title: Effect of low-GDP bicarbonate-lactate-buffered peritoneal dialysis solutions on plasma levels of adipokines and gut appetite-regulatory peptides. A randomized crossover study.
abstract: BACKGROUND
  Malnutrition is common in patients treated with peritoneal dialysis (PD). Previous studies have disclosed disturbances in the hormonal axes regulating appetite in these patients. The effect of newer biocompatible PD solutions on these disorders is undetermined.
  
  
  METHODS
  Using a crossover randomized design, 21 patients stable on PD underwent 5 weeks of therapy with each of classic glucose degradation product (GDP)-rich lactate-buffered PD solutions (L) and newer low-GDP bicarbonate-lactate-buffered PD solutions (BL). At the end of each phase, we scrutinized patients for adequacy markers, peritoneal transport (peritoneal equilibration test with 3.86% glucose-based solutions), general biochemical markers and, more specifically, cytokines, adipokines (leptin and adiponectin) and selected gastrointestinal peptides which regulate appetite in the short term [ghrelin, peptide YY, cholecystokinin, glucagon-like peptide 1 (GLP1)]. For plasma GLP1 levels, we analysed a group of healthy, sex-, age- and body mass index-matched controls.
  
  
  RESULTS
  Use of BL solutions was associated with higher plasma levels of acylated (but not total) ghrelin (median 243 BL versus 141 pg/mL L, P = 0.05), adiponectin (median 20.2 BL versus 17.6 mcg/mL L, P = 0.008) and growth hormone (median 1.8 BL versus 1.0 ng/mL L, P = 0.013), without significant differences for the other cytokines, leptin or gut peptides scrutinized. We did not observe significant differences between L and BL solutions concerning estimations of adequacy, peritoneal transport or general biochemical markers.
  
  
  CONCLUSIONS
  Use of GDP-free, neutral-pH, bicarbonate-lactate-buffered PD solutions is associated with higher plasma levels of acylated ghrelin and adiponectin than classic solutions. These findings may contribute to explaining improved appetite scores and overall survival rates reported with the use of so-called biocompatible PD solutions.
authors.affiliation: Division of Nephrology, University Hospital a Coruña, A Coruña, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Carmona
authors.forename: Miguel
authors.initials: M
authors.lastname: Pérez-Fontán
authors.forename: Ana
authors.initials: A
authors.lastname: Guitián
authors.forename: Javier
authors.initials: J
authors.lastname: Peteiro
authors.forename: Teresa
authors.initials: T
authors.lastname: García-Falcón
authors.forename: Andrés
authors.initials: A
authors.lastname: López-Muñiz
authors.forename: Jesús
authors.initials: J
authors.lastname: García-Buela
authors.forename: Fernando
authors.initials: F
authors.lastname: Cordido
mesh_terms: D054392:Adipokines / Q000097:blood*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000494:pharmacology*; D002021:Buffers; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions; D005260:Female; D005500:Follow-Up Studies; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000473:pathology; D007773:Lactates / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D010530:Peritoneal Dialysis; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D054392:Adipokines; D001639:Bicarbonates; D002021:Buffers; D015314:Dialysis Solutions; D054439:Ghrelin; D007773:Lactates; D010446:Peptide Fragments; D003404:Creatinine