Composition of Peritoneal Dialysis Solutions: Potential Hazards

Abstract

The ideal components of peritoneal dialysate and their ideal concentrations have yet to be defined. This article reviews the hazards inherent in present solutions and emphasises the dual needs for uniformity of approach to composition and for agreement on minimal international standards for solution quality control.

The Euro-Balance Trial: The effect of a new biocompatible peritoneal dialysis fluid (balance) on the peritoneal membrane

“…GDP have been shown, in in vitro studies, to be cytotoxic, to modulate cell proliferation, cell migration, to retard remesothelialization, and to down-regulate cytokine and growth factor synthesis [13,[17][18][19][20]. In vivo studies have highlighted potential adverse effects of GDP on leukocyte recruitment [21,22], and clinical observations have linked GDP to infusion pain and impaired ultrafiltration capacity [23].…”

Formaldehyde scavenging from peritoneal dialysis solutions using reduced aminothiol compounds

“…In addition, the singlet peak corresponded to protons either associated with the S or N (X) atoms, however, the exact identity of the intermediate(s) could not be determined under the conditions of this study. 3 3, were determined. The parameters obtained for the scavenger product and thiazolidine-4-carboxylic acid were identical, confirming that formaldehyde scavenging with L-cysteine produced this derivative.…”

“…Both low and higher molecular weight aldehydes are generated from glucose degradation after the heat sterilization procedure during the manufacture of the solutions. [1][2][3][4][5][6] Aldehydes have also been discovered in freezing solutions, caused by the autoxidation of the cryoprotective compounds. 7 In vitro studies have demonstrated that aldehyde toxicity diminished the viability of frozen mouse oocytes and zygotes; as well as fibroblasts and peritoneal mesothelial cells in culture.…”

“…Aldehydes have been identified in PD (1.5, 2.5, 4.25% glucose w/v) solutions, saline injection solutions (5, 10% glucose w/v) and IPN solutions (20, 50 and 70% w/v glucose) at levels corresponding to the concentration of glucose. Both low and higher molecular weight aldehydes are generated from glucose degradation after the heat sterilization procedure during the manufacture of the solutions 1–6 . Aldehydes have also been discovered in freezing solutions, caused by the autoxidation of the cryoprotective compounds 7 .…”

Prolonged preservation of rat peritoneal mesothelial cells (RPMC) and rat peritoneal fibroblasts (RPFB) with neutral pH peritoneal dialysis solution depleted of glucose degradation products (GDPs)

“…16,17 Neutralizing PD solutions by manually injecting sodium bicarbonate ameliorates such problems; however, this procedure is not practical for treating a large number of patients. 16,17 Neutralizing PD solutions by manually injecting sodium bicarbonate ameliorates such problems; however, this procedure is not practical for treating a large number of patients.…”