The Effect of Neutral Peritoneal Dialysis Solution with Low Glucose-Degradation-Product on the Fluid Status and Body Composition--A Randomized Control Trial.

Cheuk-Chun Szeto,Man-Ching Law,Chi-Bon Leung,Phyllis M S Cheng,Bonnie C H Kwan,Philip K T Li,Agnes S M Choy,Vickie W K Kwong,Kai-Ming Chow,Kathrin Eller

doi:10.1371/journal.pone.0141425

Cheuk-Chun Szeto, Man-Ching Law + Show 8 more

Open Access

https://doi.org/10.1371/journal.pone.0141425

Copy DOI

Abstract

BackgroundPrevious studies report conflicting results on the benefit of peritoneal dialysis (PD) patients treated with low glucose degradation product (GDP) solution. The effects of low GDP solution on body fluid status and arterial pulse wave velocity (PWV) have not been studied.MethodsWe randomly assigned 68 incident PD patients to low GDP (Intervention Group) or conventional solutions (Control Group); 4 dropped off before they received the assigned treatment. Patients were followed for 52 weeks for changes in ultrafiltration, residual renal function, body fluid status and arterial PWV.ResultAfter 52 weeks, Intervention Group had higher overhydration (3.1 ± 2.6 vs 1.9 ± 2.2 L, p = 0.045) and extracellular water volume (17.7 ± 3.9 vs 15.8 ± 3.1 L, p = 0.034) than Control Group. There was no significant difference in PWV between groups. There was no significant difference in residual renal function between the Groups. Intervention Group had lower ultrafiltration volume than Control Group at 4 weeks (0.45 ± .0.61 vs 0.90 ± 0.79 L/day, p = 0.013), but the difference became insignificant at later time points. Intervention Group had lower serum CRP levels than Control Group (4.17 ± 0.77 vs 4.91 ± 0.95 mg/dL, p < 0.0001).ConclusionIncident PD patients treated with low GDP solution have less severe systemic inflammation but trends of less ultrafiltration, and more fluid accumulation. However, the effects on ultrafiltration and fluid accumulation disappear with time. The long term effect of low GDP solution requires further study.Trial RegistrationClinicalTrials.gov NCT00966615

Highlights

Long term peritoneal dialysis (PD) by bio-incompatible solution has been proposed to be the cause of progressive loss of peritoneal permeability [1,2]
Incident PD patients treated with low GDP solution have less severe systemic inflammation but trends of less ultrafiltration, and more fluid accumulation
The effects on ultrafiltration and fluid accumulation disappear with time

Summary

Introduction

Long term peritoneal dialysis (PD) by bio-incompatible solution has been proposed to be the cause of progressive loss of peritoneal permeability [1,2]. Amongst the ingredients in conventional PD solution, its acidic pH and the presence of glucose-degradation-product (GDP) are probably the major factors resulting in bio-incompatibility [3,4]. The use of neutral pH, low GDP solution resulted in a superior profile of PD effluent mesothelial cell marker and a lower degree of systemic inflammation as compared to conventional PD solution [10]. There are no published data on the effect of low GDP solution on the overall body fluid status or arterial stiffness of PD patients. We compare a double-chamber bag Stay-Safe Balance system and the conventional glucose-based solution in terms of nutritional status, arterial stiffness, and body composition and fluid status. Previous studies report conflicting results on the benefit of peritoneal dialysis (PD) patients treated with low glucose degradation product (GDP) solution. The effects of low GDP solution on body fluid status and arterial pulse wave velocity (PWV) have not been studied

Methods

Results

Discussion

Conclusion