Heat Sterilization of Glucose-Containing Fluids for Peritoneal Dialysis: Biological Consequences of Chemical Alterations

Abstract

G lucose solutions used for medical purposes are sterile. Sterilization is commonly performed through the addition of energy , either in the form of radiation or heat. It has been known for many years that such a treatment leads to derangement and breakdown of the glucose molecules (1,2). The degree of degradation, however, depends on several factors other than the mode of sterilization, such as storage time, pH, light, glucose concentration, catalyzing substances, and temperature. Reports in the past have pointed out that glucose degradation products are toxic to different cell species. One of the first reports concerning this was published more than lOO years ago. The paper published in 1887 inAnnales de l'Institute Pasteur by E. Roux demonstrated the killing of spores due to the carbohydrate fraction of a medium exposed to sunlight (3). In 1935 it was demonstrated that 20 different carbohydrate (including glucose) solutions exposed to ultraviolet radiation inhibited the growth of bacteria ( 4). Since then, many other reports have described toxicity for microorganisms (5-7). Later, side effects due to glucose degradation products were observed on plant cells (8) as well as mammalian cells (9). It has also been shown that the degradation products can cause chromosomal breaks in human lymphocytes (10). For many years the interest in glucose degradation has focused mainly on safety in food production, cell culture media, and fluids for intravenous injection. In spite of the fact that a patient on peritoneal dialysis is exposed to around 3000 L of fluid every year, very little attention to date has been paid to glucose degradation products in heatsterilized peritoneal dialysis fluids.