Peritoneal dialysis to treat strokes?

Peritoneal dialysis reduced the concentration of glutamate in a group of experimental rats, suggesting that this intervention may decrease the amount of brain damage caused by ischemic strokes in humans. These study findings were published online Sept. 3 in The Journal of Clinical Investigation.

Researchers in Spain gave rats a permanent middle cerebral artery occlusion (pMCAO) and noted that the plasma concentration of glutamate increased 4.5 and 5.5 hours after ischemia. One day later, they observed a cerebral infarct of 23.3 percent.

Performing peritoneal dialysis 2.5 hours after pMCAO significantly mitigated the glutamate increase caused by ischemia and was also associated with a significant decrease in the size of the infarct, which diminished to 12.1 percent.

In another group of rats whose middle cerebral arteries were exposed but not blocked, there were no changes in plasma glutamate concentrate and no cerebral infarct.

“These data indicate that by decreasing the glutamate concentration in the blood, peritoneal dialysis effectively promotes brain-to-blood glutamate efflux, minimizing the ischemic increase in extracellular glutamate and the resulting tissue damage,” wrote the researchers, led by Maria del Carmen Godino of Universidad Complutense in Madrid, Spain.

To determine whether the rescued tissue was still viable, they performed blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) 14 days after the infarct in the rats who underwent dialysis and the rats who did not. Testing revealed that the tissue was functional.

“Taken together, our results indicate that the functional deficit produced by ischemic insult can be partially prevented by peritoneal dialysis,” they wrote.

Peritoneal dialysis, they argued, offers several advantages over drugs given after a stroke, such as recombinant tissue plasminogen activator (rtPA). Dialysis is quicker, can be used in both thrombotic and hemorrhagic strokes and is a procedure that many health professionals already know how to implement.

“Nonetheless, preclinical work is needed in order to prove that peritoneal dialysis is also effective and safe in aged and/or comorbid animals, reflecting the clinical situation, and clinical trials are required to demonstrate the efficacy of peritoneal dialysis in acute ischemic stroke and other brain pathologies,” the authors concluded.