Bicarbonate/lactate-based peritoneal dialysis solution increases cancer antigen 125 and decreases hyaluronic acid levels

Background In a randomized, controlled trial comparing a pH neutral, bicarb onate/lactate (B/L)-buffered PD solution to conventional acidic, lactate-bu ffered solution (C), the overnight dialysate levels of markers of inflammat ion/wound healing [hyaluronic acid (HA)], mesothelial cell mass/membrane in tegrity [cancer antigen 125 (CA125)], and fibrosis [transforming growth fac tor-beta1 (TGF-beta1) and procollagen I peptides (PICP)] were assessed over a six-month treatment period. Methods. One hundred six patients were randomized (2:1) to either the B/L g roup or C group. Overnight effluents were collected at entry into the study (time = 0 all patients on control solution) and then at three and six mont hs after randomization. Aliquots were filtered, stored frozen, and assayed for HA, CA125, TGF-beta1, and PICP. Differences between groups were assesse d by repeated-measures analysis of variance for unbalanced data using the S AS procedure MIXED. Results. In patients treated with B/L, there was a significant (P = 0.03) i ncrease in CA125 after six months compared with time = 0 (19.76 +/- 11.8 vs . 24.4 +/- 13.8 U/mL; mean +/- SD; N = 51). In the same group of patients, HA levels were significantly decreased at both three and six months in the B/L-treated group (time = 0, 336.0 +/- 195.2; time = 3 months, 250.6 +/- 16 7.6; and time = 6 months, 290.5 +/- 224.6 ng/mL; mean +/- SD; P = 0.006, N = 47 and P = 0.003, N = 48, respectively). No significant changes in CA125 or HA levels were observed in the control group. There were no significant changes observed in the levels of PICP or TGF-beta1 in the B/L or C group o ver the six-month treatment period. Conclusions. These results suggest that continuous therapy with the B/L sol utions modulates the levels of putative markers of peritoneal membrane inte grity and inflammation. In the long term, this may positively impact the pe ritoneal membrane, Increasing its life as a dialyzing organ.