EFFECTS OF HYALURONAN USED AS A SUPPLEMENT IN PERITONEAL DIALYSIS SOLUTIONS

Abstract

Hyaluronan present in the peritoneal cavity is removed during the course of peritoneal dialysis. The addition of hyaluronan to dialysis fluids has been proposed as a means to improve peritoneal transport functions and to protect the peritoneal membrane during peritoneal dialysis. Studies in rats have examined the effect of hyaluronan, added to dialysis solutions, on peritoneal permeability, inflammation and morphology. Addition of 10 mg/dL high-molecular weight (hmw) hyaluronan (m.w. 1.8-2.4 × 106 D) to the dialysis solution caused significant improvements in fluid and solute transport. Net ultrafiltration of water across the peritoneum increased, whereas the membrane's permeability to protein declined. During an eight hour dwell in the peritoneal cavity, about 25% of the administered hyaluronan was absorbed, and concentrations in the peritoneal interstitium and in blood increased significantly. Absorbed hyaluronan was rapidly metabolised and, was not affected by the uremic status of the animal. Hyaluronan reduced the acute intraperitoneal inflammation induced by the initiation of peritoneal dialysis and the surgical procedure. In rats exposed to dialysis solution supplemented with hyaluronan (10 mg/dL) for one month, the interstitial connective tissue in the peritoneal membrane was less thickened than that of control rats, and the membrane had a lower permeability to protein and reduced hydraulic conductivity. potentially helping to promote the removal of water during dialysis. Thus, supplementation of peritoneal dialysis solutions with hyaluronan may improve peritoneal transport and fluid removal while helping to reduce peritoneal inflammation caused by the dialysis procedure.