Objectives: Peritonitis remains a principal cause of dropout in peritoneal dialysis (PD). The physiological host response to a peritoneal infection involves a rise in numbers of circulating leukocytes to the peritoneal cavity. We evaluated the effects of (1) conventional peritoneal dialysis fluid (PDF), (2) bicarbonate-based PDF, low in glucose degradation products, and (3) non-glucose PDF on peritoneal leukocyte recruitment in response to an inflammatory stimulus using intravital microscopy. Methods: The visceral peritoneum was exposed to EBSS, conventional lactate-buffered and bicarbonate/lactate-buffered glucose-based PDF and three lactate-buffered non-glucose PDF – icodextrin, amino acid-based PDF and amino acid/glycerol-based PDF. The number of rolling, adhering and extravasated leukocytes and leukocyte rolling velocity was assessed at different time intervals after stimulation with lipopolysaccharide (LPS). Results: Exposure to LPS dissolved in EBSS dramatically increased the number of rolling, adhering and extravasated leukocytes and decreased leukocyte rolling velocity. Conventional PDF completely abolished LPS-induced leukocyte recruitment. Bicarbonate/lactate-buffered PDF only minimally affected the process of leukocyte recruitment, whereas icodextrin PDF resulted in partial inhibition of the immune response. The amino acid-based and the amino acid/glycerol-based PDF inhibited leukocyte recruitment to a similar extent as conventional PDF. Conclusions: Bicarbonate/lactate-buffered PDF has superior biocompatibility towards peritoneal host defense, in spite of its high glucose concentrations. Lactate-buffered non-glucose containing PDF has substantial inhibitory effects on leukocyte recruitment, indicating that the bioincompatibility of high lactate concentrations and/or low pH may not be underestimated.

Mortier S, Lameire NH, De Vriese AS: The effects of peritoneal dialysis solutions on peritoneal host defense. Perit Dial Int 2004;24:123–138.
Jörres A, Jörres D, Gahl GM, Kessel M, Muller C, Kottgen E, Serke S, Schulz E, Mahiout A: Leukotriene B4 and tumor necrosis factor release from leukocytes: effect of peritoneal dialysate. Nephron 1991;58:276–282.
Topley N, Mackenzie R, Petersen MM, Beavis MJ, Williams D, Thomas N, Faict D, Peluso F, Coles GA, Davies M: In vitro testing of a potentially biocompatible continuous ambulatory peritoneal dialysis fluid. Nephrol Dial Transplant 1991;6:574–581.
Liberek T, Topley N, Jorres A, Coles GA, Gahl GM, Williams JD: Peritoneal dialysis fluid inhibition of phagocyte function: effects of osmolality and glucose concentration. J Am Soc Nephrol 1993;3:1508–1515.
Topley N, Kaur D, Petersen MM, Jörres A, Passlick-Deetjen J, Coles GA, Williams JD: Biocompatibility of bicarbonate buffered peritoneal dialysis fluids: influence on mesothelial cell and neutrophil function. Kidney Int 1996;49:1447–1456.
Cendoroglo M, Sundaram S, Jaber BL, Pereira BJ: Effect of glucose concentration, osmolality, and sterilization process of peritoneal dialysis fluids on cytokine production by peripheral blood mononuclear cells and polymorphonuclear cell functions in vitro. Am J Kidney Dis 1998;31:273–282.
Mortier S, De Vriese AS, McLoughlin RM, Topley N, Schaub TP, Passlick-Deetjen J, Lameire NH: Effects of conventional and new peritoneal dialysis fluids on leukocyte recruitment in the rat peritoneal membrane. J Am Soc Nephrol 2003;14:1296–1306.
Duwe AK, Vas SI, Weatherhead JW: Effects of the composition of peritoneal dialysis fluid on chemiluminescence, phagocytosis, and bactericidal activity in vitro. Infect Immun 1981;33:130–135.
De Vriese AS, Verbeuren TJ, Vallez MO, Lameire NH, De Buyzere M, Vanhoutte PM: Off-line analysis of red blood cell velocity in renal arterioles. J Vasc Res 2000;37:26–31.
De Vriese AS, Lameire NH: Intravital microscopy: an integrated evaluation of peritoneal function and structure. Nephrol Dial Transplant 2001;16:657–660.
Mortier S, De Vriese AS, Van de Schaub TP, Passlick-Deetjen J, Lameire NH: Hemodynamic effects of peritoneal dialysis solutions on the rat peritoneal membrane: role of acidity, buffer choice, glucose concentration, and glucose degradation products. J Am Soc Nephrol 2002;13:480–489.
Kubes P, Kerfoot SM: Leukocyte recruitment in the microcirculation: the rolling paradigm revisited. News Physiol Sci 2001;16:76–80.
Brulez HF, ter Wee PM, Snijders SV, Donker AJ, Verbrugh HA: Mononuclear leucocyte function tests in the assessment of the biocompatibility of peritoneal dialysis fluids. J Clin Pathol 1999;52:901–909.
Schambye HT, Pedersen FB, Christensen HK, Berthelsen H, Wang P: The cytotoxicity of continuous ambulatory peritoneal dialysis solutions with different bicarbonate/lactate ratios. Perit Dial Int 1993;13(suppl 2):S116–S118.
Mahiout A, Matata BM, Brunkhorst R: Effect of glucose and pyruvate in acidic and non-acidic peritoneal dialysis fluids on leukocytes cell functions. Kidney Int 1997;51:860–867.
Plum J, Schoenicke G, Grabensee B: Osmotic agents and buffers in peritoneal dialysis solution: monocyte cytokine release and in vitro cytotoxicity. Am J Kidney Dis 1997;30:413–422.
Wieslander AP, Nordin MK, Martinson E, Kjellstrand PT, Boberg UC: Heat-sterilized PD fluids impair growth and inflammatory responses of cultured cell lines and human leukocytes. Clin Nephrol 1993;39:343–348.
Jonasson P, Bagge U, Wieslander A, Braide M: Heat-sterilized PD fluid blocks leukocyte adhesion and increases flow velocity in rat peritoneal venules. Perit Dial Int 1996;16(suppl 1):S137–S140.
Jörres A, Gahl GM, Frei U: Peritoneal dialysis fluid biocompatibility: does it really matter? Kidney Int 1994;48(suppl):S79–S86.
Topley N, Alobaidi HM, Davies M, Coles GA, Williams JD, Lloyd D: The effect of dialysate on peritoneal phagocyte oxidative metabolism. Kidney Int 1988;34:404–411.
Liberek T, Topley N, Jörres A, Petersen MM, Coles GA, Gahl GM, Williams JD: Peritoneal dialysis fluid inhibition of polymorphonuclear leukocyte respiratory burst activation is related to the lowering of intracellular pH. Nephron 1993;65:260–265.
Douvdevani A, Rapoport J, Konforty A, Yulzari R, Moran A, Chaimovitz C: Intracellular acidification mediates the inhibitory effect of peritoneal dialysate on peritoneal macrophages. J Am Soc Nephrol 1995;6:207–213.
Jin HM, Di YD, Xu QJ: Effects of commercial glucose-based peritoneal dialysates on peripheral blood phagocytes apoptosis. Perit Dial Int 1999;19(suppl 2):S388–S393.
Schambye HT: Effect of different buffers on the biocompatibility of CAPD solutions. Perit Dial Int 1996;16(suppl 1):S130–S136.
Passlick-Deetjen J, Jaeckle-Meyer I: Bicarbonate buffers in peritoneal dialysis. Artif Organs 1998;22:17–19.
Tilton RG, Baier LD, Harlow JE, Smith SR, Ostrow E, Williamson JR: Diabetes-induced glomerular dysfunction: links to a more reduced cytosolic ratio of NADH/NAD+. Kidney Int 1992;41:778–788.
Brunkhorst R, Mahiout A: Pyruvate neutralizes peritoneal dialysate cytotoxicity: maintained integrity and proliferation of cultured human mesothelial cells. Kidney Int 1995;48:177–181.
Wong TYH, Phillips AO, Witowski J, Topley N: Glucose-mediated induction of TGF-β1 and MCP-1 in mesothelial cells in vitro is osmolality and polyol pathway dependent. Kidney Int 2003;63:1404–1416.
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