A randomized clinical trial with a 0.6% amino acid/ 1.4% glycerol peritoneal dialysis solution.
BACKGROUND
Glucose is an accepted osmotic agent for peritoneal dialysis (PD) although it has several drawbacks. Some of these drawbacks have been addressed by the introduction of solutions with low glucose degradation products and physiological pH in dual-chambered bags. Despite this achievement, there is a need for alternative osmotic agents.This randomized clinical trial analyzes 3-month's clinical experience with a mixture of 0.6% amino acids and 1.4% glycerol.


METHODS
The study was performed at the renal units of the University Hospitals Ghent, Belgium, and Utrecht, The Netherlands. Stable PD patients were randomized for either protocol A (test solution, n = 5) or protocol B (control regimen, n = 5). In both protocols, there was a run-in phase of 1 month with a dialysis regimen of 2 x 2 L 2.27% glucose solution (Dianeal; Baxter, Nivelles, Belgium), 1 x 2 L Extraneal (Baxter), and 1 x 2 L glucose solution (Dianeal). After this month-long run-in period, patients in group A received during 3 months 2 x 2 L amino acid/glycerol solution, 1 x 2 L Extraneal, and at least 1 x 2 L of a classic glucose solution.


RESULTS
Glucose absorption decreased in the test group during the test phase (from 84.2 +/- 8.7 to 11.7 +/- 11.6 g/24 hours, p = 0.001). Dialysate levels of cancer antigen 125 (CA125) increased in the test group, from 17.5 +/- 11.0 to 32.4 +/- 4.6 units/L (p = 0.04), whereas, in the control group, the levels remained stable (15.5 +/- 8.7 and 14.9 +/- 9.8 units/L respectively, p = 0.4). There were no differences in serum urea, serum bicarbonate, serum osmolarity, serum albumin, or parameters related to skin-fold thickness or serum glycerol levels between control and test solutions. No differences were observed in obtained ultrafiltration after a 4-hour dwell with 2.27% glucose or the test solution, both measured at week 4 of the run-in period and week 12 of the test period.


CONCLUSIONS
This study demonstrated that the use of a new 0.6% amino acid/1.4% glycerol-containing dialysis solution is safe and well tolerated. Glucose load was reduced significantly and dialysate CA125 levels improved significantly. Ultrafiltration was comparable with that of a 2.27% glucose solution. All these factors, in combination with the potential nutritional benefits, can contribute to a beneficial impact on the success of the PD technique. Further long-term studies in larger patient groups are warranted to explore the potential of this promising new solution.
Van Biesen
Wim
W
Renal Division, University Hospital Ghent, Belgium. wim.vanbiesen@rug.ac.be
Boer
Walter
W
De Greve
Bart
B
Dequidt
Clement
C
Vijt
Denise
D
Faict
Dirk
D
Lameire
Norbert
N
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000494:pharmacology*; D015314:Dialysis Solutions / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005990:Glycerol / Q000494:pharmacology*; D006801:Humans; D007674:Kidney Diseases / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status / Q000187:drug effects; D010531:Peritoneal Dialysis, Continuous Ambulatory; D011446:Prospective Studies; D013997:Time Factors; D014462:Ultrafiltration; D014882:Water-Electrolyte Balance / Q000187:drug effects
D000596:Amino Acids; D015314:Dialysis Solutions; D005990:Glycerol