Initiating CAPD with a regimen low in glucose and glucose degradation products, with icodextrin and amino acids (NEPP) is safe and efficacious.
BACKGROUND
The high Levels of glucose, glucose degradation products (GDPs), and lactate buffer present in standard peritoneal dialysis (PD) solutions contribute to peritoneal damage, malnutrition, and dyslipidemia. Therefore, we studied the feasibility of a PD regimen as low as possible in glucose and GDPs.


METHODS
In a prospective 30-week study, patients new to continuous ambulatory PD (CAPD) were randomized to either a standard PD regimen (SPD; 4 dwells glucose-/lactate-based) or a low glucose-GDP regimen (NEPP; 1 dwell amino acids, 1 dwell icodextrin, and two dwells bicarbonate/lactate-buffered glucose-based solution).


RESULTS
Results obtained during a 30-week study period for 63 new CAPD patients (30 NEPP, 33 SPD) were analyzed. Intraperitoneal glucose load was lower in the NEPP group (111 +/- 76 vs 159 +/- 40 g/day at 30 weeks, p < 0.001). Dialysis efficacy, ultrafiltration, weight, blood pressure, and laboratory results were similar in the groups, whereas, in the NEPP group, cancer antigen 125 in dialysate effluents decreased less but dialysate-to-plasma ratios were slightly higher.


CONCLUSIONS
Short-term treatment of new CAPD patients with a PD regimen low in glucose and GDPs is feasible. Dialysis efficacy, ultrafiltration, and metabolic consequences are similar to those during a standard glucose-lactate-based regimen, whereas peritoneal transport seems slightly higher and preservation of mesothelial cell mass better during NEPP.
le Poole
Caatje Y
CY
Department of Internal Medicine, Red Cross Hospital, The Hague.
Welten
Angelique G A
AG
Weijmer
Marcel C
MC
Valentijn
Rob M
RM
van Ittersum
Frans J
FJ
ter Wee
Piet M
PM
D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000008:administration & dosage; D005240:Feasibility Studies; D005260:Female; D005936:Glucans / Q000008:administration & dosage; D005947:Glucose / Q000008:administration & dosage; D017127:Glycation End Products, Advanced / Q000008:administration & dosage; D006801:Humans; D000077607:Icodextrin; D007263:Infusions, Parenteral; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D010537:Peritoneum / Q000187:drug effects; D011446:Prospective Studies; D016896:Treatment Outcome
D000596:Amino Acids; D005936:Glucans; D017127:Glycation End Products, Advanced; D000077607:Icodextrin; D005947:Glucose