Effects of the composition of peritoneal dialysis fluid on chemiluminescence, phagocytosis, and bactericidal activity in vitro.

Commercial fluid used for peritoneal lavage in peritonitis and in peritoneal dialysis suppressed the activity of peripheral blood leukocytes as measured by chemiluminescence, phagocytosis, and bacterial killing. Suppression was found to be due to the low pH and high osmolality of the fluid. The pH was adjusted to noninhibitory levels in vivo within 30 min, whereas osmolality changes were less rapid and remained at inhibitory levels for fluids of high dextrose concentration (4.25%). Chemiluminescence was the most sensitive assay for inhibitory effects of pH and osmolality, as well as for urea and heparin. The metabolic waste product urea at levels normally found in dialysate and heparin at concentrations routinely added to fluid inhibited only chemiluminescence, whereas creatinine and added insulin were not inhibitory. High fluid volume also resulted in a decrease in efficiency of bacterial killing. These results suggest some changes to be made in the treatment of peritonitis and in peritoneal dialysis.