title: The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial.
abstract: BACKGROUND
  The balANZ trial recently reported that neutral pH, low glucose degradation product (biocompatible) peritoneal dialysis (PD) solutions significantly delayed anuria and reduced peritonitis rates compared with conventional solutions. This article reports a secondary outcome analysis of the balANZ trial with respect to peritoneal membrane function.
  
  
  METHODS
  Adult, incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. Peritoneal equilibration tests were performed at 1, 6, 12, 18 and 24 months. Peritoneal small solute clearances and ultra-filtration (UF) were measured at 3, 6, 9, 12, 18 and 24 months.
  
  
  RESULTS
  Of the 185 patients recruited into the trial, 85 patients in the Balance group and 82 patients in the control group had peritoneal membrane function evaluated. Mean 4-h dialysate:plasma creatinine ratios (D:P Cr 4h) at 1 month were significantly higher in the Balance group compared with controls (0.67 ± 0.10 versus 0.62 ± 0.10, P = 0.002). Over the 2-year study period, mean D:P Cr 4 h measurements remained stable in the Balance group but increased significantly in controls [difference -0.004 per month, 95% confidence interval (95% CI) -0.005 to -0.002, P < 0.001]. Similar results were obtained for dialysate glucose ratios (D/D0 glucose). Peritoneal UF was significantly lower in the Balance group than in controls at 3 and 6 months. Over the 2-year study period, peritoneal UF increased significantly in the Balance group but remained stable in controls (difference 24 mL/day/month, 95% CI 9-39, P = 0.002). No differences in peritoneal small solute clearances, prescribed dialysate fill volumes or peritoneal glucose exposure were observed between the two groups.
  
  
  CONCLUSIONS
  Biocompatible and conventional PD solutions exert differential effects on peritoneal small solute transport rate and UF over time. Adequately powered trials assessing the impact of these differential membrane effects on PD technique and patient survival rates are warranted.
authors.affiliation: Department of Renal Medicine, Princess Alexandra Hospital, Brisbane, Australia. david_johnson@health.qld.gov.au
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Fiona G
authors.initials: FG
authors.lastname: Brown
authors.forename: Margaret
authors.initials: M
authors.lastname: Clarke
authors.forename: Neil
authors.initials: N
authors.lastname: Boudville
authors.forename: Tony J
authors.initials: TJ
authors.lastname: Elias
authors.forename: Marjorie W Y
authors.initials: MW
authors.lastname: Foo
authors.forename: Bernard
authors.initials: B
authors.lastname: Jones
authors.forename: Hemant
authors.initials: H
authors.lastname: Kulkarni
authors.forename: Robyn
authors.initials: R
authors.lastname: Langham
authors.forename: Dwarakanathan
authors.initials: D
authors.lastname: Ranganathan
authors.forename: John
authors.initials: J
authors.lastname: Schollum
authors.forename: Michael G
authors.initials: MG
authors.lastname: Suranyi
authors.forename: Seng H
authors.initials: SH
authors.lastname: Tan
authors.forename: David
authors.initials: D
authors.lastname: Voss
mesh_terms: D015314:Dialysis Solutions / Q000378:metabolism*; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy*; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000378:metabolism*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D015314:Dialysis Solutions; D005947:Glucose