Document Detail


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.
MedLine Citation:
PMID:  18178947     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. 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. 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 (x10(6)/L) with Lac was 1.6 +/- 1.6 and with Bic/Lac 2.6 +/- 3.3 (p = 0.07). 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.
Authors:
Jernej Pajek; Radoslav Kveder; Andrej Bren; Andrej Gucek; Alojz Ihan; Josko Osredkar; Bengt Lindholm
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis     Volume:  28     ISSN:  0896-8608     ISO Abbreviation:  Perit Dial Int     Publication Date:    2008 Jan-Feb
Date Detail:
Created Date:  2008-01-07     Completed Date:  2008-06-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8904033     Medline TA:  Perit Dial Int     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  44-52     Citation Subset:  IM    
Affiliation:
Department of Nephrology, University Medical Center Ljubljana, Slovenia. jernej.pajek@mf.uni-lj.si
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Ascitic Fluid / metabolism
Bicarbonates / pharmacology*
Buffers
C-Reactive Protein / metabolism
CA-125 Antigen / metabolism
Cross-Over Studies
Dialysis Solutions / pharmacology*
Female
Flow Cytometry
Humans
Interleukin-6 / metabolism
Lactic Acid / pharmacology*
Macrophages / metabolism
Male
Middle Aged
Peritoneal Dialysis, Continuous Ambulatory / methods*
Peritonitis / physiopathology*
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Bicarbonates; 0/Buffers; 0/CA-125 Antigen; 0/Dialysis Solutions; 0/Interleukin-6; 50-21-5/Lactic Acid; 9007-41-4/C-Reactive Protein
Comments/Corrections
Comment In:
Perit Dial Int. 2008 Jan-Feb;28(1):28-31   [PMID:  18178944 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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