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Peritoneal toxicities of hypertonic dextrose dialysate
1Renal Section, Veterans Affairs Medical Center, Albuquerque, New Mexico, USA.
Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|February 22, 2000
Summary
Hypertonic dextrose dialysate causes peritoneal cell damage and fibrosis. Alternative fluid control methods in peritoneal dialysis are recommended to avoid its toxic effects.
Area of Science:
- Nephrology
- Cell Biology
- Biochemistry
Background:
- Peritoneal dialysis is a common treatment for kidney failure.
- Hypertonic dextrose dialysate is frequently used for fluid management.
- Potential toxicities of this dialysate require thorough review.
Purpose of the Study:
- To review the peritoneal toxicities associated with hypertonic (4.25%) dextrose dialysate.
- To explore the mechanisms underlying these toxicities.
- To recommend alternative fluid management strategies in peritoneal dialysis.
Main Methods:
- In vitro studies using peritoneal cell lines (polymorphonuclear cells, macrophages).
- In vivo animal studies investigating dialysate effects.
- Review of literature on advanced glycosylation end-products and peritoneal solute transport.
Main Results:
- Hypertonic dextrose dialysate exhibits direct cytotoxicity to peritoneal cells.
- It impairs phagocytosis, bacterial killing, and inflammatory mediator production.
- Inhibition of mesothelial cell proliferation and promotion of peritoneal fibrosis were observed.
- High glucose dialysate leads to advanced glycosylation end-product deposition and high solute transport.
Conclusions:
- Hypertonic dextrose dialysate poses significant risks to the peritoneum.
- Fluid control should prioritize salt/water restriction and tailored dialysis schedules.
- Future research into novel osmotic agents may offer safer alternatives.