Peritoneal toxicities of hypertonic dextrose dialysate

This report reviews the peritoneal toxicities of hypertonic (4.25%) dextrose dialysate. In vitro incubation of peritoneal cell lines (polymorphonuclear cells, macrophages) in hypertonic dextrose solutions have demonstrated direct cytotoxicity, decreased phagocytosis and bacterial killing, and decreased production of superoxide and inflammatory cytokines and leukotrienes. Hypertonic dextrose dialysate also inhibits the proliferation of mesothelial cells and causes increased mesothelial production of transforming growth factor, potentially leading to peritoneal fibrosis. In vivo animal studies have also shown peritoneal toxicity of hypertonic dextrose dialysate. Recently, the use of peritoneal dialysate with high glucose concentration has been found to lead to the deposition of advanced glycosylation end-products in the peritoneal structures and to the development of high peritoneal solute transport. Fluid control in peritoneal dialysis should not be based on the liberal use of hypertonic dextrose dialysate. Instead, it should be achieved by restriction of salt and water intake and prescription of the peritoneal dialysis schedule (particularly the dwell time) based on peritoneal equilibration test (PET) findings. Newer osmotic agents may obviate the use of hypertonic dialysate in the future.