Toxicity of Heat Sterilized Peritoneal Dialysis Fluids is Derived from Degradation of Glucose

Martinson, E. E.; Wieslander, Anders; Kjellstrand, Per; Boberg, Ulf

doi:10.1097/00002480-199207000-00057

Cited by 43 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Those factors therefore meet the definition of bioincompatibility as proposed by some authors, which could be a result of low pH (3,4) or of high GDPs (5)(6)(7)(8)(9)(10). The relevance and toxicity of GDPs have been demonstrated to be independent from those of glucose.…”

supporting

confidence: 54%

A New Neutral-Ph Low-Gdp Peritoneal Dialysis Fluid

et al. 2012

View full text Add to dashboard Cite

BackgroundConventional peritoneal dialysis fluids (PDFs) consist of ready-to-use solutions with an acidic pH. Sterilization of these fluids is known to generate high levels of glucose degradation products (GDPs). Although several neutral-pH, low-GDP PD solutions have been developed, none are commercially available in the United States. We analyzed pH and GDPs in Delflex Neutral pH (Fresenius Medical Care North America, Waltham, MA, USA), the first neutral-pH PDF to be approved by the US Food and Drug Administration.MethodsWe evaluated whether patients (n = 26; age range: 18 - 78 years) could properly mix the Delflex Neutral pH PDF after standardized initial training. We further analyzed the concentrations of 10 different glucose degradation products in Delflex Neutral pH PDF and compared the results with similar analyses in other commercially available biocompatible PDFs.ResultsAll pH measurements (n = 288) in the delivered Delflex Neutral pH solution consistently fell within the labeled range of 7.0 ± 0.4. Analysis of mixing errors showed no significant impact on the pH results. Delflex Neutral pH, Balance (Fresenius Medical Care, Bad Homburg, Germany), BicaVera (Fresenius Medical Care), and Gambrosol Trio (Gambro Lundia AB, Lund, Sweden) exhibited similar low total GDP concentrations, with maximums in the 4.25% solutions of 88 μmol/L, 74 μmol/L, 74 μmol/L, and 79 μmol/L respectively; the concentration in Physioneal (Baxter Healthcare Corporation, Deerfield, IL, USA) was considerably higher at 263.26 μmol/L The total GDP concentration in Extraneal (Baxter Healthcare Corporation) was 63 μmol/L, being thus slightly lower than the concentrations in the 4.25% glucose solutions, but higher than the concentrations in the 1.5% and 2.5% glucose solutions.ConclusionsThe new Delflex Neutral pH PDF consistently delivers neutral pH with minimal GDPs.

show abstract

supporting

confidence: 54%

A New Neutral-Ph Low-Gdp Peritoneal Dialysis Fluid

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Apart from tonicity, pH, and high glucose contents, the formation of glucose degradation products during heat‐sterilization and storage of the dialysate is another important consideration. Glucose as a highly reactive substance is easily degraded into glucose degradation products (GDP), which are toxic [31] and can give rise to early or advanced glycation end products. Exposure of HPMCs to glycated BSA marginally inhibited C3 expression compared with control, while C4 expression was also decreased though the reduction did not achieve statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Regulation of complement C3 and C4 synthesis in human peritoneal mesothelial cells by peritoneal dialysis fluid

Tang

Leung

Chan

et al. 2004

Clinical and Experimental Immunology

View full text Add to dashboard Cite

SUMMARYAlthough complement is activated in the peritoneal cavity during chronic peritoneal dialysis (PD), little is known about its role in peritoneal defence and injury related to long-term PD. We examined the impact of glucose and commercial peritoneal dialysis solutions on complement expression in HPMCs obtained by primary culture from omental tissues of consented patients undergoing elective abdominal surgery. Constitutive expression of C3 and C4 mRNA in HPMCs was up-regulated upon exposure to 75 m M glucose in a time-dependent manner. C3 and C4 protein was secreted in both apical and basolateral directions. Glucose doses beyond 100 m M markedly down-regulated C3 and C4 expression, and stimulated LDH release dose-dependently. Such cytotoxic effects were attenuated using equivalent doses of mannitol instead of glucose. Treatment with conventional lactate-buffered dialysis solution gave rise to down-regulation of C3 and C4 expression, and heightened LDH release in HPMCs. These effects correlated with the glucose strength of the solution, persisted despite replacement with a bicarbonate-buffered solution, aggravated by glycated albumin, and were partially abrogated by supplementation with 10% fetal bovine serum in the culture system. Our findings suggest that the artificial conditions imposed by PD lead to alterations in local complement synthesis that have implications for the role of the peritoneal mesothelium in both inflammation and defence.

show abstract

“…This process is substantially accelerated by heating [33]. Accordingly it has been shown that the degradation of glucose in PD solutions occurs primarily during autoclaving and to lesser extent during storage [18,26,27]. If, however, PDFs are sterilized by filtration, GDP formation is substantially reduced [44].…”

Section: Glucose Degradation Products In Peritoneal Dialysis Fluidsmentioning

confidence: 99%

Glucose Degradation Products in Peritoneal Dialysis: From Bench to Bedside

Jörres

2003

Kidney Blood Press Res

View full text Add to dashboard Cite

In continuous ambulatory peritoneal dialysis patients, treatment success is inextricably linked to the functional and morphological integrity of the peritoneal membrane. This membrane, however, is repeatedly exposed to peritoneal dialysis fluids (PDFs) with unphysiological composition (e.g., acidic pH, high glucose content, hyperosmolarity). More recently, attention of researchers and clinicians has been focused on the presence of glucose degradation products (GDPs) that are generated during heat sterilization of PDF. These GDPs were found to adversely affect peritoneal cell function both acutely and chronically. Recently, a new family of multi-chambered PDFs has been introduced into clinical practice. By keeping the glucose in a separate compartment at very low pH, the generation of GDPs during heat sterilization is markedly reduced. Initial clinical studies indicate that treatment with these novel PDFs may lead to improved clinical outcomes. The current article reviews recent experimental and clinical experience with both conventional and multi-chambered PDFs.

show abstract

Toxicity of Heat Sterilized Peritoneal Dialysis Fluids is Derived from Degradation of Glucose

Cited by 43 publications

References 0 publications

A New Neutral-Ph Low-Gdp Peritoneal Dialysis Fluid

A New Neutral-Ph Low-Gdp Peritoneal Dialysis Fluid

Regulation of complement C3 and C4 synthesis in human peritoneal mesothelial cells by peritoneal dialysis fluid

Glucose Degradation Products in Peritoneal Dialysis: From Bench to Bedside

Contact Info

Product

Resources

About