Changing prescribing practice in CAPD patients in Korea: increased utilization of low GDP solutions improves patient outcome.
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.
Lee
Ho Yung
HY
Department of Internal Medicine, Yonsei University College of Medicine, CPO Box 8044, Seoul, Korea. hyl@yumc.yonsei.ac.kr
Choi
Hoon Young
HY
Park
Hyeong Cheon
HC
Seo
Bo Jeung
BJ
Do
Jun Young
JY
Yun
Sung Ro
SR
Song
Hyun Yong
HY
Kim
Yeong Hoon
YH
Kim
Yong-Lim
YL
Kim
Dae Joong
DJ
Kim
Yong Soo
YS
Kim
Moon Jae
MJ
Shin
Sug Kyun
SK
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
D015314:Dialysis Solutions; D005947:Glucose