Toxicity of effluent peritoneal dialysis fluid

Area of Science:

• Nephrology
• Biocompatibility of medical devices

Background:

• Commercial heat-sterilized peritoneal dialysis (PD) fluids have non-physiological properties like low pH and high osmolality.
• These properties, along with toxic glucose degradation products (GDPs), may negatively affect host defense in PD patients.
• The impact of GDP-induced cytotoxicity in PD fluids has not been thoroughly investigated.

Purpose of the Study:

• To assess the cytotoxicity of PD fluids over time after instillation in patients.
• To evaluate the equilibration of pH and osmolality of PD fluids in the peritoneal cavity.
• To determine the clinical significance of GDPs in PD fluids.

Main Methods:

• Effluent peritoneal dialysates were collected from PD patients at various dwell times (0, 5, 15, 30, 120, 240 minutes).
• Cytotoxicity was measured using fibroblast cell growth inhibition (L929 cell line).
• Osmolality and pH of the dialysates were also determined.

Main Results:

• PD fluids exhibited cytotoxicity due to GDPs for dwell times exceeding 30 minutes.
• Cytotoxicity was no longer observed in effluent fluids after 4 hours of dwell time.
• Osmolality gradually decreased, while pH rapidly increased to near-neutral levels within 5 minutes.

Conclusions:

• Glucose degradation products in PD fluids contribute to cytotoxicity.
• The presence of GDPs may be as clinically significant as low pH and high osmolality.
• Further research into GDPs is warranted to improve PD fluid biocompatibility and patient outcomes.