Changes in biocompatibility of dialysis fluid during its dwell in the peritoneal cavity

Objective: To evaluate the changes in biocompatibility of peritoneal dialysis solutions during intraperitoneal dwell. Design: We studied the effect of the drained dialysates at time 0 and after 30, 60, 120, 240, and 360 minutes of intraperitoneal dwell on the growth of peritoneal mesothelial cells and fibroblasts and the synthesis of proteins by these cells. On one day the patients were dialyzed with glucose-based Dianeal and on alternate days with an amino acid-containing solution based on Travasol. Patients: Dialysates were collected from 4 patients during continuous ambulatory peritoneal dialysis (CAPD) training. Results: Unused dialysis solutions containing glucose or amino acids inhibit growth of mesothelial cells and fibroblasts. Dialysates obtained after 30 or 60 minutes of intraperitoneal dwell support the growth of these cells in away similar to 10% fetal calf serum, but dialysates drained after a longer dwell of 120-360 minutes had a stronger effect on growth of these cells than did serum. All glucose-based dialysates stimulate the synthesis of collagen in mesothelial cells, whereas they reduce the synthesis of non-collagen proteins. All glucose-based dialysates reduce the synthesis of collagen and non-collagen proteins in fibroblasts compared with the production of these proteins in the presence of serum. Conclusion: Changes in the properties of the dialysis solutions during their intraperitoneal dwells do not seem to increase their biocompatibility. Indeed, excessive mitogenic effect and the stimulation of collagen synthesis of the dialysates may induce pathological changes in the peritoneum.