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Biocompatibility studies with bicarbonate-based solutions

F B Pedersen1

  • 1Department of Nephrology, Odense University Hospital, Denmark.

Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|January 1, 1994
PubMed
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Bicarbonate-based dialysis fluids show improved biocompatibility over acidic lactate-based solutions in peritoneal dialysis (PD). While long-term clinical data is pending, in vitro and animal studies suggest reduced toxicity for these bicarbonate-based (BB) fluids.

Area of Science:

  • Nephrology
  • Biocompatibility Studies
  • Peritoneal Dialysis

Background:

  • Peritoneal dialysis (PD) fluid biocompatibility impacts mesothelial cells and host defense.
  • Conventional acidic lactate-based (LB) fluids exhibit toxicity due to high acidity, lactate, and osmolality.
  • Bicarbonate-based (BB) fluids offer a potential alternative with normalized pH and bicarbonate buffering.

Purpose of the Study:

  • To review biocompatibility tests and studies of bicarbonate-based continuous ambulatory peritoneal dialysis (CAPD) fluids.
  • To compare the cellular toxicity and effects of BB fluids versus conventional LB fluids.

Main Methods:

  • In vitro cell culture studies assessing mesothelial and white blood cell functions.
  • Animal studies evaluating fluid tolerance, ultrafiltration, and peritoneal membrane integrity.

Related Experiment Videos

  • In vivo human studies measuring early cellular responses to intraperitoneal dwell.

    • Main Results:

    • In vitro tests indicate BB fluids are less toxic to peritoneal cells than LB fluids.
    • High glucose BB fluids remain cytotoxic.
    • Animal studies show BB fluids are well-tolerated, some increase ultrafiltration, but membrane integrity preservation is not consistently demonstrated.
    • Human studies suggest detectable differences in cell toxicity within 30 minutes of dwell time.

    Conclusions:

    • Bicarbonate-based PD fluids demonstrate improved biocompatibility in vitro and in animal models compared to acidic LB fluids.
    • Further long-term clinical evaluation is necessary, but current data suggests BB fluids are a promising alternative for PD.
    • Careful formulation, particularly regarding glucose content, is crucial for optimizing BB fluid safety.