title: Effect of Neutral-pH, Low-Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time.
  
  
  METHODS
  Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers.
  
  
  RESULTS
  Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including >1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =-110; 95% confidence interval, -312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06).
  
  
  CONCLUSIONS
  The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
authors.forename: Seychelle
authors.initials: S
authors.lastname: Yohanna
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia;
authors.forename: Ali M A
authors.initials: AM
authors.lastname: Alkatheeri
authors.affiliation: Division of Nephrology, McMaster University, Hamilton, Ontario, Canada; and.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Brimble
authors.affiliation: Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Brendan
authors.initials: B
authors.lastname: McCormick
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
authors.forename: Arthur
authors.initials: A
authors.lastname: Iansavitchous
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada;
authors.forename: Peter G
authors.initials: PG
authors.lastname: Blake
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; arsh.jain@lhsc.on.ca.
authors.forename: Arsh K
authors.initials: AK
authors.lastname: Jain
mesh_terms: D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000009:adverse effects / Q000737:chemistry / Q000378:metabolism / Q000627:therapeutic use*; D005947:Glucose / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014554:Urination; D014563:Urodynamics
chemical_list: D015415:Biomarkers; D015314:Dialysis Solutions; D003404:Creatinine; D005947:Glucose
keywords: biocompatible; degradation products; glucose; peritoneal dialysis; residual renal function; urine volume