Lactate-Buffered and Bicarbonate-Buffered Solutions with Less Glucose Degradation Products in a Two-Chamber System

Abstract

During past years, industry has realized several improvements in techniques and materials—for example, with respect to catheter and connection systems—with the goal of reducing the incidence of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Still, peritonitis represents a major problem in peritoneal dialysis (PD) treatment (1). As a contributor to the patient’s therapy, industry is also always searching for alternative, more biocompatible solutions. The restricted biocompatibility of present CAPD solutions—acidic pH; high glucose concentrations, whether directly or indirectly via formation of glucose degradation products (GDPs); hyperosmolality; and nonphysiological high lactate concentrations—may play a role in the limited use of CAPD as renal replacement therapy. Today, about 50% of PD patients are estimated to drop out over a period of five years for various reasons, including peritonitis and loss of ultrafiltration capacity by the peritoneal membrane (2). This statistic strongly suggests a direct relationship between the repeated and long-term exposure of the peritoneal membrane to conventional PD solutions and the potential functional impairment of peritoneal cell populations. Therefore, to ensure membrane longevity, the protection of the peritoneal membrane is a matter of concern.