OBJECTIVE: To review the current literature on the in vitro biocompatibility of peritoneal dialysis solutions buffered with bicarbonate and compare them to existing conventional lactate-buffered solutions. RESULTS: Conventional lactate-buffered solutions are known to inhibit or modulate cell functions related to host defense mechanisms; these effects are mediated by their low pH in combination with lactate concentration, as well as their glucose content, associated osmolality, and the presence of glucose breakdown products. CONCLUSIONS: Bicarbonate-buffered solutions appear to present a viable alternative for use in CAPD based on their significantly improved biocompatibility profile. The results of on-going clinical trials will clarify whether these in vitro data will impact significantly on peritoneal host defence, infection rate and the long term function of the peritoneal membrane in vivo.

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