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Perit Dial Int 28(Supplement_3): 117-122 2008
© 2008 International Society for Peritoneal Dialysis
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Part 5: Peritoneal Solution

COULD SOLUTIONS LOW IN GLUCOSE DEGRADATION PRODUCTS PRESERVE RESIDUAL RENAL FUNCTION IN INCIDENT PERITONEAL DIALYSIS PATIENTS? A 1-YEAR MULTICENTER PROSPECTIVE RANDOMIZED CONTROLLED TRIAL (BALNET STUDY)

Sung Gyun Kim1, Sejoong Kim2, Young-Hwan Hwang3, Kiwon Kim4, Ji Eun Oh1, Wookyung Chung5, Kook-Hwan Oh2, Hyung Jik Kim1 and Curie Ahn2 for the Korean Balnet Study Group

1 Department of Internal Medicine and Kidney Research Institute, Hallym University College of Medicine, Chuncheon;2 Department of Internal Medicine, Seoul National University College of Medicine, Seoul;3 Department of Internal Medicine, Eulji University College of Medicine, Seoul; 4 Nephrology Clinic, Center for Clinical Services, National Cancer Center, Ilsan;5 Department of Internal Medicine, Gacheon University of Medicine and Science, Incheon, Republic of Korea

Correspondence to: Kook-Hwan Oh, Department of Internal Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744 South Korea; or Sung Gyun Kim, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070 South Korea.
ohchris{at}hanmail.net or sgkim{at}hallym.ac.kr

{diamondsuit} Objectives: In vitro studies of peritoneal dialysis (PD) solutions demonstrated that a lactate-buffered fluid with neutral pH and low glucose degradation products (LF) has better biocompatibility than a conventional acidic lactate-buffered fluid (CF). However, few clinical trials have evaluated the long-term benefit of the biocompatible solution on residual renal function (RRF). To compare LF with CF, we performed a prospective, randomized study with patients starting PD.

{diamondsuit} Patients and Methods: After 1-month run-in period, 91 new PD patients were randomized for 12 months of treatment with either LF (Balance: Fresenius Medical Care, Bad Homburg, Germany; n = 48) or CF (Stay*Safe: Fresenius; n = 43). We measured RRF, acid-base balance, peritoneal equilibration test, and adequacy of dialysis every 6 months after the run-in period.

{diamondsuit} Results: After 12 months of treatment, the residual glomerular filtration rate (GFR) in patients using LF tended to be higher than that of patients on CF (p = 0.057 by repeated-measures analysis of variance). We observed a significant difference in the changes of residual GFR between the two groups (p = 0.009), a difference that was especially marked in the subgroup whose baseline residual GFR was more than 2 mL/min/1.73 m2. In addition, serum total CO2 levels were higher (p = 0.001) and serum anion gap was lower (p = 0.019) in the LF group. We observed no differences between groups for Kt/V, C-reactive protein, or normalized protein equivalent of nitrogen appearance.

{diamondsuit} Conclusions: In incident PD patients with significant residual GFR, LF may better preserve RRF over a 12-month treatment period. Additionally, pH-neutral PD fluid may improve acid-base balance as compared with CF.

KEY WORDS: Biocompatibility; glucose degradation products; residual renal function.






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