title: A peritoneal dialysis regimen low in glucose and glucose degradation products results in increased cancer antigen 125 and peritoneal activation.
abstract: BACKGROUND
  Glucose and glucose degradation products (GDPs) in peritoneal dialysis fluids (PDFs) are both thought to mediate progressive peritoneal worsening.
  
  
  METHODS
  In a multicenter, prospective, randomized crossover study, incident continuous ambulatory peritoneal dialysis patients were treated either with conventional lactate-buffered PDF (sPD regimen) or with a regimen low in glucose and GDPs: Nutrineal×1, Extraneal×1, and Physioneal×2 (NEPP regimen; all solutions: Baxter Healthcare, Utrecht, The Netherlands). After 6 months, patients were switched to the alternative regimen for another 6 months. After 6 weeks of run-in, before the switch, and at the end of the study, 4-hour peritoneal equilibration tests were performed, and overnight effluents were analyzed for cells and biomarkers. Differences between the regimens were assessed by multivariate analysis corrected for time and regimen sequence.
  
  
  RESULTS
  The 45 patients who completed the study were equally distributed over both groups. During NEPP treatment, D(4)/D(0) glucose was lower (p < 0.01) and D/P creatinine was higher (p = 0.04). In NEPP overnight effluent, mesothelial cells (p < 0.0001), cancer antigen 125 (p < 0.0001), hyaluronan (p < 0.0001), leukocytes (p < 0.001), interleukins 6 (p = 0.001) and 8 (p = 0.0001), and vascular endothelial growth factor (VEGF, p < 0.0001) were increased by a factor of 2-3 compared with levels in sPD effluent. The NEPP regimen was associated with higher transport parameters, but that association disappeared after the addition of VEGF to the model. The association between NEPP and higher effluent levels of VEGF could not be attributed to glucose and GDP loads.
  
  
  CONCLUSIONS
  Study results indicate preservation of the mesothelium and increased peritoneal activation during NEPP treatment. Whether the increase in VEGF reflects an increase in mesothelial cell mass or whether it points to another, undesirable mechanism cannot be determined from the present study. Longitudinal studies are needed to finally evaluate the usefulness of the NEPP regimen for further clinical use.
authors: Department of Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
authors: Caatje Y
authors: CY
authors: le Poole
authors: Angelique G A
authors: AG
authors: Welten
authors: Piet M
authors: PM
authors: ter Wee
authors: Nanne J
authors: NJ
authors: Paauw
authors: Amina N
authors: AN
authors: Djorai
authors: Rob M
authors: RM
authors: Valentijn
authors: Robert H J
authors: RH
authors: Beelen
authors: Jacob
authors: J
authors: van den Born
authors: Frans J
authors: FJ
authors: van Ittersum
mesh_terms: D018394:CA-125 Antigen / Q000096:biosynthesis* / Q000187:drug effects*; D018592:Cross-Over Studies; D015314:Dialysis Solutions / Q000737:chemistry / Q000494:pharmacology*; D005947:Glucose / Q000032:analysis / Q000494:pharmacology*; D006801:Humans; D007958:Leukocyte Count; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000187:drug effects* / Q000502:physiology*; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D018394:CA-125 Antigen; D015314:Dialysis Solutions; D005947:Glucose