Liver Cell Reactive Components in Peritoneal Dialysis Fluids

Abstract

Metabolic changes in peritoneal dialysis (PD) patients are an important aspect concerning long-term outcome. Liver plays the main role in regulating metabolism. The effects of peritoneal dialysis fluids (PDF) on liver cell function are scarcely investigated. Therefore, we investigated the effects of PDF, different in some components, on liver cell metabolism in vitro. Metabolic activity (MTT), cell integrity (LDH release), proliferation (BrdU incorporation) and synthesis of albumin and transferrin are measured by incubating HepG2 cells for 3 h and 24 h with six different PDFs: (a) lactate-buffered, pH5.5: PDF I (1.5% gluc.); PDF II (4.5% gluc.); (b) bicarbonate-buffered, pH7.4: PDF III (1.5% gluc.), PDF IV (4.5% gluc.); (c) amino acid-based solutions, pH 7.4: PDF V (low AA level) and PDF VI (high AA level). Metabolic activity of bicarbonate-treated cells is greatly enhanced in comparison to lactate-buffered PDFs. These findings are confirmed by proliferation data. Synthesis of albumin and transferrin is significantly enhanced by amino acid-based solutions. Our data demonstrate, that lactate-buffered PDF impair liver cells much stronger than bicarbonate-buffered PDF. pH is the parameter which contributes to cytotoxicity and impaired metabolism to a major extent. In contrast to glucose-containing solutions, amino acid-based PDF stimulate protein synthesis in liver cells.

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

“…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].…”

Peritoneal Dialysis for Patients with End-Stage Renal Disease and Liver Cirrhosis

“…Concern may therefore arise that cirrhotic patients on PD are at increased risk of peritonitis, due to the inherent risk of SBP, as well as catheter- and technique-related peritonitis. An additional risk to infections is thought to be related to lactate-buffered PD solutions (24).…”

Prevention of membrane damage in patient on peritoneal dialysis with new peritoneal dialysis solutions

“…Zareie et al have shown that amino acid-based PDF results in reduced immune activation (evidenced by decreased number of rolling leukocytes and decreased induction of omental milky spots), reduced neoangiogenesis, mesothelial damage and fibrosis of the peritoneal membrane compared to glucose-containing PDF [68]. Riegel et al have shown that amino acid-based PDFs stimulate protein synthesis in liver cells much more than glucose-containing PDF [69].…”