict, Dirk, Lameire, Norbert H., De Vriese, Ans
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2005; Nature Publishing; Elsevier Limited
• Subjects: Animals; Bicarbonates; biocompatibility; Biological and medical sciences; buffer; dialysate; Dialysis Solutions - adverse effects; Dialysis Solutions - pharmacology; Female; glucose degradation products; Guanosine Diphosphate; Infection - epidemiology; Lactic Acid; Medical sciences; Models, Animal; Nephrology. Urinary tract diseases; Peritoneal Cavity - physiology; peritoneal membrane; Rats; Rats, Wistar; Ultrafiltration; Viscera - cytology; Viscera - drug effects; buffer; glucose degradation products; biocompatibility; dialysate; peritoneal membrane; Animal model; Nephrology; Rat; Rodentia; Dialysate; Glucose; Buffer solution; Switching; Urology; Hydrogencarbonates; Lactates; glucose degradation products. dialysate; Vertebrata; Mammalia; Low; Biocompatibility; Membrane; Dialysis; Lactic acid; Degradation product; Peritoneum
• ISSN: 0085-2538; 1523-1755
• DOI: 10.1111/j.1523-1755.2005.00237.x

Benefits of switching from a conventional to a low-glucose degradation product (GDP) bicarbonate/lactate-buffered dialysis solution in a rat model.
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.
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).
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-β 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-β expression, and fibrosis compared to continuous standard PDF exposure for 20 weeks.
Low-GDP bicarbonate/lactate-buffered PDF has the potential to slow down standard PDF-induced peritoneal membrane damage.