The mesothelium under the siege of dialysis solutions: old glucose, new glucose, and glucose-free osmotic agents.

Use of one bag of glucose peritoneal dialysis fluid (PDF) results in the development of a dose-related senescent mesothelial cell phenotype not linked to acidic pH or the presence of lactate buffer. This complication derives mostly from oxidative stress induced both by glucose itself and by glucose degradation products (GDPs). New glucose formulations are offered in dual- or three-chambered bags, keeping the glucose at a low pH. The result is a reduced presence but not complete elimination of GDPs. These formulations have the potential to slow injury to the peritoneal membrane. Icodextrin and amino-acid PDFs, used for one exchange daily, have advantages and drawbacks alike. Icodextrin offers excellent ultrafiltration, but on the other hand, mesothelial cells incubated with this osmotic agent show reduced viability and proliferation and DNA damage. These unwanted effects appear to result from a substantial degree of oxidative stress. An amino-acid-based PDF offers a positive nutritional effect; however its ultrafiltration capability is not higher than an equimolar 1.5% glucose solution. Amino-acid solution appears to be more biocompatible than glucose-based fluid. So far glucose PDF offered in a single-compartment bag is not a biocompatible solution for long-term peritoneal dialysis. Icodextrin does not appear to be more biocompatible than glucose. Amino-acid-based solution is less harmful to the mesothelium, but its usefulness is still limited.