Table 2.

Effects of toxins on membrane integrity (left side of table) and clinical and metabolic drawbacks (right side of table) that may be correlated with the use of lactate-buffered PD solutions

Effects of toxins on membrane integrity	Clinical and metabolic drawbacks
Local release of cytokines and growth factors:	Need of lactate conversion to bicarbonate in the liver
→ inflammatory state
→ fibrogenic processes
→ neo-angiogenesis	Loss of bicarbonate due to its back-diffusion into the dialysate
→ peritoneal fibrosis
Impairment of
→ mesothelial cell integrity	Abdominal pain during the inflow of dialysate
→ peritoneal macrophage function
→ intraperitoneal host defence
→ membrane permeability