In 2018, the Global Leadership Initiative on Malnutrition (GLIM) experts accepted screening for malnutrition with any validated tool. In gerontological dietetics, Mini Nutritional Assessment-Short Form (MNA-SF) remains the most frequently used one. We evaluated the diagnostic performance of MNA-SF against the GLIM criteria in a representative group of older adults (PolSenior2 study population). The complete dataset was available for 5614 participants. We compared two groups of respondents: fulfilling GLIM criteria (GLIM malnutrition, positive screening) and GLIM malnutrition, screening negative. At least one phenotypic and one etiological GLIM criterion was diagnosed in 1136 (20.2%) study participants, including 789 with positive screening results. Therefore, malnutrition would have been undiagnosed in one-third of the malnourished group (30.5% of the group was diagnosed based on the GLIM criterion). In comparison with participants with GLIM malnutrition, screening positive, those with GLIM malnutrition, screening negative were younger and more often had an acute or chronic inflammatory disease. They were less likely to report unintentional weight loss and reduced food intake, and they had higher body weight and BMI. The sensitivity of the MNA-SF in diagnosing malnutrition was estimated at 69.5%. Based on our findings, using a high clinical malnutrition risk profile as an alternative to screening tools for malnutrition in the GLIM diagnostic algorithm could be beneficial.

INTRODUCTION:Older individuals are at risk of malnutrition resulting from chronic diseases-related body and muscle mass reduction. In turn, nutritional deficiencies may enhance catabolic processes, leading to accelerated aging and comorbidity, thus creating a vicious cycle. Our study aimed to assess the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to determine the health correlates of malnutrition in a representative sample of community-dwelling older adults. METHODS:We used the GLIM criteria to diagnose malnutrition in 5,614 participants of the PolSenior2 study. The PolSenior2 study was a population-based survey designed to assess the medical, psychological, social, and economic characteristics of community-dwelling older adults. RESULTS:Malnutrition was diagnosed in 13.4% of the participants using the GLIM criteria. Results of multiple logistic regression showed that the risk of depression [OR 4.18, p<0.001], peptic ulcer disease [OR 2.73, p<0.001], past stroke [OR 1.71, p<0.001], cognitive impairment [OR 1.34, p = 0.015], and chronic pain [OR 1.23, p = 0.046] were independent correlates of malnutrition. CONCLUSION:Due to the high risk of malnutrition, special attention should be paid to individuals in late old age. Suspected malnutrition should also be considered in people at risk of depression, with peptic ulcer disease, past stroke, and cognitive impairment. Chronic pain should also prompt the diagnosis for malnutrition.

Polypharmacy and inappropriate prescribing are critical challenges in geriatric medicine, leading to adverse drug reactions, hospitalizations, and increased healthcare costs. The updated STOPP/START version 3 criteria provide an expanded tool for identifying potentially inappropriate medications (PIMs) and potentially prescribing omissions (PPOs) in older adults. This study aimed to evaluate the prevalence of PIMs and PPOs in a cohort of partially dependent older patients and identify factors associated with prescribing inappropriateness. A retrospective, cross-sectional study was conducted in two day-care centres in Poland. The study included 296 patients with polypharmacy (≥5 medications) and partial dependency. PIMs and PPOs were identified using STOPP/START version 3, and data were analyzed for factors influencing the prevalence of inappropriate prescribing. STOPP version 3 identified 543 PIMs in 73.6% of participants, with the most frequent related to analgesics as well as acetylsalicylic acid in cardiovascular indications. START version 3 detected 517 PPOs in 78.7% of patients, with cardiovascular treatments and laxatives being the most commonly omitted. Factors influencing PIMs prevalence included the number of received medications, the diagnosis of depression, and recurrent falls in the previous year. PPOs prevalence was significantly associated with multimorbidity, a high number of received medications, the diagnosis of heart failure, coronary artery disease, benign prostate hyperplasia and depression. Our study highlights the importance of using tools for optimizing pharmacotherapy due to the high prevalence of both PIMs and PPOs. Many frequent inappropriate prescribing regard relatively new medications and refer to recent updates in evidence-based medicine.

Background: Multimorbidity, polypharmacy, and inappropriate prescribing are significant challenges in the geriatric population. Tools such as the Beers List, FORTA, and STOPP/START criteria have been developed to identify potentially inappropriate prescribing (PIP). STOPP/START criteria detect both potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). The latest, third version of STOPP/START criteria expands the tool, based on the growing literature. The study aimed to evaluate the prevalence of PIP and the number of PIP per person identified by STOPP/START version 3 and to compare it to the previous version. Methods: This retrospective, cross-sectional study enrolled one hundred geriatric patients with polypharmacy from two day-care centers for partially dependent people in Poland. Collected data included demographic and medical data. STOPP/START version 3 was used to identify potentially inappropriate prescribing, whereas the previous version served as a reference. Results: STOPP version 3 detected at least one PIM in 73% of the study group, a significantly higher result than that for version 2 (56%). STOPP version 3 identified more PIMs per person than the previous version. Similarly, START version 3 had a significantly higher prevalence of PPOs (74% vs. 57%) and a higher number of PPOs per person than the previous version. The newly formed STOPP criteria with high prevalence were those regarding NSAIDs, including aspirin in cardiovascular indications. Frequent PPOs regarding newly formed START criteria were the lack of osmotic laxatives for chronic constipation, the lack of mineralocorticoid receptor antagonists, and SGLT-2 inhibitors in heart failure. Conclusions: This study showed the high effectiveness of the STOPP/START version 3 criteria in identifying potentially inappropriate prescribing, with a higher detection rate than version 2.

PurposeChanges in nutritional status are important extrapulmonary manifestations of the chronic obstructive pulmonary disease (COPD). The study aimed to assess the prevalence of different body composition phenotypes in older patients with COPD and to investigate the relationship between these phenotypes and the severity of the disease, as well as physical performance of the subjects.Patients and methodsThe study included 124 subjects aged ≥60 with COPD. In all of them body composition analysis and muscle strength measurement were performed. Additionally, data from patients’ medical records were analyzed. Study sample was divided into four groups based on the phenotypic body composition: normal phenotype (N), sarcopenia, obesity and sarcopenic obesity (SO).ResultsIncidence of sarcopenia was significantly higher in patients with severe or very severe COPD based on GOLD in comparison with subjects with mild or moderate obstruction (p = 0.043). Participants with sarcopenia, obesity and SO had lower results of the 6-min walk test than subjects with N (225.77 m, 275.33 m, 350.67 m, 403.56 m, respectively). Moreover, sarcopenia and SO had lower results than obesity (p = 0.001, p = 0.041, respectively).ConclusionSarcopenia is common in patients with advanced COPD. Sarcopenia and SO are associated with poorer physical performance. All older people with COPD should routinely have their body composition assessed, instead of simply measuring of body weight or body mass index (BMI).

Vitamin B12, folate, iron deficiency (IDA), chronic kidney disease (CKD), and anemia of inflammation (AI) are among the main causes of anemia in the elderly. WHO criteria of nutritional deficiencies neglect aging-related changes in absorption, metabolism, and utilization of nutrients. Age-specific criteria for the diagnosis of functional nutritional deficiency related to anemia are necessary. We examined the nationally representative sample of Polish seniors. Complete blood count, serum iron, ferritin, vitamin B12, folate, and renal parameters were assessed in 3452 (1632 women, 1820 men) participants aged above 64. Cut-off points for nutritional deficiencies were determined based on the WHO criteria (method-A), lower 2.5 percentile of the studied population (method-B), and receiver operating characteristic (ROC) analysis (method-C). Method-A leads to an overestimation of the prevalence of vitamin B12 and folate deficiency, while method-B to their underestimation with over 50% of unexplained anemia. Based on method-C, anemia was classified as nutritional in 55.9%. In 22.3% of cases, reasons for anemia remained unexplained, the other 21.8% were related to CKD or AI. Mild cases were less common in IDA, and more common in non-deficiency anemia. Serum folate had an insignificant impact on anemia. It is necessary to adopt the age-specific criteria for nutrient deficiency in an old population.

A simple, short, cheap, and reasonably sensitive and specific screening tool assessing both nutritional and non-nutritional risk factors for sarcopenia is needed. Potentially, such a tool may be the Mini Sarcopenia Risk Assessment (MSRA) Questionnaire, which is available in a seven-item (MSRA-7) and five-item (MSRA-5) version. The study’s aim was Polish translation and validation of both MSRA versions in 160 volunteers aged ≥60 years. MSRA was validated against the six sets of international diagnostic criteria for sarcopenia used as the reference standards. PL-MSRA-7 and PL-MSRA-5 both had high sensitivity (≥84.9%), regardless of the reference standard. The PL-MSRA-5 had better specificity (44.7–47.2%) than the PL-MSRA-7 (33.1–34.7%). Both questionnaires had similarly low positive predictive value (PL-MSRA-5: 17.9–29.5%; PL-MSRA-7: 14.4–25.2%). The negative predictive value was generally high for both questionnaires (PL-MSRA-7: 89.8–95.9%; PL-MSRA-5: 92.3–98.5%). PL-MSRA-5 had higher accuracy than the PL-MSRA-7 (50.0–55% vs. 39.4–45%, respectively). Based on the results, the Mini Sarcopenia Risk Assessment questionnaire was successfully adopted to the Polish language and validated in community-dwelling older adults from Poland. When compared with PL-MSRA-7, PL-MSRA-5 is a better tool for sarcopenia risk assessment.

Introduction SARC-F is a quick questionnaire recommended as a screening tool for sarcopenia. The aim of the study was to translate, adapt, and validate the Polish version of the SARC-F for community-dwelling older adults in Poland. Materials and methods We included 160 Polish volunteers aged ≥ 60 years (44% of men). The Polish version of SARC-F was adapted following standardized forward-backward translation procedure. SARC-F was validated against the six sets of diagnostic criteria as the reference standards [developed independently by European Working Group on Sarcopenia in Older People1 (EWGSOP1), European Working Group on Sarcopenia in Older People2 (EWGSOP2), Foundation for the National Institutes of Health (FNIH) Sarcopenia Project, Asia Working Group for Sarcopenia (AWGS), the International Working Group for Sarcopenia (IWGS), and Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD)]. Results SARC-F score ≥ 4 points was observed in 18.8% of the study population. Cronbach’s alpha was 0.70. The sensitivity of SARC-F varied from 33.3% to 50.0% depending on the diagnostics criteria used, while the specificity was about 85%. Positive predictive value (PPV) was low (about 30%) for five out of six sets of the diagnostic criteria used (EWGSOP2, IWGS, AWGS, FNIH, and SCWD), while the negative predictive value (NPV) was generally high (>88%). The area under the ROC curves (AUC) was 0.652–0.728. SARC-F had the largest AUC against FNIH criteria (0.728), indicating a moderate diagnostic accuracy. Similar results were found for EWGSOP2 and IWGS criteria. The AUC values were below 0.7 for AWGS, SCWD, and EWGSOP1 criteria. Conclusion Based on the results, the Polish version of SARC-F shows excellent reliability and good internal consistency. High specificity and high NPV make SARC-F a useful tool to rule-out sarcopenia with high accuracy in community-dwelling older adults, independently of the diagnostic criteria used.

Anemia is an independent risk factor for functional decline and mortality among older adults. Since mild anemia in older people is often under-diagnosed and ignored, its prevalence needs precise determination and recognition of predisposing factors. None of the previous studies based on the data obtained from the representative elderly population identified the influence of socio-economic factors on the prevalence of anemia. PolSenior was a cross-sectional population-based study performed on the nationally representative sample of Polish seniors. Complete blood count was assessed in 4003 respondents aged 65 years or above (1910 women) divided into six five-year cohorts and a reference group of 622 people aged 55 - 59 years (333 women). Anemia was defined based on the WHO criteria: Hb < 12.0 g/dL in women and Hb < 13.0 g/dL in men. The following socio-economic factors were evaluated through the multiple logistic regression analysis: education level, marital status, place of residence, living arrangements and self-reported poverty. The prevalence of anemia in older persons standardized for the population was 10.8% (17.4% of the study group) and was more frequent in men than in women (20.8% versus 13.6%). The frequency of anemia progressed with age from 5.3% in the youngest to 37.7% in the oldest cohort, and the progression was higher in men. The multiple logistic regression analysis revealed the link between anemia and age in both genders, as well as unmarried status and urban dwelling in men. When age was not taken into account, logistic regression showed the link between anemia and unmarried status, urban place of residence (both genders), and low level of education (women only). Among seniors, those poorly educated, unmarried and city inhabitants require intense screening for anemia.

Introduction: In patients with dementia, observational scales are recommended for use in the assessment of pain. Unfortunately, their application is rare, and as a consequence pain is frequently underdiagnosed and undertreated in these types of subjects. Thus, the aim of the study was to assess analgesic treatment in nursing home residents with cognitive impairment and to delineate the relationship between pain and behavioral and psychological symptoms of dementia. Patients and methods: The research was conducted in 2 nursing home facilities in Wielko-polska, Poland. The analyzed group consisted of 96 residents (78 female) with moderate and severe cognitive impairment in whom pain was assessed with the Abbey Pain Scale (APS) and agitation with the Cohen-Mansfield Agitation Inventory (CMAI). Thereafter, medical files related to drug prescriptions were analyzed. Results: Analgesics were consumed by 33 individuals (34%); 24 (25%) received regular pain treatment and 7 individuals (7%) - as when needed pain treatment. A relationship was found between the APS and CMAI (r=0.45, p<0.0001). Subjects with a higher CMAI received sedative drugs more frequently (p,p<0.001), and despite having a higher APS (p=0.001), this did not correlate with higher analgesia. Conclusion: Our study suggests that pain can be an important underlying cause of behavioral disturbances in older subjects with dementia. In order to reduce their frequency and to avoid excessive usage of sedatives, proper pain assessment and management are essential.

INTRODUCTION AND OBJECTIVE:A decreased concentration of iron, and consecutively haemoglobin, ferritin and decreased level of saturated transferrin, were observed in obese individuals more often than in healthy subjects. The purpose of this study was to determine whether iron, ferritin, transferrin saturation are significantly diminished in obese female patients compared to non-obese counterparts, and whether excess adiposity and inflammation were associated with depleted iron.MATERIAL AND METHODS:Female patients (n=48) diagnosed with obesity (BMI > 30 kg/m2), aged 18-40 were accepted for the study. A control group (n=30) encompassed normal weight women, aged 18-30. All obese women obtained an individually adjusted dietary plan with an energy content of 1,500 kcal. Blood glucose, insulin, lipids, ferritin, TIBC and iron concentrations were assayed in serum twice, initially and after 8 weeks of dieting.RESULTS:The obese women at the initial evaluation, in comparison to non-obese control women, were characterized by a significantly lower mean red blood cell volume (MCV; 84.2±12.4 vs. 91.3±9.3 fL; p<0.0001), serum iron level (92.6±42.4 vs. 119.8±44.0 μg/dL; p<0.01), and transferrin saturation (TSAT; 25.9±12.7 vs. 38.8±15.7%; p<0.01), but by higher plasma level of the C-reactive protein (CRP; 7.0±6.7 vs. 1.2±1.3 mg/L; p<0.01). The obese women after 8 weeks of diet decreased their mean total body weight from 104.1±21.3 to 99.2±20.7 kg (p<0.0001). CRP level decreased slightly but significantly from 6.9±7.1 to 6.2±7.5 (p<0.05).CONCLUSIONS:Obese women exhibit an increased level of CRP which may affect iron homeostasis. Weight loss leads to decrease in the CRP level, but it does not change haematologic parameters in the period of 8 weeks.

Previous studies have shown that life-long caloric restriction in rats protects the kidneys from age-dependent injury. In this study, we analyzed whether late-life-introduced caloric restriction has a similar effect. The study lasted 12 months. Three groups of animals were analyzed: rats fed "ad libitum" (AD, n = 9), rats on 60% caloric restriction (CR, n = 9), and rats fed "ad libitum" for the first six months of their life then switched to 60% caloric restriction thereafter (LCR, n = 9). At the end of the study kidney function was assessed and kidney samples were analyzed histologically. Serum creatinine and urine albumin were higher in AD than in both CR and LCR (P < 0.001). Creatinine clearance (Cl-cr) corrected for body weight was lowest in AD and comparable in CR and LCR. Similarly Cl-cr corrected for kidney weight was lower in AD than in both CR and LCR (P < 0.05). Severe albuminuria was observed only in AD. In CR and LCR the amount of albumin excreted was comparable (AD vs. CR, P < 0.0001; AD vs. LCR, P < 0.001). In morphometric analysis, the mean size of the glomeruli was higher in AD than in both CR and LCR (P < 0.01). Similar results were found for the mesangial area (AD vs. CR, P < 0.001; AD vs. LCR, P < 0.01) and for mesangial cell counts (AD vs. CR, P < 0.001; AD vs. LCR, P < 0.05). No difference was found between CR and LCR in morphometry. In conclusion, our study indicates that late-life introduction of caloric restriction reverses most of the structural and functional changes observed in the kidneys of "ad libitum"-fed rats.

Background: Peritoneal dialysis (PD) solutions contribute to peritoneal membrane damage. We investigated how conventional and biocompatible PD solutions with different glucose concentrations affect morphological and functional signs of peritoneal fibrosis as well as the TGF-β1/Smad signaling pathway in a chronic PD rat model. Methods: Non-uremic male Wistar rats (n = 28) were dialyzed thrice daily for 28 days with 20 ml of a conventional solution (Dianeal® 1.36%, D1, or 3.86%, D3) or a biocompatible solution (Physioneal® 1.36%, P1, or 3.86%, P3). A peritoneal equilibration test was performed. Six rats without dialysis served as controls. Results: The use of conventional solutions, particularly D3, resulted in expansion of the submesothelial compact zone, loss of mesothelial cell layer integrity, hypercellularity, accumulation of collagen I, increased vessel numbers and increased TGF-β1/Smad expression, but this did not significantly change fluid and solute peritoneal transport characteristics. In comparison with D1 and D3, the use of P1 and P3 was associated with less TGF-β1/Smad expression and less expansion of the submesothelial cell layer. Conclusions: Our findings indicate that biocompatible solutions with less glucose may decrease the rate of peritoneal fibrosis. The TGF-β1/Smad pathway is stimulated by PD solutions, representing a plausible pathophysiological mechanism.

Background: To evaluate if peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists have a potential protective effect on the peritoneum changes induced by bioincompatible peritoneal dialysis (PD) solution in vivo. Methods: Male Wistar rats were dialyzed three times daily for 28 days with 1.36% Dianeal® (two groups: with (D+R) or without (D) rosiglitazone) or 1.36% Physioneal® (two groups: with (P+R) or without (P) rosiglitazone). Peritoneal transport of fluid and small solutes was assessed. Nine rats that did not receive dialysis served as controls. Results: Significant morphological changes were found in the D group compared with controls. Additional use of rosiglitazone in the D+R group resulted in less morphological changes and expression of collagen I as well as an increased drainage volume. The expression of VEGF was inhibited by rosiglitazone while no apparent effect was found regarding TGF/Smad pathway. Conclusions: The addition of rosiglitazone to standard dialysis fluids can maintain the peritoneal morphology and increase ultrafiltration in a PD rat model.

We examined the effect of L-2-oxothiazolidine-4-carboxylate (OTZ) on peritoneal morphology and function of mesothelial cells in rats during peritoneal dialysis (PD). We implanted intraperitoneal catheters into 14 rats and injected the rats twice daily for 4 weeks with standard PD fluid (group C, control; n = 7) or PD fluid supplemented with OTZ 1 mmol/L (group OTZ; n = 7). At the beginning and the end of the study, we collected samples of 4-hour dwell effluents from every rat under sterile conditions. We used those samples to test, in ex vivo conditions, the effect on primary cultures of rat peritoneal mesothelial cells with regard to synthesis of total protein and collagen in mesothelium. After 4 weeks, the rats were humanely killed, and glutathione peroxidase activity in erythrocytes was measured. Morphologic analysis of the peritoneal membrane was also performed. As compared with group OTZ, group C showed intraperitoneal adhesions that were more severe, a higher density of mesothelial cells, a higher density of peritoneal vessels, similar peritoneal thickness, lower activity of glutathione peroxidase, and greater ability of their dialysate effluent to induce synthesis of total proteins and collagen in cultured mesothelial cells. Relationships between various parameters were analyzed. We conclude that OTZ preserves peritoneal morphology and the function of mesothelial cells during PD.

Peritoneal fibrosis (PF) is one of the most serious causes of technique failure in long-term peritoneal dialysis (PD). Although the mechanisms responsible for the genesis of PF are not well understood, angiotensin II is known to promote fibrosis and inflammation in various tissues and angiotensin converting enzyme inhibitors (ACEIs) have been shown to attenuate those effects. We previously showed that ACEIs have beneficial effects on peritoneal alterations induced by hypertonic (3.86% glucose) PD solutions. In the present study, we investigated the local effects of intraperitoneal (IP) enalapril on peritoneal alterations induced by 3.86% glucose PD solution in rats on chronic PD. One week after peritoneal catheter insertion, 23 non uremic male rats were randomly divided into two groups: group A (n = 11) received 20 mL 3.86% PD solution twice daily, and group B (n = 12) received 20 mL 3.86% PD solution containing 1 mg/L enalapril twice daily. After 4 weeks of such infusions, we measured net ultrafiltration (UF) volume and obtained samples of visceral peritoneum from the liver for thickness measurement. Net UF was significantly higher (6.6 +/- 0.2 mL vs. 5.6 +/- 0.2 mL) and peritoneal thickness was significantly lower (30 +/- 5 microm vs. 52 +/- 0.8 microm) in group B. We conclude that intraperitoneal enalapril (an ACEI) protects the peritoneal membrane from the effects of hypertonic glucose. This protection might be mediated by enalapril's interference with angiotensin though inhibition of cytokine overexpression.

In previous studies, we showed that glucose reduces the morphologic changes in rat peritoneum caused by chronic intraperitoneal administration of 0.9% NaCl solution. In the present study, we set out to determine if the observed results were attributable to hyperosmolarity or to the metabolic effect of the glucose. Intraperitoneal catheters were implanted in 19 rats. The animals were then intraperitoneally exposed twice daily for 30 days to 20 mL 0.9% saline supplemented with either 250 mmol/L glucose (GLU, n = 9) or 250 mmol/L mannitol (MAN, n = 10). Control rats did not undergo catheter implantation or the dialysis procedure (CON, n = 6). At the end of the study, a 1-hour peritoneal equilibration test (PET) using Dianeal 3.86% (Baxter Healthcare SA, Castlebar, Ireland) was performed in every dialyzed rat to analyze peritoneal transport. Afterward, the rats were humanely killed by bleeding, and a semi-quantitative scale was used to evaluate adhesions in the peritoneal cavity. Imprints of the visceral mesothelium and samples of the visceral peritoneum (liver) were then taken and analyzed by light microscopy. The PET results for glucose, urea, creatinine, and total protein were comparable in both experimental groups. We found that intraperitoneal adhesions were more severe in the MAN group (6 rats with adhesions graded > 3) than in the GLU group (only 1 such rat). No difference in peritoneal thickness was observed between the experimental groups (MAN: 54.9 +/- 17.8 microns; GLU: 51.2 +/- 14.5 microns); however, in both experimental groups, the thickness was greater than in the CON group (3.9 +/- 0.6 microns). The density of the peritoneal blood vessels tended to be greater in the MAN group than in the GLU group (0.158 +/- 0.072 vessels/1000 microns 2 vs. 0.085 +/- 0.067 vessels/1000 microns 2, p = 0.0541). No visible blood vessels were evident in the CON group. The density of mesothelial cells was higher in the MAN group than in the GLU group (2456 +/- 333 cells/mm 2 vs. 2090 +/- 322 cells/mm 2, p < 0.05), and, in both experimental groups, the cell density was higher than in the CON group (817 +/- 100 cells/mm 2, p < 0.01). The nucleus: cytoplasm area ratio in mesothelial cells was comparable in the MAN and GLU groups (0.206 +/- 0.039 and 0.176 +/- 0.045), but that ratio was higher in both experimental groups than in the CON group (0.086 +/- 0.010, p < 0.01). We conclude that glucose-induced changes in the peritoneum of rats exposed to chronic peritoneal dialysis depend on both osmotic and metabolic effects.

In the past, we had observed that infusion of normal saline into the peritoneal cavity stimulates an inflammatory response. In the present study, we examined what effect the addition of glucose to normal saline would have on the peritoneal inflammatory response and change in peritoneal morphology. After catheter implantation, rats were infused intraperitoneally (i.p.) for 3 days with Dianeal 1.36% (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.). Dialysate samples were collected on day 3 after a 4-hour dwell. Next, rats were exposed to either NaCl (n = 7) or NaCl with glucose 250 mmol/L (Glu, n = 7) twice daily for 4 weeks. After 2 weeks and 4 weeks of the study, dialysate samples were collected after a 4-hour dwell to analyze the activity of inflammatory reaction. At the end of the experiment, imprints of peritoneal mesothelium were taken. Control animals (C, n = 6) did not undergo catheter implantation or the dialysis procedure. The inflammatory reaction--cell count, cell differentiation, nitric oxide production, protein loss, and monocyte chemoattractant protein-1 (MCP-1) concentration in dialysate expressed as a percentage of the initial value--did not change during the study in rats exposed to NaCl. On the other hand, in Glu-treated animals, the protein concentration was decreased after 4 weeks of the study (74% +/- 23%, p < 0.05), as was MCP-1 (24% +/- 12%, p < 0.05). The nitrites concentration was decreased after 2 weeks (72% +/- 19%; p < 0.05). Intraperitoneal adhesions were found in 6 rats of the NaCl group (86%) and in only 4 rats (57%) of Glu group. In the NaCl rats, a higher density of mesothelial cells was observed (2792 +/- 510 cells/mm2) as compared with Glu rats (2028 +/- 561 cells/mm2; p < 0.05) and with control rats (1629 +/- 422 cells/mm2, p < 0.05). The NaCl group also showed a higher nucleus: cytoplasm surface ratio (0.25 +/- 0.03) as compared with the Glu group (0.18 +/- 0.02, p < 0.01) and with the control group (0.14 +/- 0.01, p < 0.01). Addition of glucose to normal saline suppresses the peritoneal inflammatory response and mesothelial hyperplasia occurring with intraperitoneal infusion of NaCl solution alone.