Inflammation

Objective: PD induces an inflammatory response of the peritoneal membrane (PM), ultimately leading to alterations of the PM. Recently, we showed that the PM reacts immediately on the presence of the Tenckhoff catheter with production of profibrotic and inflammatory markers, which seems to be maintained by the ensuing installation of lactate-buffered (L-) PD fluid (PDF). We hypothesize that biocompatible PDFs that are considered to better preserve the PM and have less systemic effects, induce less inflammation of the PM in the initiation phase of PD. We conducted a study exploring the effect of biocompatible PDF in the first weeks of PD. Methods: 14 consecutive new PD patients (pts) without any history of PD were included. The study started with the 1st flush after implantation of the catheter. During 9 weeks, flushes and effluents were collected for laboratory analysis. Pts were treated with bicarbonate/lactate-buffered PDF (Physioneal®). We compared this group with 12 pts who were treated earlier in a similar study with L-PDF (Dianeal®). Results: Peritoneal response was observed instantly upon instillation of PDF. CA125 was 64.4±60.4 U/mL (mean±SD) immediately after implantation of the catheter and decreased to 16.5±9.6 during the first 6 weeks on PD (p<0.0001). Profibrotic markers, VEGF, and TGFβ-1 increased rapidly during the study respectively 19.9±16.4 to 249.7±112.5 pg/mL (p<0.0001) and 36.8±46.1 to 110.1±121.5 pg/mL (p=0.011). Proinflammatory markers MCP-1 and HA show similar patterns, resp. 9.7±6.6 to 241.6±160.1 pg/mL (p<0.0001) and 109.1±176.6 to 632.1±1193.7 ng/mL (p=0.08). Comparing these results in pts using biocompatible PDF to earlier obtained outcomes in pts using conventional PDF we found no statistically significant differences between the 2 groups. Conclusions: This study confirms our earlier findings that production of profibrotic and inflammatory markers starts immediately after implantation of the Tenckhoff catheter and increases with more continuous installation of L-PDF. Furthermore, during these first weeks of PD, effluent levels of mesothelial cells, profibrotic and inflammatory markers did not differ statistically between biocompatible and conventional PDF.