Effects of Dialysis Solution on the Cardiovascular Function in Peritoneal Dialysis Patients

Abstract

Objective Peritoneal dialysis (PD) patients have an increased cardiovascular burden. In this study, we aimed to compare certain PD solutions (Physioneal and Dianeal ) in terms of the ambulatory blood pressure, echocardiographic parameters (ECHO), carotid atherosclerosis, endothelial function and serum asymmetric dimethylarginine (ADMA) level. Methods A total of 45 PD patients were enrolled in this prospective randomized controlled study: 23 patients in the Dianeal group and 22 patients in the Physioneal group. Ambulatory blood pressure measurements, echocardiography, carotid artery intima-media thickness measurements and flow mediated dilatation (FMD) and ADMA values were obtained at baseline and 12 months. Results The baseline parameters were similar between the groups with respect to the echocardiographic parameters, 24-hour ambulatory blood monitoring measurements and ADMA and FMD levels. All 24-hour blood pressure monitoring measurements, except for the average daytime systolic blood pressure, were significantly decreased in both groups at the first year. In the Physioneal group, a significant decrease was observed with regard to the ADMA levels. Considering the FMD values, significant augmentation was seen at the end of the first year in both groups. Improvements in the FMD measurements were prominent in the Physioneal group; however, this finding was not statistically significant. Conclusion The use of solutions with a neutral pH in PD patients results in decreased ADMA levels, which may be an important contributor to reductions in the incidence of cardiovascular events and deaths in this population.

Clinical benefits of biocompatible peritoneal dialysis solutions

“…Tanto el pH como el lactato también están implicados en las alteraciones de las defensas peritoneales como disminución de la capacidad fagocítica de los macrófagos que provoca una acidificación intracelular y con ello así mismo se altera la función de los neutrófilos 20,21 . Por otra parte, está bien documentado que ambos, pH y lactato, aumentan la citotoxicidad mesotelial 22,23 .…”