Cell Function,Viability,and Icodextrin

The bioincompatibility of conventional dialysis fluids is related primarily to the combination of low pH and high lactate concentrations. This results in the reduction of intracellular pH and a consequent inhibition of cell function. The use of high glucose concentrations to increase fluid osmolality adds to the cytotoxicity and has a further inhibitory effect on peritoneal cells.

The clinical need for fluids that provide sustained ultrafiltration has led to a novel approach using a high molecular weight glucose polymer (icodextrin) to generate an ultrafiltration gradient in an iso-osmolar fluid. In the studies presented we have had the opportunity of examining, in the laboratory setting, the biocompatibility of such a fluid.

As in previous studies with conventional fluids, pH per se has a profound effect on most modalities of cell function. In addition, there appearto be a few areas where problems can be ascribed to icodextrin itself. Furthermore, it is possible that Staph. epidermidis survives better in icodextrin than in conventional dialysate. Whether the benefits of sustained ultrafiltration outweigh the possible disadvantages outlined can only be judged when the results from ongoing clinical trials are available.