Bicarbonate is not the ultimate answer to the biocompatibility problems of CAPD solutions: a cytotoxicity test of...

Human polymorphonuclear granulocytes (PMN) were tested for migration and phagocytosis after exposure to CAPD solutions and effluents sampled during the first hour of dialysis from patients treated with lactate or bicarbonate based CAPD-solutions. The effluents from the lactate based solutions (Dianeal and Lockolys) reduced the migration and enhanced the phagocytosis compared to values obtained in a standard cell culture medium. Both cell functions increased during the dialysis period. In contrast, the cell-function only changed slightly when 87b, a bicarbonate based CAPD-solution (pH = 7.4, [HCO3-) = 29mM), was employed. During the first 30 minutes, the cells performed at a higher level when exposed to the 87b effluent than when exposed to the lactate effluents. The observations further indicated that optimal conditions for PMNs are at a bicarbonate concentration of less than 20 mM and a lactate concentration of less than 15mM.

PMN migration is reduced by both lactate and bicarbonate based CAPD solutions and effluents collected during the first hour of dialysis. The bio-compatibility of CAPD solutions may be improved by combining the lactate and bicarbonate buffering systems in a solution with a concentration of less than 20 mM of bicarbonate and less than 15 mM of lactate.