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NDT Plus 2008 1(Supplement 4):iv56-iv62; doi:10.1093/ndtplus/sfn126
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

This article appears in the following NDT Plus issue: Dialysis Initiatives May 2007, Berlin, Germany [View the issue table of contents]

Effects of reducing the lactate and glucose content of PD solutions on the peritoneum. Is the future GLAD?

Raymond T. Krediet, Machteld M. Zweers, Roos van Westrhenen, Agnes Zegwaard and Dirk G. Struijk

Division of Nephrology, Department of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Correspondence: Raymond T. Krediet, Room F4-215, Division of Nephrology, Department of Medicine, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Tel: +31-20-5665990; Fax: +31-20-6914904; E-mail: C.N.deboer{at}amc.uva.nl


  Abstract

Background. Long-term peritoneal dialysis (PD) may lead to functional and morphologic changes in the peritoneal membrane, probably because of the continuous exposure to conventional dialysis solutions.

Methods. The morphologic changes include neoangiogenesis and fibrosis. The authors of this article developed a long-term peritoneal exposure model in rats, in which the morphological alterations could be induced after daily peritoneal infusion of a 3.86% glucose/lactate-buffered conventional PD solution.

Results and Conclusions. In the present article, a review of the model and of the results obtained with various available and experimental solutions is given. It appeared that high lactate concentrations contributed to the glucose-induced neoangiogenesis by pseudohypoxia. Glucose degradation products were probably more important in the induction of peritoneal fibrosis. The promising results of a combination of amino acids, glycerol and glucose, each in a low concentration, buffered with either pyruvate or bicarbonate/lactate, are presented and discussed. The combination of glycerol, amino acids and dextrose, dissolved in a bicarbonate/lactate buffer (GLAD), may be an option for a new generation of dialysis fluids.

Key Words: peritoneal dialysis solutions • glucose • glycerol • lactate • pyruvate

Received for publication February 19, 2008. Accepted for publication June 19, 2008.


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KARL D. NOLPH STATE OF THE ART LECTURE: FEASIBLE AND FUTURE OPTIONS FOR SALVATION OF THE PERITONEAL MEMBRANE
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[Abstract] [Full Text] [PDF]


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