A New Lactate-Based, Plasticizer-Free, Neutral Peritoneal Dialysis Fluid Provided in a Two-Compartment System: Effect on Peripheral Leukocyte Function

Abstract

Background: A new neutral peritoneal dialysis fluid (PDF; Balance^®) provided in a two-compartment bag (pH 7.4, no plasticizers, minimal glucose degradation products – GDP) was investigated in comparison with a neutral control (Hanks’ balanced salt solution with gelatin 0.1%) and other PDFs with standard properties and plasticizers (Andy plus^®, pH 5.2, GDP), plasticizer free (stay safe^®, pH 5.2, GDP), and in addition plasticizer free after sterile filtration instead of heat sterilization (pH 5.2) regarding the function of peripheral blood leukocytes. Methods: Blood was drawn from 12 volunteers, and blood monocytes (MN) and polymorphonuclear leukocytes (PMNL) were collected. The cells were incubated for 30 min in control medium and the PDFs: glucose 1.5% (83 mmol/l) and 4.25% (238 mmol/l). Respiratory burst of cells was evaluated by chemiluminescence and superoxide (SO) generation after stimulation with phorbol myristate acetate. Results: In comparison with the control medium, incubation of MN in the two-compartment PDF showed preservation of respiratory burst. In contrast, the incubation of MN in standard PDF and plasticizer-free PDF showed impaired functions. The same was found for PMNL. SO anion measurement in MN and PMNL after incubation in the new two-compartment PDF also showed preservation of cell function in comparison with the control medium. The incubation of PMNL in standard PDF and plasticizer-free PDF with a high glucose content showed depressed SO anion generation. Conclusions: These in vitro data demonstrate a better preservation of in vitro phagocyte function with adaptation of pH and reduction of glucose, GDP, and plasticizers in PDFs. The best results are achieved with the two-compartment, lactate-based neutral PDF.

Apoptosis of Mesothelial Cells Caused by Unphysiological Characteristics of Peritoneal Dialysis Fluids

“…However, the major influence of acidic pH on the survival of MCs with very high necrotic rates after 4 and 24 h in our experimental setting most likely covers these apoptotic effects. An impairment of cell function by low pH was observed previously in several studies (30,33). In the early phase of the incubation (0.5 h), this effect was not detectable in our study, as in the studies before.…”

“…This effect was explained by narrowing of the membranes of the mitochondria, which led to facilitation of the biochemical processes involved in the mitochondrial pathway of apoptosis (28). For high glucose concentrations, the data are inconsistent: on one hand, the up‐regulation of an antiapoptotic protein (Bcl‐2) by high glucose concentrations was demonstrated (29); on the other hand, high glucose levels could cause increased oxidative stress by up‐regulation of the hexose‐monophosphate pathway, as shown for leukocytes (30). Taking all these findings together, the increased apoptotic rates of MCs after incubation in neutral two‐compartment PDFs might be caused by the pro‐apoptotic stimulus of high osmolarity in combination with an oversupply of energy (glucose) for the biochemical pathways of apoptosis in the “biocompatible” environment, which clearly offers protection against necrosis and seems to facilitate apoptosis.…”

Inflammation in Peritoneal Dialysis

“…There are preliminary data demonstrating a better preservation of in vitro phagocyte function with adaptation of pH and reduction of plasticizers in PDFs [9]. Nevertheless, the Blue Ribbon Panel failed to collect enough evidence of harmful health effects to remove plasticizers from use in medical tubing.…”

What Is the Role of Automated Peritoneal Dialysis and Continuous Flow Peritoneal Dialysis?

“…The in vitro data have shown better preservation of phagocyte function with adaptation of pH and reduction of glucose, GDPs, and plasticizers in PD fluids [19]. The best results are achieved with the two-compartment, neutral pH, low GDP solutions.…”