Another reason to restrict the use of a hypertonic, glucose-based peritoneal dialysis fluid: its impact on peritoneal macrophage function in vivo.

Previous in vitro studies have revealed that the currently used peritoneal dialysis fluids (PDFs) inhibit several functions of phagocytic cells. Glucose-mediated hypertonicity was demonstrated to be one of the major detrimental factors. To investigate the clinical relevance of these in vitro findings, we compared the in vivo effect of a PDF with 3.86% glucose (D386) and a PDF containing 1.36% of glucose (D136) on peritoneal macrophage (PMO) function in eight CCPD patients. In a randomized cross-over setting, each patient used exclusively D136 or D386 on day one. The next day the patients who used D136 were switched to D386 and vice versa. PMO were isolated from the effluents and studied for their phagocytic capacity and chemiluminescence response. PMOs obtained from D386 effluents were significantly less phagocytic as compared to PMOs obtained after the in vivo use of D136 (38 +/- 7.1 vs 63 +/- 8.3%, p less than 0.02). In addition PMOs exposed to D386 were less able to mount a respiratory burst (peak response 4 +/- 1.0 vs 15 +/- 1.4% of control cells, p less than 0.05). Thus, the in vivo use of D386 was accompanied by significantly decreased PMO functions. These findings further stress the need to search for alternative solutions that do not rely on glucose-mediated hypertonicity for ultrafiltration.