Biocompatibility of neutral bicarbonate-buffered peritoneal dialysis solution

Abstract

In order to facilitate the safe and long-term delivery of peritoneal dialysis, it is necessary to reduce the concentrations of the non-physiological components of peritoneal dialysis fluid and improve the biocompatibility of such fluid. Although lactate-buffered neutral and icodextrin-based peritoneal dialysis fluids, which were developed to address these issues, have been used in recent years, their biocompatibility remains a concern due to their high lactate levels. In 2014, a new dialysis fluid containing a physiological level of bicarbonate and a low concentration of lactate as a buffer (bicarbonate-buffered neutral peritoneal dialysis fluid) was marketed in Japan. Although overseas reports have indicated that exhibits superior biocompatibility, it remains unknown whether this is due to the effects of bicarbonate or lactate because these reports were based on comparisons between bicarbonate-buffered neutral and lactate-buffered acidic peritoneal dialysis fluids. However, an experiment using cultured peritoneal mesothelial cells, which was designed to compare lactate-buffered and bicarbonate-buffered neutral peritoneal dialysis fluids, revealed more marked inhibition of cell damage by the latter fluid than the former fluid. The problem with lactate thus resurfaced. In the future, the clinical usefulness of bicarbonate-buffered neutral peritoneal dialysis fluid needs to be confirmed by monitoring the effects of its use.