Abstract
BackgroundGlucose is widely used as an osmotic agent in peritoneal dialysis (PD), but exerts untoward effects on the peritoneum. The potential protective effect of a reduced exposure to hypertonic glucose has never been investigated.MethodsThe cohort of PD patients attending our center which tackled the challenge of a restricted use of hypertonic glucose solutions has been prospectively followed since 1992. Small-solute transport was assessed using an equivalent of the glucose peritoneal equilibration test after 6 months, and then every year. Study was stopped on July 1st, 2008, before use of biocompatible solutions. Repeated measures in patients treated with PD for 54 months were analyzed by using (1) the slopes of the linear regression for D4/D0 ratios over time computed for each individual, and (2) a linear mixed model.ResultsIn the study period, 44 patients were treated for a total of 2376 months, 2058 without hypertonic glucose. There was one episode of peritoneal infection every 18 patient-months. The mean of slopes of the linear regression for D4/D0 ratios was found to be significantly positive (Student’s test, p < .001) and the results of the mixed model reflected a similar significant increase for D4/D0 ratios over time. These results reflected a significant decrease of small-solute transport.ConclusionIn this large series, minimizing the use of hypertonic glucose solutions was associated in patients on long term PD with an overall decrease of small-solute transport within 54 months, despite a high rate of peritoneal infection.
Highlights
Glucose is widely used as an osmotic agent in peritoneal dialysis (PD), but exerts untoward effects on the peritoneum
We fitted a linear mixed model on the whole data from inclusion to end of follow-up
In conclusion, we showed that a persistent restricted use of hypertonic glucose solutions was feasible, and in patients on long term PD was associated with an overall decrease of solute transport (SST) over a 54-month period in spite of a high rate of peritoneal infection
Summary
Glucose is widely used as an osmotic agent in peritoneal dialysis (PD), but exerts untoward effects on the peritoneum. Glucose is widely used as an osmotic agent for peritoneal dialysis (PD) because it is inexpensive and reasonably safe in the short term. Its long-term use, is associated with both systemic and peritoneal untoward effects, partly mediated by glucose degradation products (GDP) generated during the manufacturing process for dialysate bags. GDP exposure may accelerate the decline in residual renal function and cause fluid overload [2]. All these processes contribute to develop cardiovascular disease and reduce. Low-glucose dialysis regimens using icodextrin and amino-acid containing solutions in combination with biocompatible glucose solutions have been recently developed [5]. No previous study has addressed the effects of a deliberate reduction in exposure to hypertonic glucose on peritoneal membrane
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