Experimental Study Of Ultrafiltration And Biocompatibility In Low/Free Sugar Peritoneal Dialysate

Background Continuous ambulatory peritoneal dialysis Continuous ambulatory peritoneal dialysis (CAPD) replacement therapy is one of the main alternatives for patients with end stage renal disease (ESRD). The glucose degradation products (GDPs) and bio-incompatibility of Conventional glucose peritoneal dialysis fluid caused the structural and functional changes of peritoneal which eventually lead to peritoneal fibrosis (PF) and ultrafiltration failure (UFF). Thus, low sugar or sugar-free peritoneal dialysis fluid comes to be one of the world's hot spots in kidney research.Chapter one The preparation of peritoneal dialysis solution with low sugar or sugar-freeObjective The preparation of the low-sugar or sugar-free peritoneal dialysis solutionMaterials and Methods1) The preparation of peritoneal dialysis fluid:we used distilled water, ketones calcium, sodium chloride, magnesium chloride as the electrolyte, sodium lactate as buffer, different combinations of glucose powder, amino acid powder, salvia powder, A powder composition for the penetrant, and prepared seven kinds of low sugar or sugar-free peritoneal dialysis fluid according to the principle of glucose peritoneal dialysis fluid formulations, including①0.1% salvia+1.0% GS+0.5% A solution (groupⅠ);②0.1% Salvia+1.1% AA+0.5% A solution (groupⅡ);③1.0% GS+0.1% GS (groupⅢ);④1.1% AA+0.1% salvia (groupⅣ);⑤0.5% A solution (groupⅤ);⑥0.1% salvia (groupⅥ);⑦ketone calcium dialysate group.2) Test and adjust the PH value of low sugar or sugar-free peritoneal dialysis fluid, saline,2.5% glucose peritoneal dialysis solution and 7.5% icodextrin peritoneal dialysis by PH meter.3) Measurement the osmolality of low sugar or sugar-free peritoneal dialysis solution, normal saline,2.5 glucose peritoneal dialysis solution, 7.5% icodextrin peritoneal dialysis solution by freezing osmotic pressure apparatus.4) Sterilized the low sugar or sugar-free peritoneal dialysis solution with high pressure and temperature cooker.Results1. The physical properties of dialysis solutions:groupⅠ,Ⅲ,Ⅳdialysate solution were brighter yellow-brown, groupⅡand group IVwere brownish black, while groupⅤand ketone calcium dialysate group were pale yellow.2. The PH value:the value of groupⅠtoⅥand ketone calcium dialysate group were 6.3,7.3,6.3,7.3,6.3,6.3,6.3, respectively, compared with 7.0 of saline group,5.2 of 2.5%GS and 5.8 of 7.5% icodextrin peritoneal dialysis solution.3. Osmotic pressure:the osmolality of groupⅠtoⅥand ketone calcium dialysate group were 340-350,375-385,326-330,360-365, 278-284,270-276,260-266, (mosm/kgH2O) respectively, compared with 280-284 of saline group,390-396 of 2.5%GS and 280-285of 7.5% icodextrin peritoneal dialysis solution.ConclusionThe seven kinds of low sugar or sugar-free peritoneal dialysis fluid meet the requirements and go to the next experiment, according to the principle that the osmotic pressure should between the scope of 275-520mOsm/(kg·H2O) and the PH value were varied at 5.0-7.4.Chapter two The ultrafiltration of low sugar or sugar-free peritoneal dialysis fluidObjective To observe the ultrafiltration of low sugar or sugar-free peritoneal dialysis fluid.Methods 180 female mouce were randomly divided into 10 groups, including four control groups of saline, ketone calcium,2.5% GS, 7.5% icodextrin peritoneal dialysis solution respectively, and six experimental groups with 0.1% sal via +1.0% GS +0.5% A solution (groupⅠ); 0.1% salvia +1.1% AA+0.5% A solution (groupⅡ); 1.0% GS+0.1% salvia (groupⅢ); 1.1% AA +0.1% salvia (groupⅣ); 0.5% A solution (groupⅤ) and 0.1% salvia (groupⅥ). We killed and measured the ultrafiltration of each group of 6 mouce after peritoneal injection of 3ml peritoneal dialysis mentioned above for 2h,4h,6h respectively.Results1) Comparision of low sugar or sugar-free peritoneal dialysis fluid ultrafiltration after 2h treatment:compared with 2.5% GS and 7.5% Icod peritoneal dialysate control groups, the ultrafiltration of groupⅠand groupⅡwere significantly increased (P<0.01), while groupⅢ,Ⅳ,Ⅴwere significantly reduced (P<0.01); However, compared with ketone dialysate calcium group, the ultrafiltration of groupⅥwas increased significantly (P<0.01).2) Comparision of low sugar or sugar-free peritoneal dialysis fluid ultrafiltration after 4h treatment:compared with 2.5% GS peritoneal dialysate control groups, the ultrafiltration of groupⅠand groupⅡwere no significant difference (P> 0.05), and significantly reduced when compared with 7.5% Icod peritoneal dialysate control group (P<0.01); But there were no statistical difference between groupⅢ,Ⅳ,Ⅴand control groups (P> 0.05).3) Comparision of low sugar or sugar-free peritoneal dialysis fluid ultrafiltration after 6h treatment:compared with 2.5% GS control groups, the ultrafiltration of groupⅠand groupⅡwere significantly increased (P <0.01), and have no statistical difference compared with 7.5%Icod peritoneal dialysate control group (P> 0.05).Conclusion1) The groupⅠandⅡdialysate dialysis solution had a long-time ultrafiltration properties.2) The ultrafiltration of peritoneal dialysis solution was increased after adding into salvia.3) The groupⅤhad a certain degree of dialysis ultrafiltration.Chapter three The biocompatibility of low sugar or sugar free peritoneal dialysis solutionObjective To observe the biocompatibility of low sugar or sugar free peritoneal dialysis solution.Methods 120 female mouce were randomly divided into 10 groups, including four control groups of saline, ketone calcium,2.5% GS, 7.5% icodextrin peritoneal dialysis solution respectively, and six experimental groups with 0.1% salvia +1.0% GS +0.5% A solution (groupⅠ); 0.1% salvia +1.1% AA +0.5% A solution (groupⅡ); 1.0% GS+0.1% salvia (groupⅢ); 1.1% AA+0.1% salvia (groupⅣ); 0.5% A solution (groupⅤ) and 0.1% salvia (groupⅥ). We killed and measured the number of white blood cells, neutrophils, and TNF-a level in peritoneal dialysis effluent of each group of 6 mouce after peritoneal injection of 3ml peritoneal dialysis mentioned above for 2h,4h,6h respectively.Results1) Comparision of the number of white blood cells and neutrophils in peritoneal dialysis effluent after 2h treatment:compared with 2.5% GS and 7.5% Icod peritoneal dialysate control groups, the WBC number of groupⅠand groupⅡwere significantly decreased (P<0.01), However, compared with ketone calcium dialysate group, the WBC number of groupⅥwas significantly reduced (P<0.01).2) Comparision of the number of white blood cells and neutrophils in peritoneal dialysis effluent after 4h treatment:compared with 2.5% GS control groups, the WBC number of groupⅠand groupⅡhad no statistical difference (P> 0.05), and significantly increased when compared with 7.5% Icod peritoneal dialysate control group (P<0.01).3) Comparision of TNF-a level in peritoneal dialysis effluent after 2h treatment:there were no statistical difference between groupⅠ,Ⅲ, 2.5% GS, and 7.5% Icod control groups (P> 0.05); However, compared with groupⅣ,2.5% GS and 7.5% Icod control groups, the TNF-a level of groupⅡwas significantly reduced (P<0.01), and groupⅤwas significantly reduced compared with 2.5% GS, and 7.5% Icod control groups (P<0.01).4) Comparision of TNF-a level in peritoneal dialysis effluent after 4h treatment:there were no statistical difference between groupⅠ,Ⅲ, 2.5% GS and 7.5% Icod control groups (P> 0.05); However, compared with groupⅣ,Ⅴ,2.5% GS and 7.5% Icod control groups, the TNF-a level of groupⅡwas significantly reduced (P<0.01), and group V was significantly reduced compared with 2.5% GS, and 7.5% Icod control groups (P<0.01).Conclusion1. Compared with 2.5% GS and 7.5% Icodextrin dialysate control groups, the WBC count of groupⅠand groupⅡwas significantly reduced after 2h treatment.2. The added sal via may reduce the white blood cells into the peritoneal dialysate after 2h intervention.3. The TNF-a level were no significant difference between group I and 2.5% glucose dialysis solution.4. Compared with 2.5% glucose contrl group, the TNF-a level of groupⅡ,Ⅴwere significantly reduced which suggested a better biocompatibility...