Association of Biocompatible Peritoneal Dialysis Solutions with Peritonitis Risk, Treatment, and Outcomes

Abstract

SummaryBackground and objectives The effect of biocompatible peritoneal dialysis (PD) solutions on PD-related peritonitis is unclear. This study sought to evaluate the relationship between use of biocompatible solutions and the probability of occurrence or clinical outcomes of peritonitis.Design, setting, participants, & measurements The study included all incident Australian patients receiving PD between January 1, 2007, and December 31, 2010, using Australia and New Zealand Dialysis and Transplant Registry data. All multicompartment PD solutions of neutral pH were categorized as biocompatible solutions. The independent predictors of peritonitis and the use of biocompatible solutions were determined by multivariable, multilevel mixed-effects Poisson and logistic regression analysis, respectively. Sensitivity analyses, including propensity score matching, were performed.Results Use of biocompatible solutions gradually declined (from 7.5% in 2007 to 4.2% in 2010), with preferential use among smaller units and among younger patients without diabetes mellitus. Treatment with biocompatible solution was associated with significantly greater overall rate of peritonitis (0.67 versus 0.47 episode per patientyear; incidence rate ratio, 1.49; 95% confidence interval [CI], 1.19 to 1.89) and with shorter time to first peritonitis (hazard ratio [HR], 1.48; 95% CI, 1.17 to 1.87), a finding replicated in propensity score-matched cohorts (HR, 1.36; 95% CI, 1.09 to 1.71).Conclusions In an observational registry study, use of biocompatible PD solutions was associated with higher overall peritonitis rates and shorter time to first peritonitis. Further randomized studies adequately powered for a primary peritonitis outcome are warranted.

High Peritoneal Glucose Exposure Is Associated with Increased Incidence of Relapsing and Recurrent Bacterial Peritonitis in Patients Undergoing Peritoneal Dialysis

“…By doing so, it leads to compromised peritoneal innate immune defense against exogenous pathogen insult [6,7,8]. During recent years, numerous clinical studies have compared the incidence of peritonitis in PD patients receiving glucose-based solution versus new biocompatible fluid with low level of glucose degradation products [9,10,11]. But the findings were not consistent among the individual studies [12].…”

“Biocompatible” Neutral pH Low‐GDP Peritoneal Dialysis Solutions: Much Ado About Nothing?

“…Interestingly, there has been an emergence of observational data with regard to a higher peritonitis risk with the use of NpHLGDP solutions compared to conventional PD solutions. After publication of the balANZ trial, the same authors sought to clarify the relationship between peritonitis and NpHLGDP solutions in a large multicenter observational study of 2245 incident PD patients in Australia (75). In contrast with their previous findings in balANZ, they found higher rates of peritonitis with NpHLGDP solutions (incidence rate ratio 1.49, 95% CI 1.19-1.89) compared to the use of conventional PD solutions.…”

A fluorogenic assay for methylglyoxal

“…glyoxal, MG, 3-DG and others, are formed during heat sterilization of PD fluids with glucose osmolyte [32]. These compounds, also known as GDPs (glucose degradation products), may produce adverse effects when the PD fluids are used clinically [33], and concentrations may vary during dispatch and storage at ambient conditions at the PD centre or home of the patient [34]. A facile method for measuring GDPs could provide simple screening of GDPs and confidence in use of low GDP PD fluids at the PD clinic.…”