The clinical usefulness of peritoneal dialysis fluids with neutral pH and low glucose degradation product concentration: an open randomized prospective trial.
BACKGROUND
Long-term peritoneal dialysis (PD) is associated with the development of various structural and functional changes to the peritoneal membrane when bioincompatible conventional peritoneal dialysis fluids (PDFs) are used. In this study, we looked at patients that were treated with conventional PDFs and then changed to novel biocompatible PDFs with a neutral pH and a low concentration of glucose degradation products (GDPs) to investigate whether this change could result in the arrest or reversal of peritoneal membrane deterioration.


METHODS
In an open label, randomized prospective trial, the clinical effects of conventional PDFs and biocompatible PDFs with neutral pH and very low concentration of GDPs were compared in 104 patients equally divided between both study PDFs. Blood and effluent dialysate samples, peritoneal equilibration tests, and adequacy evaluation were undertaken at baseline, 4, 8, and 12 months. The target variables were the ratio of dialysate-to-plasma (D/P) creatinine, peritoneal ultrafiltration, residual renal function, dialysis adequacy indices, and effluent cancer antigen 125 (CA125).


RESULTS
D/P creatinine values were not different in the two groups. Peritoneal ultrafiltration was significantly higher in the low-GDP PDF group than in the conventional PDF group at all follow-up times (4 months: 9.1 +/- 4.3 vs 6.0 +/- 3.0; 8 months: 8.3 +/- 3.4 vs 6.0 +/- 3.0; 12 months: 8.9 +/- 3.3 vs 6.1 +/- 3.3 mL/g dextrose/day; p < 0.05). Peritoneal Kt/V urea values and total weekly Kt/V urea values at 4 months were significantly higher in the low-GDP PDF group than in the conventional PDF group. Residual renal function was not statistically significant. Effluent CA125 levels were significantly higher in the low-GDP PDF group at all follow-up visits (4 months: 37.8 +/- 20.8 vs 22.0 +/- 9.5; 8 months: 41.2 +/- 20.3 vs 25.9 +/- 11.3; 12 months: 40.4 +/- 21.4 vs 28.6 +/- 13.0 U/mL; p < 0.05). Among anuric patients, peritoneal ultrafiltration at 4, 8, and 12 months, total weekly Kt/V at 4 and 8 months, and CA125 levels at all follow-up visits were significantly higher in patients treated with low-GDP PDF than those treated with conventional PDF. However, among anuric patients, D/P creatinine showed no significant differences between the low-GDP PDF group and the conventional PDF group.


CONCLUSIONS
The use of biocompatible PDFs with neutral pH and low GDP concentration can contribute to improvement of peritoneal ultrafiltration and peritoneal effluent CA125 level, an indicator of peritoneal membrane integrity in PD patients.
Choi
Hoon Young
HY
Division of Nephrology, Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea.
Kim
Dong Ki
DK
Lee
Tae Hee
TH
Moon
Sung Jin
SJ
Han
Seung Hyeok
SH
Lee
Jung Eun
JE
Kim
Beom Seok
BS
Park
Hyeong Cheon
HC
Choi
Kyu Hun
KH
Ha
Sung Kyu
SK
Han
Dae-Suk
DS
Lee
Ho Yung
HY
D001002:Anuria / Q000503:physiopathology; D001672:Biocompatible Materials; D018394:CA-125 Antigen / Q000032:analysis; D003404:Creatinine / Q000032:analysis; D005260:Female; D005947:Glucose / Q000032:analysis*; D015312:Hemodialysis Solutions / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism; D014508:Urea / Q000032:analysis
D001672:Biocompatible Materials; D018394:CA-125 Antigen; D015312:Hemodialysis Solutions; D014508:Urea; D003404:Creatinine; D005947:Glucose