title: Effects of neutral pH and low-glucose degradation product-containing peritoneal dialysis fluid on systemic markers of inflammation and endothelial dysfunction: a randomized controlled 1-year follow-up study.
abstract: BACKGROUND
  The local peritoneal effects of low-glucose degradation product (GDP)-containing peritoneal dialysis fluid (PDF) have been extensively described. However, the systemic effects of prolonged prescription of these solutions are unknown. This study aimed to evaluate the effects of neutral pH and low-GDP PDF on systemic inflammation and endothelial dysfunction markers in peritoneal dialysis (PD) patients.
  
  
  METHODS
  This is a multicenter, open labeled, randomized controlled trial including one hundred fifty-two patients initiating continuous ambulatory peritoneal dialysis for end-stage renal disease from seven centers in Korea. Participants were randomly allocated to conventional PDF (Stay safe®; Fresenius Medical Care, Bad Homburg, Germany) or low-GDP PDF (Balance®; Fresenius Medical Care) and were followed for 1 year. Primary outcome variable was the inflammation and endothelial dysfunction index (IEDI), a composite score derived from serum levels of soluble intercellular adhesion molecule (sICAM)-1, soluble vascular cellular adhesion molecule (sVCAM)-1 and high-sensitivity C-reactive protein (hs-CRP). sICAM-1, sVCAM-1, residual renal function (RRF), peritoneal membrane transport characteristics, ultrafiltration volume and nutritional parameters were measured as secondary outcome variables.
  
  
  RESULTS
  Of 152 patients randomized, 146 (low-GDP: conventional PDF, 79:67) patients entered the trial (46% male, 53% with diabetes mellitus). At 12-month follow-up, the low-GDP group had significantly lower levels of IEDI, sICAM-1 and sVCAM-1 compared to the conventional group; hs-CRP was not different between groups. Peritoneal transport characteristics, RRF, nutritional parameters, incidence of peritonitis and death-censored technique survival were not different between groups.
  
  
  CONCLUSIONS
  Neutral pH and low-GDP PDF likely produce fewer changes in markers of endothelial dysfunction compared to conventional PDF in incident PD patients.
authors.affiliation: Division of Nephrology and Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Park
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Do
authors.forename: Yeong Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Ho Yung
authors.initials: HY
authors.lastname: Lee
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Kim
authors.forename: Sug-Kyun
authors.initials: SK
authors.lastname: Shin
authors.forename: Hyun Chul
authors.initials: HC
authors.lastname: Kim
authors.forename: Yoon-Kyung
authors.initials: YK
authors.lastname: Chang
authors.forename: Jong-Oh
authors.initials: JO
authors.lastname: Yang
authors.forename: Hyun-Chul
authors.initials: HC
authors.lastname: Chung
authors.forename: Chan-Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Won Kee
authors.initials: WK
authors.lastname: Lee
authors.forename: Jong-Yeon
authors.initials: JY
authors.lastname: Kim
authors.forename: Yong-Lim
authors.initials: YL
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001692:Biological Transport; D015415:Biomarkers / Q000378:metabolism*; D015314:Dialysis Solutions / Q000009:adverse effects / Q000493:pharmacokinetics*; D004730:Endothelium, Vascular / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005950:Glucose Solution, Hypertonic / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007249:Inflammation / Q000209:etiology* / Q000378:metabolism / Q000401:mortality; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality; D010538:Peritonitis / Q000209:etiology / Q000378:metabolism / Q000401:mortality; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014018:Tissue Distribution; D014882:Water-Electrolyte Balance; D055815:Young Adult
chemical_list: D015415:Biomarkers; D015314:Dialysis Solutions; D005950:Glucose Solution, Hypertonic