Impact of a Low-Glucose Peritoneal Dialysis Regimen on Fibrosis and Inflammation Biomarkers

Abstract

♦ Background: The impact of a low-glucose peritoneal dialysis (PD) regimen on biomarkers of peritoneal inflammation, fibrosis and membrane integrity remains to be investigated. ♦ Methods: In a randomized, prospective study, 80 incident PD patients received either a low-glucose regimen comprising Physioneal (P), Extraneal (E) and Nutrineal (N) (Baxter Healthcare Corporation, Deerfield, IL, USA) (PEN group), or Dianeal (control group) for 12 months, after which both groups continued with Dianeal dialysis for 6 months. Serum and dialysate levels of vascular endothelial growth factor (VEGF), decorin, hepatocyte growth factor (HGF), interleukin-6 (IL-6), macrophage migration inhibitory factor (MIF), hyaluronan (HA), adiponectin, solubleintracellular adhesion molecule (s-ICAM), vascular cell adhesion molecule-1 (VCAM-1) and P-selectin, and dialysate cancer antigen 125 (CA125), were measured after 12 and 18 months. This paper focuses on results after 12 months, when patients in the PEN group changed to glucose-based PD fluid (PDF). ♦ Results: At the end of 12 months, effluent dialysate levels of CA125, decorin, HGF, IL-6, adiponectin and adhesion molecules were significantly higher in the PEN group compared to controls, but all decreased after patients switched to glucose-based PDF. Macrophage migration inhibitory factor level was lower in the PEN group but increased after changing to glucose-based PDF and was similar to controls at 18 months. Serum adiponectin level was higher in the PEN group at 12 months, but was similar in the 2 groups at 18 months. Body weight, residual renal function, ultrafiltration volume and total Kt/V did not differ between both groups. Dialysate-to-plasma creatinine ratio at 4 h was higher in the PEN group at 12 months and remained so after switching to glucose-based PDF.

MicroRNA‐302c modulates peritoneal dialysis‐associated fibrosis by targeting connective tissue growth factor

“…In clinical settings, PD effluent markers were used to assess peritoneal functionality and morphology. Established effluent biomarkers include cancer antigen 125 (CA125), VEGF, hyaluronan (HA), interleukin‐6 (IL‐6) and tumour necrosis factor (TNF‐α) . In various studies, PD effluent was also used as a source of biomarkers for the early detection of long‐term alterations in the peritoneum and peritoneal fibrosis.…”

Hyperbranched polyglycerol is superior to glucose for long-term preservation of peritoneal membrane in a rat model of chronic peritoneal dialysis

“…Because of a high level of glucose, and mostly glucose degradation products in the PD solution (e.g. PYS) that can lead to peritoneal membrane damage, fibrosis development and eventually ultrafiltration failure [7, 11, 12], alternative osmotic agents, such as polyglucose (icodextrin, Baxter Extraneal) or amino acids (Baxter Nutrineal) are developed, and their efficiency in preserving the peritoneal membrane integrity and function has been documented in both experimental and clinical studies [20, 26]. However, both icodextrin and amino acid therapies have several drawbacks that could limit their broad therapeutic uptake.…”

Peritoneal dialysis has optimal intradialytic hemodynamics and preserves residual renal function: Why isn't it better than hemodialysis?

“…Clinically, modality‐specific risk factors for cardiovascular disease are relevant to the decision‐making processes around choosing dialysis type and how it is prescribed in individual patients, even if, at present, this is not underpinned by definitive evidence. As examples: emphasizing the benefits of PD in a patient with risk factors for dialysis‐induced myocardial stunning or using lower glucose‐containing regimes (so‐called “PEN” regime) for PD patients with diabetes. As always, such considerations need to be weighed alongside individual patient preferences, and future research is needed particularly in PD, to definitively establish the most important modifiable processes that contribute to cardiovascular morbidity and mortality.…”

“…emphasizing the benefits of PD in a patient with risk factors for dialysis-induced myocardial stunning or using lower glucose-containing regimes (so-called "PEN" regime) 78 for PD patients with diabetes. As always, such considerations need to be weighed alongside individual patient preferences, and future research is needed particularly in PD, to definitively establish the most important modifiable processes that contribute to cardiovascular morbidity and mortality.…”