title: A randomized clinical trial with a 0.6% amino acid/ 1.4% glycerol peritoneal dialysis solution.
abstract: 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.
authors.affiliation: Renal Division, University Hospital Ghent, Belgium. wim.vanbiesen@rug.ac.be
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.forename: Walter
authors.initials: W
authors.lastname: Boer
authors.forename: Bart
authors.initials: B
authors.lastname: De Greve
authors.forename: Clement
authors.initials: C
authors.lastname: Dequidt
authors.forename: Denise
authors.initials: D
authors.lastname: Vijt
authors.forename: Dirk
authors.initials: D
authors.lastname: Faict
authors.forename: Norbert
authors.initials: N
authors.lastname: Lameire
mesh_terms: 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
chemical_list: D000596:Amino Acids; D015314:Dialysis Solutions; D005990:Glycerol