Charged Polymers as Osmotic Agents for Peritoneal Dialysis

Abstract

A sustained ultrafiltration during long-dwell peritoneal dialysis exchanges cannot be achieved with rapidly absorbable small molecular weight substances such as commonly used glucose. Uncharged polymeric substances are absorbed slower, but yield insufficient osmotic driving force because osmolality is inversely proportional to the molecular weight.Charged polymers induce colloid osmotic pressure not only because of the molecules themselves, but also by ions kept in the peritoneal cavity by opposite charges of polymers. In an in vitro model of peritoneal dialysis, a sustained ultrafiltration has been achieved with several synthetic polymers including polyacrylate, dextran sulfate and polyethylenimine. However, these polymers were locally toxic to the peritoneal membrane when tested in rats and rabbits.Chemically modified gelatin derivatives, such as polygelin, exypolygelatin, and succinylated gelatin are widely used in Europe as plasma substitutes. They are metabolized and have proven to be systemically non-toxic. These gelatin derivative solutions were tested in rat models of peritoneal dialysis. Up to 10% solutions achieved sustained ultrafiltration at the rate proportional to the concentration and no untoward systemic or local effects on the peritoneum were observed. Absorption of gelatin molecules ranged from 40–60% of the infused amounts. The results of the studies indicate that gelatin derivitives have potential for clinical use as osmotic agents in long-dwell peritoneal dialysis exchanges if the absorption rates in humans are markedly lower than in rats.