Effects of Glucose-Free Dialysis Solutions on Human Peritoneal Mesothelial Cells

Abstract

Background: Glucose-free dialysis solutions may be more biocompatible owing to the physiological pH and the lack of glucose degradation products, and the effects can be reflected by the changes in some markers of peritoneal mesothelial cells (PMC). Method: Peritoneal effluents were collected in 17 CAPD patients after one daily exchange of glucose-containing dialysate to Nutrineal (1.1% amino acid-based PDF), and human PMC were cultured from peritoneal effluent and treated with various peritoneal dialysis (PD) solutions. Results: The level of cancer antigen 125 (CA125) in peritoneal effluent increased significantly after using Nutrineal® for 3 months (p = 0.045), whereas that of procollagen I peptide (PICP) remained unaltered. Production of CA125 by human PMC showed a time-responsive increase after stimulation with Nutrineal and Extraneal (icodextran-based PDF). An increased expression of CA125 was observed in cultured human PMC treated with various PD solutions, and the increase induced by Nutrineal was lower than that induced by 4.25% Dianeal® and Extraneal®. A lower increase was also observed for lactate dehydrogenase (LDH). The levels of heat shock protein 70 (HSP70), however, were not altered. Conclusion: Nutrineal is more biocompatible to the peritoneal membrane than the conventional PD solutions tested herein, reflected by both the in vivo and in vitro response of CA125.

Biocompatibility of a bicarbonate-buffered amino-acid-based solution for peritoneal dialysis

“…The finding of the study reported here that exposure to Aminobic did not affect HSP-72 response and did not acutely impair HPMC viability points to improved biocompatible profile of the solution. At first glance, these data appear to be in line with those of Chang et al [24], who also found no up-regulation of HSP in response to amino-acid solution. Surprisingly, however, these authors also found no significantly increased expression of HSP in cells exposed to the conventional PD solution with acidic pH and high GDP contents.…”

“…Interestingly, the incubation of cells with Aminobic resulted in a significant increase in unstimulated IL-6 secretion. A similar effect has been reported by Chang et al [24]. Plum et al [31] and Martikainen et al [32] who detected increased intraperitoneal levels of IL-6 in patients receiving amino-acid-based solutions and linked this effect to better preservation of HPMC.…”

“…These differences may be related to details of the experimental design. Chang et al [24] used PD-effluent-derived HPMC obtained from only few uremic patients. Such cells are primed in vivo both by uremia and PD fluids and may be at various stages of epithelial-to-mesenchymal conversion and display different functional properties [25].…”

“…Similarly, beneficial effects of amino-acid-based PD solutions have been demonstrated in HPMC [24] and HepG2 cells [26] with the use of the lactate dehydrogenase (LDH) test. Interestingly, Plum et al used the MTT test to detect improved biocompatibility of HPMC after short-term exposure to a bicarbonate-buffered amino-acid PD solution compared with the same solution buffered with lactate [27].…”

Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis

“…In our observational study, a cause-effect relationship cannot be established. The data on dialysis effectivity (Kt/v), type of peritoneum ("slow transporters", "fast transporters") and dialysis regime were not recorded, and especially the influence of the use of icodextrin or non-glucose based peritoneal dialysis solution (Nutrineal) on glycemic variability would have been of interest to delineate [37][38][39][40][41]. Furthermore, data on peritonitis as a complication of PD, which can affect ultrafiltration and glucose absorption [42], were not available in the present study.…”