Mortality and technique failure in peritoneal dialysis patients using advanced peritoneal dialysis solutions.
BACKGROUND
Despite the theoretical benefits of biocompatible physiological-pH bicarbonate/lactate-buffered (B/L) peritoneal dialysis solution, there is only limited evidence supporting a superior clinical outcome associated with its use.


METHODS
Observational study.


METHODS
2,163 patients starting peritoneal dialysis therapy between July 2003 and December 2006 from 54 centers in Korea were enrolled.


METHODS
B/L solution and icodextrin use.


RESULTS
All-cause mortality and technique failure.


METHODS
Patient outcomes were compared between patients prescribed B/L and conventional solutions by using propensity score and intention-to-treat analyses.


RESULTS
542 patients initiated peritoneal dialysis therapy with B/L solution, and 1,621, with conventional solution. Fifteen patients prescribed B/L solution switched to conventional solution, and 386 of those initially using conventional solution switched to B/L solution during follow-up. Propensity score matching yielded 542 matched pairs of patients. In the matched cohort, there were no significant differences in age, diabetes, cardiovascular comorbidity, socioeconomic status, icodextrin use, or center experience between the 2 groups. All-cause deaths occurred in 52 (9.6%) patients in the B/L-solution group compared with 102 (18.9%) in the conventional-solution group (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.50 to 0.98; P = 0.04). In addition, icodextrin use was significantly associated with a reduced risk of death (HR, 0.40; 95% CI, 0.28 to 0.58; P < 0.001). Thirty-three (6.1%) and 48 (8.9%) technique failures occurred in the B/L- and conventional-solution groups, respectively (HR, 0.91; 95% CI, 0.58 to 1.43; P = 0.7). The survival benefit of B/L solution persisted in the unmatched cohort (HR, 0.69; 95% CI, 0.52 to 0.93; P = 0.02).


CONCLUSIONS
Retrospective analysis, lack of laboratory data, and unknown indications for use of B/L solution.


CONCLUSIONS
Use of a biocompatible B/L peritoneal dialysis solution with physiological pH is associated with improved survival compared with conventional solution. Large randomized clinical trials are warranted to confirm this finding.
Han
Seung Hyeok
SH
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Ahn
Song Vogue
SV
Yun
Jee Young
JY
Tranaeus
Anders
A
Han
Dae-Suk
DS
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005260:Female; D005936:Glucans / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D017127:Glycation End Products, Advanced / Q000378:metabolism; D006801:Humans; D000077607:Icodextrin; D007674:Kidney Diseases / Q000628:therapy; D007723:Korea; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods* / Q000401:mortality*; D012107:Research Design; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D015314:Dialysis Solutions; D005936:Glucans; D017127:Glycation End Products, Advanced; D000077607:Icodextrin; D005947:Glucose