Low-GDP fluid (Gambrosol trio) attenuates decline of residual renal function in PD patients: a prospective randomized study.
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.
Haag-Weber
Marianne
M
St. Elisabeth-Krankenhaus, Straubing, Germany. marianne.haag-weber@kfh-dialyse.de
Krämer
Rosemarie
R
Haake
Rüdiger
R
Islam
Mohamed Shariful
MS
Prischl
Friedrich
F
Haug
Ulrike
U
Nabut
José L
JL
Deppisch
Reinhold
R
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
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