Peritoneal dialysis fluid biocompatibility impact on human peritoneal membrane permeability

Area of Science:

• Nephrology
• Biocompatibility studies
• Molecular biology

Background:

• Peritoneal dialysis (PD) utilizes specialized fluids to manage kidney failure.
• Conventional lactate-based peritoneal dialysis fluid (CPDF) and bicarbonate/lactate-based fluid (BPDF) have different biocompatibility profiles.
• Understanding the impact of these fluids on peritoneal membrane function and gene expression is crucial for optimizing PD treatment.

Purpose of the Study:

• To compare the effects of CPDF and BPDF on peritoneal ultrafiltration (UF) and permeability.
• To investigate variations in gene expression in peritoneal cells exposed to CPDF and BPDF.
• To assess the biocompatibility of BPDF in patients undergoing peritoneal dialysis.

Main Methods:

• A non-randomized, sequential prospective study involving 40 incident PD patients.
• Peritoneal equilibration tests (PETs) were conducted using CPDF and BPDF (2.27% glucose) over 48-hour intervals.
• Gene expression analysis (reverse transcription polymerase chain reaction) was performed on mesothelial cells from peritoneal effluents.

Main Results:

• BPDF was associated with significantly lower urea and creatinine transfer, reduced UF, and lower pore area compared to CPDF.
• No significant differences were observed in the gene expression of aquaporins, nitric oxide synthases (NOS3, NOS2), or interleukin-6.
• A decreased SNAIL/E-CADHERIN mRNA ratio was noted when the dialysis sequence began with BPDF, indicating potential effects on epithelial-mesenchymal transition.

Conclusions:

• Patients initiating PD treatment with BPDF demonstrated a superior biocompatibility profile.
• BPDF is associated with reduced peritoneal permeability to small molecules and lower UF.
• These findings suggest BPDF may offer a more biocompatible option for peritoneal dialysis.