title: Changing prescribing practice in CAPD patients in Korea: increased utilization of low GDP solutions improves patient outcome.
abstract: BACKGROUND
  Novel, biocompatible peritoneal dialysis (PD) solutions have become available in recent years. In 2001, low glucose degradation products (GDP), neutral pH solutions became commercially available in Korea. To date, there are no reports regarding the large scale adoption of these solutions in clinical practice and regarding what, if any, impact these solutions have on patient outcomes.
  
  
  METHODS
  Using a database of almost 4000 patients treated by PD in Korea, we conducted a prospective, longitudinal observational study documenting the patterns of use of one novel low GDP solution (balance, Fresenius Medical Care, St Wendel, Germany) in 1909 PD incident patients between 1 January 2002 and midyear 2005. Outcomes including patient and technique survival and peritonitis rates were analysed using univariate and multivariate analysis.
  
  
  RESULTS
  Prescription of low GDP solutions reached between 70 and 80% by the year 2003 and persisted at this level. Patients prescribed low GDP PD solution tended to be younger and were more likely to be treated in centres with larger enrollment in the database. Survival of diabetic patients treated with the new PD solution was identical to that of the non-diabetic patients treated with standard PD fluids (PDF) and treatment with low GDP PDF independently reduced the relative risk (RR) of death (RR = 0.613; CI 0.50-0.74; P < 0.00001) in a proportional hazards model which included age, diabetes and centre experience. In a univariate analysis, low GDP PD solution was associated with a longer technique survival (P = 0.049) but this effect was not significant in multivariate analysis. No significant differences in peritonitis-free interval or peritonitis rate could be attributed to the prescribed PDF.
  
  
  CONCLUSIONS
  Prescription of low GDP, pH-neutral PD solutions has rapidly increased in Korea. This change has resulted in a significant improvement in patient and technique survival without any measurable change in peritonitis incidence or rate. Reasons for the improved patient survival cannot be determined from this analysis and require further study.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, CPO Box 8044, Seoul, Korea. hyl@yumc.yonsei.ac.kr
authors.forename: Ho Yung
authors.initials: HY
authors.lastname: Lee
authors.forename: Hoon Young
authors.initials: HY
authors.lastname: Choi
authors.forename: Hyeong Cheon
authors.initials: HC
authors.lastname: Park
authors.forename: Bo Jeung
authors.initials: BJ
authors.lastname: Seo
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Do
authors.forename: Sung Ro
authors.initials: SR
authors.lastname: Yun
authors.forename: Hyun Yong
authors.initials: HY
authors.lastname: Song
authors.forename: Yeong Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
authors.forename: Dae Joong
authors.initials: DJ
authors.lastname: Kim
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Moon Jae
authors.initials: MJ
authors.lastname: Kim
authors.forename: Sug Kyun
authors.initials: SK
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D015314:Dialysis Solutions / Q000737:chemistry* / Q000378:metabolism / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007723:Korea; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015314:Dialysis Solutions; D005947:Glucose