| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Clinical |
Division of Nephrology, Department of Internal Medicine, Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Korea
Correspondence to: H.Y. Lee, Department of Internal Medicine, Yonsei University College of Medicine, CPO Box 8044, Seoul, Korea. hyl{at}yumc.yonsei.ac.kr
Background: Long-term peritoneal dialysis (PD) is
associated with the development of various structural and functional changes
to the peritoneal membrane when bioincompatible conventional peritoneal
dialysis fluids (PDFs) are used. In this study, we looked at patients that
were treated with conventional PDFs and then changed to novel biocompatible
PDFs with a neutral pH and a low concentration of glucose degradation products
(GDPs) to investigate whether this change could result in the arrest or
reversal of peritoneal membrane deterioration. Methods: In an open label, randomized prospective
trial, the clinical effects of conventional PDFs and biocompatible PDFs with
neutral pH and very low concentration of GDPs were compared in 104 patients
equally divided between both study PDFs. Blood and effluent dialysate samples,
peritoneal equilibration tests, and adequacy evaluation were undertaken at
baseline, 4, 8, and 12 months. The target variables were the ratio of
dialysate-to-plasma (D/P) creatinine, peritoneal ultrafiltration, residual
renal function, dialysis adequacy indices, and effluent cancer antigen 125
(CA125). Results: D/P creatinine values were not different in
the two groups. Peritoneal ultrafiltration was significantly higher in the
low-GDP PDF group than in the conventional PDF group at all follow-up times (4
months: 9.1 ± 4.3 vs 6.0 ± 3.0; 8 months: 8.3 ± 3.4 vs
6.0 ± 3.0; 12 months: 8.9 ± 3.3 vs 6.1 ± 3.3 mL/g
dextrose/day; p < 0.05). Peritoneal Kt/V urea values and total
weekly Kt/V urea values at 4 months were significantly higher in the low-GDP
PDF group than in the conventional PDF group. Residual renal function was not
statistically significant. Effluent CA125 levels were significantly higher in
the low-GDP PDF group at all follow-up visits (4 months: 37.8 ± 20.8 vs
22.0 ± 9.5; 8 months: 41.2 ± 20.3 vs 25.9 ± 11.3; 12
months: 40.4 ± 21.4 vs 28.6 ± 13.0 U/mL; p < 0.05).
Among anuric patients, peritoneal ultrafiltration at 4, 8, and 12 months,
total weekly Kt/V at 4 and 8 months, and CA125 levels at all follow-up visits
were significantly higher in patients treated with low-GDP PDF than those
treated with conventional PDF. However, among anuric patients, D/P creatinine
showed no significant differences between the low-GDP PDF group and the
conventional PDF group. Conclusion: The use of biocompatible PDFs with neutral
pH and low GDP concentration can contribute to improvement of peritoneal
ultrafiltration and peritoneal effluent CA125 level, an indicator of
peritoneal membrane integrity in PD patients.
KEY WORDS: Glucose degradation products; neutral pH; biocompatibility; peritoneal function; CA125.
Received 18 December 2006; accepted 21 October 2007.
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
 |
