Biocompatible peritoneal dialysis solutions: do they indeed affect the outcome?
Numerous studies have confirmed beneficial effects of polyglucose dialysis solution (PG-DS), an amino acid dialysis solution (AA-DS), and bicarbonate (bic) or bicarbonate/lactate (bic/lac) buffered solutions on selected components of peritoneal bioavailability or clinical parameters of peritoneal dialysis (PD) patients. Few adverse effects have also been described. A question arises whether these solutions affect the PD outcome. A better controlled fluid status of PD patients associated with the use of PG-DS has been shown in a double-blind randomized controlled trial. Continuous cyclic PD patients treated with the PG-DS did not show changes in solute kinetics and peritoneal membrane markers remained unaltered. The use of PG-DS in anuric automated PD patients was associated with less impaired membrane function. A prospective, randomized, controlled study on the AA-DS in malnourished continuous ambulatory PD patients did not show significant effects of the AA-DS on patient survival, hospitalization rate, C-reactive protein levels, total urea Kt/V, ultrafiltration and drop-out rates, but nutritional status improved or was stable. Improved acid-base balance with bic-buffered solutions was shown in patients treated with automated PD or continuous PD. A registry-based study suggests better survival of patients treated with a neutral pH, low glucose degradation product solution, but there were no differences in dialysis technique survival, peritonitis-free survival, or peritonitis rates. However, reduced peritonitis rate was also reported with the use of bic/lac solutions. Current concepts of PD solutions involve efforts to use fluids which combine the advantages of PG-DS, AA-DS and bic-buffered solutions. Large-scale studies should be continued to improve biocompatibility of peritoneal solutions and to establish their effect on the clinical outcome.
Department of Nephrology, Transplantology and Internal Diseases, Karol Marcinkowski University of Medical Sciences, Poznań, Poland. alicja_grzegorzewska@yahoo.com
Alicja E
AE
Grzegorzewska
D001639:Bicarbonates; D001682:Biological Availability; D015314:Dialysis Solutions / Q000009:adverse effects / Q000493:pharmacokinetics; D018572:Disease-Free Survival; D005936:Glucans; D006801:Humans; D015994:Incidence; D008422:Materials Testing; D010530:Peritoneal Dialysis / Q000295:instrumentation*; D010537:Peritoneum / Q000378:metabolism; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate
D001639:Bicarbonates; D015314:Dialysis Solutions; D005936:Glucans