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

Abstract

Adverse outcomes in peritoneal dialysis (PD), including PD related infections, the loss of residual kidney function (RKF), and longitudinal, deleterious changes in peritoneal membrane function continue to limit the long-term success of PD therapy. The observation that these deleterious changes occur upon exposure to conventional glucose-based PD solutions fuels the search for a more biocompatible PD solution. The development of a novel PD solution with a neutral pH, and lower in glucose degradation products (GDPs) compared to its conventional predecessors has been labeled a "biocompatible" solution. While considerable evidence in support of these novel solutions' biocompatibility has emerged from cell culture and animal studies, the clinical benefits as compared to conventional PD solutions are less clear. Neutral pH low GDP (NpHLGDP) PD solutions appear to be effective in reducing infusion pain, but their effects on other clinical endpoints including peritoneal membrane function, preservation of RKF, PD-related infections, and technique and patient survival are less clear. The literature is limited by studies characterized by relatively few patients, short follow-up time, heterogeneity with regards to the novel PD solution type under study, and the different patient populations under study. Nonetheless, the search for a more biocompatible PD solution continues with emerging data on promising non glucose-based solutions.

A Novel Formulation of Glucose-Sparing Peritoneal Dialysis Solutions with l-Carnitine Improves Biocompatibility on Human Mesothelial Cells

“…Actually, a more evident increase in micro-vascular density correlating with an increase in small solute transport was seen with low GDP, neutral pH PD solutions when compared to conventional PD solutions. Though conclusions need to be drawn with caution, it has to be noted that clinical trials of low GDP, neutral pH PD solutions have failed to demonstrate a significant benefit with regards to peritoneal membrane function and UF capacity, suggesting that the presence of glucose as the main osmotic agent in PD therapy is the real culprit of the morphological changes observed in both low GDP, neutral pH and high GDP, acidic pH PD solutions [19,65,66].…”

Associations of neutral pH, low-GDP peritoneal dialysis solutions with patient survival, transfer to haemodialysis and peritonitis

“…Peritoneal dialysis (PD) provides life-saving kidney replacement therapy for patients with kidney failure. However, PD is associated with various complications, including local and systemic effects of glucose degradation products (GDPs) [ 1 ]. Studies have shown that exposure to GDPs is associated with mesothelial denudation, fibroblast cytotoxicity and induction of profibrotic cytokine and vascular endothelial growth factor (VEGF) synthesis [ 2–7 ].…”

Assessing transport across the peritoneal membrane: Precision medicine in dialysis

“…15 This limitation is also true in the field of PD, where important questions ranging from the choice of solutions to the treatment of peritonitis or long-term membrane dysfunction remain debated. 1,[16][17][18] Yet, guidelines and recommendations may contribute to quality improvement provided they are implemented, used to develop policies and evaluated in terms of impact on clinical practice. 19 In such context, actualized recommendations for evaluating peritoneal transport have the potential to significantly impact on the field.…”