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Perit Dial Int 28(1): 44-52 2008
© 2008 International Society for Peritoneal Dialysis
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ORIGINAL ARTICLES

SHORT-TERM EFFECTS OF A NEW BICARBONATE/LACTATE-BUFFERED AND CONVENTIONAL PERITONEAL DIALYSIS FLUID ON PERITONEAL AND SYSTEMIC INFLAMMATION IN CAPD PATIENTS: A RANDOMIZED CONTROLLED STUDY

Jernej Pajek1, Radoslav Kveder1, Andrej Bren1, Andrej Gucek1, Alojz Ihan2, Josko Osredkar3 and Bengt Lindholm4

Department of Nephrology,1 University Medical Center Ljubljana; Institute of Microbiology and Immunology,2 Medical Faculty, University of Ljubljana; Clinical Institute for Clinical Chemistry and Biochemistry,3 University Medical Center Ljubljana, Ljubljana, Slovenia; Divisions of Baxter Novum and Renal Medicine,4 Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

Correspondence to: J. Pajek, Department of Nephrology, University Medical Center Ljubljana, Zaloska 2, 1525 Ljubljana, Slovenia. jernej.pajek{at}mf.uni-lj.si

{diamondsuit} Objectives: This study was designed to compare the local peritoneal and systemic inflammatory effects of a conventional lactate-based (Lac) peritoneal dialysis (PD) solution and a new biocompatible bicarbonate/lactate-based (Bic/Lac) solution having low concentration of glucose degradation products.

{diamondsuit} Methods: 26 stable, prevalent PD patients were enrolled in this prospective study. They sequentially underwent 3 months of therapy with the Lac solution and 3 months with the Bic/Lac solution in a randomized order. Flow cytometry was used to measure the expression of inflammatory molecules on peritoneal cells in overnight effluent collected at the end of each study period.

{diamondsuit} Results: 21 patients successfully completed the study. Mean fluorescence intensity of human leukocyte antigen (HLA)-DR and CD14 expression by macrophages were not different between Lac and Bic/Lac. The peritoneal appearance rate of cancer antigen 125 (kU/minute) was 68 ± 37 with Lac and 133 ± 66 with Bic/Lac (p < 0.001), and of interleukin (IL)-6 (ng/minute), 0.28 ± 0.2 with Lac and 0.18 ± 0.16 with Bic/Lac (p = 0.014). HLA-DR macrophage expression and IL-6 peritoneal appearance rates did not correlate. Serum concentrations with Lac and Bic/Lac were, for IL-6, 3.49 ± 2.28 and 3.72 ± 2.46 ng/L (p = 0.17), and for high-sensitivity C-reactive protein, 2.31 ± 2.98 and 2.71 ± 3.31 mg/L (p = 0.32) respectively. The concentration of effluent macrophages (x106/L) with Lac was 1.6 ± 1.6 and with Bic/Lac 2.6 ± 3.3 (p = 0.07).

{diamondsuit} Conclusions: We conclude that, although there was a significant reduction in peritoneal IL-6 in patients using Bic/Lac solution, systemic levels of inflammatory markers did not differ between the two solutions and no changes were present in macrophage surface activation markers, suggesting perhaps a less important role of peritoneal macrophages in the intraperitoneal chronic inflammatory process. The number of effluent macrophages tended to be higher in patients using the Bic/Lac solution, possibly contributing to improved intraperitoneal defense.

KEY WORDS: Inflammation; glucose degradation products; bicarbonate/lactate solution; flow cytometry.

Received 29 March 2007; accepted 13 July 2007.






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