Lessons from single cell organisms: insights into the antimicrobial and toxic effects of peritoneal dialysate bases.

Although it was first described over a quarter of a century ago, the mechanisms behind the antimicrobial activity of fresh peritoneal dialysate have been poorly understood. Recent insight into the biochemistry appears to suggest that at least part of the effect resides in the salts of the carboxylic acids. An understanding of the metabolic pathways of both sensitive and resistant organisms has not only led to an understanding of the mechanisms of the antimicrobial effect, but also may have provided the insight for future studies to reduce toxicity to the peritoneal membrane. While our knowledge base in this area is still evolving, an improved understanding of the biochemical basis of both the antibacterial effect and toxicity of the salts of carboxylic acids in peritoneal dialysate can only prove useful.