title: Low-GDP fluid (Gambrosol trio) attenuates decline of residual renal function in PD patients: a prospective randomized study.
abstract: BACKGROUND
  Residual renal function (RRF) impacts outcome of peritoneal dialysis (PD) patients. Some PD fluids contain glucose degradation products (GDPs) which have been shown to affect cell systems and tissues. They may also act as precursors of advanced glycosylation endproducts (AGEs) both locally and systemically, potentially inflicting damage to the kidney as the major organ for AGE elimination. We conducted a clinical study in PD patients to see if the content of GDP in the PD fluid has any influence on the decline of the residual renal function.
  
  
  METHODS
  In a multicentre approach, 80 patients (GFF > or = 3 mL/min/1.732 or creatinine clearance > or =3 mL/min/1.73 m(2)) were randomized to treatment with a PD fluid containing low levels of GDP or standard PD fluid for 18 months. RRF was assessed every 4-6 weeks. Fluid balance, mesothelial cell mass marker CA125, peritoneal membrane characteristics, C-reactive protein (CRP), total protein, albumin, electrolytes and phosphate were measured repeatedly.
  
  
  RESULTS
  Data from 69 patients revealed a significant difference in monthly RRF change: -1.5% (95% CI = -3.07% to +0.03%) with low GDP (43 patients) vs -4.3% (95% CI = -6.8% to -2.06%) with standard fluids (26 patients) (P = 0.0437), independent of angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker medication. Twenty-four-hour urine volume declined more slowly with low-GDP fluid compared to standard fluids (12 vs 38 mL/month, P = 0.0241), and monthly change of phosphate level was smaller (+0.013 vs +0.061 mg/dL, P = 0.0381).
  
  
  CONCLUSIONS
  Our prospective study demonstrates for the first time a significant benefit concerning preservation of RRF and urine volume of using a PD fluid with low GDP levels. These findings suggest that GDPs might affect patient outcome related to RRF.
authors.affiliation: St. Elisabeth-Krankenhaus, Straubing, Germany. marianne.haag-weber@kfh-dialyse.de
authors.forename: Marianne
authors.initials: M
authors.lastname: Haag-Weber
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Krämer
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Haake
authors.forename: Mohamed Shariful
authors.initials: MS
authors.lastname: Islam
authors.forename: Friedrich
authors.initials: F
authors.lastname: Prischl
authors.forename: Ulrike
authors.initials: U
authors.lastname: Haug
authors.forename: José L
authors.initials: JL
authors.lastname: Nabut
authors.forename: Reinhold
authors.initials: R
authors.lastname: Deppisch
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria; D002097:C-Reactive Protein / Q000378:metabolism; D018394:CA-125 Antigen / Q000378:metabolism; D015314:Dialysis Solutions / Q000494:pharmacology*; D005260:Female; D005602:France; D005858:Germany; D017127:Glycation End Products, Advanced / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism / Q000503:physiopathology*; D007674:Kidney Diseases / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008565:Membrane Proteins / Q000378:metabolism; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D011446:Prospective Studies; D012709:Serum Albumin / Q000378:metabolism; D014882:Water-Electrolyte Balance
chemical_list: D018394:CA-125 Antigen; D015314:Dialysis Solutions; D017127:Glycation End Products, Advanced; C451759:MUC16 protein, human; D008565:Membrane Proteins; D012709:Serum Albumin; D002097:C-Reactive Protein