Peritoneal dialysis fluid inhibition of phagocyte function: effects of osmolality and glucose concentration.

Solutions were formulated to examine, independently, the roles of osmolality and glucose in the reduction of viability and inhibition of phagocyte function by dextrose-containing peritoneal dialysis fluids. The exposure of neutrophils (polymorphonuclear leukocytes) to test fluids containing > or = 2.7% (wt/vol) glucose resulted in significant cytotoxicity as assessed by the release of lactate dehydrogenase above control values (7.12 +/- 2.65%). At the highest concentration of glucose (4.5%), lactate dehydrogenase release was 15.83 +/- 0.49% (P < 0.05). These effects were directly related to the presence of D-glucose in the test fluids. In contrast, phagocytosis and the release of leukotriene B4 from PMN stimulated with serum-treated zymosan were significantly inhibited in an osmolality-, but not glucose-, dependent manner. The inhibition of tumor necrosis factor alpha and interleukin-6 release from mononuclear leukocytes was inhibited by a combination of osmolality and monosaccharide concentration. Under the same conditions, PMN respiratory burst activation remained unaffected irrespective of glucose concentration or fluid osmolality. These data indicate that, in addition to the low pH of peritoneal dialysis fluid and its high lactate concentration, its glucose content (either directly or as a consequence of the resulting hyperosmolality of the fluid) inhibits cell functional parameters. These findings suggest clinically significant inhibition of host defense mechanisms because, in high-glucose dialysis fluids, osmolality does not reach physiologic values, even during extended intraperitoneal dwell periods.

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IR-Photometry Method for Measuring Glucose Concentration in Peritoneal Dialysis Fluid

Journal of the Russian Universities Radioelectronics ◽

10.32603/1993-8985-2021-24-4-68-78 ◽

2021 ◽

Vol 24 (4) ◽

pp. 68-78

Author(s):

N. M. Zhilo ◽

M. O. Mikhailov ◽

E. L. Litinskaia ◽

K. V. Pozhar

Keyword(s):

Peritoneal Dialysis ◽

Optical System ◽

Glucose Concentration ◽

Experimental Studies ◽

The Body ◽

Artificial Kidney ◽

Dialysis Fluid ◽

Glucose Content ◽

Peritoneal Dialysis Fluid ◽

Dialysate Solution

Introduction. The transition of glucose into the blood during automated peritoneal dialysis with regeneration of the dialysis fluid leads to a decreased removal of excess fluid from the body and corresponding violations of the water-salt balance.Aim. To consider a system for automatically maintaining the concentration of glucose in the dialysate solution, which provides effective ultrafiltration, as well as to propose a non-contact photometric feedback sensor.Materials and methods. The sensor is an optical system of an IR laser diode with a power of 30 mW and a wavelength of 1600 nm, a photodiode and a quartz tube, through which the test solution circulates. The sensor measures the attenuation of the radiation passing through the solution in a pulsed mode and calculates the glucose concentration. The selected combination of digital filters provides compensation for the noise of the optical system. Experimental studies of the efficiency of the sensor were carried out on peritoneal dialysis solutions with various concentrations of urea, creatinine, uric acid and glucose. At the beginning of the experiments, the sensor was calibrated in a pure solution.Results. It was shown that the developed sensor makes it possible to measure the concentration of glucose in a solution for peritoneal dialysis in the range of 42…220 mmol / l with a relative error of about 15%. The time of one measurement is about 1 minute, which makes it possible to obtain up-to-date information on the current concentration of the solution.Conclusion. This combination of characteristics will allow the sensor to be used in artificial kidney wearable devices for assessing the glucose content in the solution, calculating the time to change the solution and as a feedback sensor in a system for maintaining the concentration of the osmotic agent.

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Replacement of Glucose with N-Acetylglucosamine in Peritoneal Dialysis Fluid—Experimental Study in Rats

Peritoneal Dialysis International ◽

10.1177/089686080102103s69 ◽

2001 ◽

Vol 21 (3_suppl) ◽

pp. 365-367 ◽

Cited By ~ 2

Author(s):

Andrzej Breborowicz ◽

Malgorzata Pawlaczyk–Kuzlan ◽

Krzysztof Pawlaczyk ◽

Ewa Baum ◽

Paul Tam ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Inflammatory Reaction ◽

Dialysis Fluid ◽

Dialysis Solution ◽

Peritoneal Dialysis Fluid ◽

Male Wistar Rats ◽

Peritoneal Permeability ◽

Peritoneal Dialysis Solution ◽

Dialysis Fluids ◽

Osmotic Solute

Background Glucose is still used as an osmotic solute in peritoneal dialysis fluids, despite evidence of its local (peritoneal) and systemic toxicities. However a constant search is underway for a new, more biocompatible osmotic solute for peritoneal dialysis fluids. Objective The present study evaluated N-acetylglucosamine (NAG) in a concentration of 220 mmol/ L as an alternative to glucose for the osmotic solute in peritoneal dialysis fluid, during chronic peritoneal dialysis in rats. Methods For 8 weeks, male Wistar rats were infused with glucose-based or NAG-based dialysis fluid. Intraperitoneal inflammation and peritoneal permeability and morphology were evaluated in all rats during the study. Results Repeated intraperitoneal infusion of the NAG-based dialysis fluid resulted in a weaker intra-abdominal inflammatory reaction as compared with the reaction in rats infused with glucose-based dialysis solution. At the end of the study, the concentration of hyaluronan in the peritoneal interstitium obtained from NAG-treated rats was higher than that found in the interstitium taken from animals exposed to dialysis fluid containing glucose. Also, peritoneal permeability to total protein was lower in NAG-treated rats. Conclusion As an alternative to glucose, NAG used for the osmotic solute in peritoneal dialysis solution decreases the intraperitoneal inflammatory reaction induced by the process of peritoneal dialysis and, indirectly (owing to the increased hyaluronan content in the peritoneal interstitium), diminishes peritoneal permeability to protein.

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Chemical and Immunological Characterization of Oxidative Nonenzymatic Protein Modifications in Dialysis Fluids

Peritoneal Dialysis International ◽

10.1177/089686080302300103 ◽

2003 ◽

Vol 23 (1) ◽

pp. 23-32 ◽

Cited By ~ 10

Author(s):

Maria Cristina Ruiz ◽

Manuel Portero–Otín ◽

Reinald Pamplona ◽

Jesús R. Requena ◽

Joan Prat ◽

...

Keyword(s):

Oxidative Stress ◽

Peritoneal Dialysis ◽

Dwell Time ◽

Immunological Methods ◽

Cross Linking ◽

Dialysis Fluid ◽

Protein Modifications ◽

Peritoneal Dialysis Fluid ◽

Dialysis Fluids

← Background Glucose degradation products (GDP) in dialysis fluids may induce nonenzymatic protein modifications, the chemical nature and biological properties of which should be better defined. ← Aims To characterize nonenzymatic protein modifications present in glucose-based peritoneal dialysis fluids (PDF) and to evaluate the relationship between concentrations of GDP and the derived nonenzymatic modifications, and the potential of PDF for generating these modifications in vitro. ← Methods The presence, distribution, and content of several nonenzymatic protein modifications in PDF were evaluated by immunological methods, by HPLC, and by gas chromatography-mass spectrometry (GC/MS). Peritoneal dialysis fluid-induced oxidative stress in cells was evaluated by flow cytometry. The potential of PDF for generating oxidative and glycoxidative modifications was examined by immunological and cross-linking analyses. ← Results The albumin present in PDF is modified by carboxymethyllysine (CML). GC/MS analyses of PDF proteins confirmed the presence of CML and demonstrated the occurrence of carboxyethyllysine, malondialdehyde lysine, and oxidation-derived semialdehydes. Furthermore, their concentrations in PDF proteins were significantly higher than those in plasma proteins (in all cases, p < 0.02). The concentration of pyrraline, a non-oxidative advanced glycation end-product, increased with dwell time up to 6 hours ( p < 0.03). The PDF induced cellular free-radical production, which was partially inhibited by the Maillard reaction inhibitor aminoguanidine ( p < 0.001). The potential to generate oxidative and glycoxidative modifications demonstrated an inverse relationship with dwell time ( p < 0.05). The PDF was able to induce collagen cross-linking in a close relationship with GDP concentration. ← Conclusions ( 1 ) PDF contains non-oxidative and several oxidative nonenzymatic protein modifications in higher concentrations than plasma. ( 2 ) Peritoneal dialysis fluid induces oxidative stress in vitro, which can be partially inhibited by aminoguanidine. ( 3 ) These properties are directly related to GDP concentration. ( 4 ) Peritoneal dialysis fluid is able to generate glycoxidative and oxidative damage to proteins in vitro in a dwell-time dependent fashion.

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The Effect of Peritoneal Dialysis Fluid on the Release of Il-113 and Tnfa by Macrophages/Monocytes

Peritoneal Dialysis International ◽

10.1177/089686089301300206 ◽

1993 ◽

Vol 13 (2) ◽

pp. 112-117 ◽

Cited By ~ 31

Author(s):

Amos Douvdevani ◽

Jayson Rapoport ◽

Aviva Konforti ◽

Moshe Zlotnik ◽

Cidio Chaimovitz

Keyword(s):

Peritoneal Dialysis ◽

Time Course ◽

Mononuclear Cells ◽

Lactate Concentration ◽

Peritoneal Macrophages ◽

Dialysis Fluid ◽

Peripheral Blood Mononuclear ◽

Peritoneal Dialysis Fluid ◽

Short Time ◽

Necrosis Factor

Objective To study the effect of dialysis fluid on the release of interleukin-1β (IL-1β) and tumor necrosis factor (TNFα) by peritoneal macrophages (PM) and peripheral blood mononuclear cells (MNC), and the time course and factors involved in this effect Design PM and MNC were incubated for various periods with Dianeal itself, or Dianeal of varying pH and composition.IL-1 β was measured by radioimmunoassay and TNFα by cytotoxicity assay. Patients PM were obtained by centrifugation of dialysis effluent from 3 continuous ambulatory peritoneal dialysis (CAPD) patients. MNC were obtained from healthy volunteers. Results Dialysis fluid inhibited the release of both cytokines. Indomethacin had no effect on the inhibition of TNFα release caused by dialysis fluid. Thus prostaglandins are not involved in this inhibition. Solutions of pH 5.2 and high lactate concentration caused an identical inhibition to that caused by dialysate, whereas the presence or absence of glucose had no effect. Thus it seems that pH and lactate are the important inhibitory factors. Time course studies showed that the inhibition of TNFα release was substantial after only 15 minutes of incubation with dialysate, whereas the inhibition of IL-1 β became significant only after 60 minutes of incubation. Conclusions Even though dialysate pH rises within 15–30 minutes after instillation into the abdomen, the initial low pH present for only a short time could have a significant effect on TNFα release by peritoneal macrophages, and thus on their ability to mount a normal inflammatory response. Lactate also has a significant inhibitory role. It is suggested that commercial dialysis solutions should have a pH of 7. Oandthata physiological buffer other than lactate be used.

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Cell Function and Viability in Glucose Polymer Peritoneal Dialysis Fluids

Peritoneal Dialysis International ◽

10.1177/089686089301300205 ◽

1993 ◽

Vol 13 (2) ◽

pp. 104-111 ◽

Cited By ~ 45

Author(s):

Tomasz Liberek ◽

Nicholas Topley ◽

Chandra D. Mistry ◽

Gerald A. Coles ◽

Tracy Morgan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Cell Viability ◽

Host Defense ◽

Survival Data ◽

Respiratory Burst ◽

Dependent Manner ◽

Peritoneal Dialysis Fluid ◽

Glucose Polymer ◽

Dialysis Fluids

Objective To investigate the biocompatibility profile of a new peritoneal dialysis fluid containing glucose polymer (GPF). Design Viability and function of peripheral neutrophils (PMN) from healthy donors and cultured human peritoneal mesothelial cells were assessed in vitro after exposure to dialysis fluids. Phagocytosis, leukotriene B4 synthesis, and respiratory burst activation were measured following stimulation with serum-treated zymosan (STZ) or opsonized Staphylococcus epidermidis (S. epidermidis). Bacterial growth in the fluids was also investigated. In vivo pH equilibration of GPF and subsequent respiratory burst activation following incubation in spent dialysate were studied. Results For all the host defense parameters measured, commercial dialysis fluids (Dianeal; 1.36% and 3.86% glucose) and GPF (pH 5.2) were significantly more inhibitory than the control buffer (pH 7.3). Mesothelial cell viability was reduced by all the fluids tested irrespective of pH. Glucose polymer fluid was significantly more inhibitory than DianeaI 1.36% for STZ phagocytosis and respiratory burst activation. In contrast, it was less suppressive than DianeaI3.86% for L TB4 synthesis. For all parameters tested, except LTB4 generation, there was a marked effect of pH, with GPF being significantly more inhibitory at pH 5.2 than at pH 7.3. None of the fluids tested supported the growth of S. epidermidis, although the viable counts in GPF were significantly higher than in Dianeal. Fluid inhibition of PMN respiratory burst activation and cytotoxicity were reduced in a time-dependent manner following increasing dwell time in vivo. Conclusions GPF does not appear to be significantly different from Dianeal as far as host defense parameters are concerned. However, the cell viability and bacterial survival data suggest some possibly negative aspects of this fluid formation.

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270 Symptomatic Icodextrin Right Pleural Effusion from Suspected Pleuroperitoneal Communication: The Utility of Simultaneous Biochemical Fingerprinting Analysis of Drained Pleural Fluid and Peritoneal Dialysis Fluid

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2019.03.272 ◽

2019 ◽

Vol 73 (5) ◽

pp. 713

Keyword(s):

Peritoneal Dialysis ◽

Pleural Effusion ◽

Pleural Fluid ◽

Dialysis Fluid ◽

Fingerprinting Analysis ◽

Pleuroperitoneal Communication ◽

Peritoneal Dialysis Fluid ◽

Biochemical Fingerprinting

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Do We Have a Biocompatible Peritoneal Dialysis Fluid?

Open Journal of Nephrology ◽

10.4236/ojneph.2012.23005 ◽

2012 ◽

Vol 02 (03) ◽

pp. 29-34

Author(s):

Shadi Hassan ◽

Batya Kristal ◽

Khalid Khazim ◽

Fadi Hassan ◽

Dunia Hassan ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Dialysis Fluid ◽

Peritoneal Dialysis Fluid

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Non-touch Aseptic technique Maintains Sterility of Antibiotic-Admixed peritoneal Dialysis Fluid

Peritoneal Dialysis International ◽

10.3747/pdi.2017.00106 ◽

2018 ◽

Vol 38 (1) ◽

pp. 65-67

Author(s):

Louis L. Huang ◽

Ellen Ramas ◽

Priti Prasad ◽

Jenny Catania ◽

Pauline Meade ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Room Temperature ◽

Positive Culture ◽

Coagulase Negative Staphylococcus ◽

Dialysis Fluid ◽

Aseptic Technique ◽

Sterile Technique ◽

Peritoneal Dialysis Fluid ◽

Culture Positive ◽

Positive Controls

There is a paucity of data on the sterility of peritoneal dialysis fluid (PDF) after drug admixture. International Society for Peritoneal Dialysis (ISPD) guidelines suggest using sterile technique when admixing antibiotics; however, the degree of sterility remains unclear. This issue is most pertinent when preparing take-home PDF for outpatient treatment of peritonitis. This study compares the sterility of PDF admixed with antibiotics using a non-touch aseptic technique (NTAT) versus sterile technique. Groups of 8 PDF mixtures (1.5% Dianeal or Icodextrin [Baxter International Inc., Spring Grove, IL, USA]) were admixed with 1 g/L ceftazidime and vancomycin, or 20 mL saline, either by a pharmacist using sterile technique in a sterile suite, or a nurse in a clinical room using NTAT. Dianeal inoculated with 1 x 106 colony-forming units (CFU)/L of coagulase-negative Staphylococcus (CNS), with and without antibiotics, served as positive controls. Admixed PDFs were left at room temperature for 72 hours, then cultured using the BacT/ALERT system. A positive culture by day 5 constituted a contamination. Differences in proportion of contamination between groups were assessed using the Chi-squared test. Eighty PDF bags underwent microbiological testing. Sterility was maintained in all bags, independent of technique (NTAT versus sterile technique), type of PDF (Dianeal versus Icodextrin), or whether antibiotics were admixed. Of the positive controls, CNS-inoculated PDFs without antibiotics were all culture positive; however, when inoculated into antibiotic-admixed PDFs, only S. haemolyticus remained culture-positive ( p < 0.0001). In conclusion, PDF sterility can be maintained using NTAT for up to 3 days at room temperature. Currently, there is insufficient evidence to adopt sterile technique in sterile suites when admixing take-home PDF.

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