Is the Effect of Low-Gdp Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved

Kooman, Jeroen P.; Cornelis, T.; Sande, Franciscus van der; Leunissen, Karel M.L.

doi:10.3747/pdi.2015.00149

Cited by 4 publications

(4 citation statements)

References 36 publications

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“…The conclusion is that the use of a neutral-pH, low-GDP solution results in better preservation of RRF. However, whether the biocompatible solutions can benefit the long-term clinical outcomes of patients cannot be predicted at present [79][80][81] .…”

Section: Dialysis Techniquesmentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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Background: Residual renal function (RRF), defined as the ability of native kidneys to eliminate water and uremic toxins, is closely correlated with mortality and morbidity rates among patients receiving either peritoneal dialysis (PD) or hemodialysis (HD) via continuous clearance of middle-sized molecules and protein-bound solutes. Therefore, preserving RRF is considered to be one of the primary goals in managing patients with end-stage renal disease (ESRD). Summary and Key Messages: In this article, we provide a review on the understanding and management of RRF in patients on dialysis. RRF may be estimated and measured by calculating the mean 24-hour urine creatinine level and urea clearance. Currently, several middle-sized molecules are reported but rarely used in practice. Many risk factors such as original renal diseases, dietary intake, and nephrotoxic agents impair RRF. Targeting such factors may halt the decline in RRF and offer better outcomes for patients on PD or HD. Except for in PD patients, RRF is a powerful predictor of survival in HD patients. RRF requires more clinical and research attention in the care of patients with ESRD on dialysis.

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Section: Dialysis Techniquesmentioning

confidence: 99%

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Liu

Dai

2016

Kidney Dis

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“…The benefits of neutral-pH, low-GDP solutions, such as preservation of residual kidney function and urine volume, have been demonstrated with convincing evidence in PD patients [ 36 ]. The improved preservation of residual kidney function might be related to less-effective fluid removal compared to standard glucose-based dialysate [ 37 ]. Indeed, research into the effect of neutral-pH, low-GDP solutions on UF volume as well as on peritoneal transport status has yielded conflicting results [ 31 ].…”

Section: Combating Pd-solution Associated Toxicitymentioning

confidence: 99%

Coupling Osmotic Efficacy with Biocompatibility in Peritoneal Dialysis: A Stiff Challenge

Bonomini,

Masola,

Monaco

et al. 2024

IJMS

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Peritoneal dialysis (PD) is a home-based efficacious modality for the replacement of renal function in end-stage kidney failure patients, but it is still under-prescribed. A major limitation is the durability of the dialytic technique. Continuous exposure of the peritoneum to bioincompatible conventional glucose-based solutions is thought to be the main cause of the long-term morpho-functional peritoneal changes that eventually result in ultrafiltration failure. Poor PD solution biocompatibility is primarily related to the high glucose content, which is not only detrimental to the peritoneal membrane but has many potential metabolic side effects. To improve the clinical outcome and prolong the survival of the treatment, PD-related bioincompatibility urgently needs to be overcome. However, combining dialytic and osmotic efficacy with a satisfactory biocompatible profile is proving to be quite difficult. New approaches targeting the composition of the PD solution include the replacement of glucose with other osmotic agents, and the addition of cytoprotective or osmo-metabolic compounds. Other strategies include the infusion of mesenchymal cells or the administration of orally active agents. In the present article, we review the current evidence on efforts to improve the biocompatible and functional performance of PD, focusing on studies performed in vivo (animal models of PD, human subjects on PD).

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“…Some authors have speculated that the preservation of RKF seen with the low GDP PD fluids may in part be due to a less forceful fluid removal compared with conventional glucose PD fluids. 107…”

Section: Residual Kidney Function and Urine Volumementioning

confidence: 99%

“…Other previously published systemic reviews and meta‐analyses have also demonstrated consistent findings 102–105 (Table 3). Some authors have speculated that the preservation of RKF seen with the low GDP PD fluids may in part be due to a less forceful fluid removal compared with conventional glucose PD fluids 107 …”

Section: The Issue Of Biocompatibility In Pd Fluidsmentioning

confidence: 99%

Peritoneal dialysis fluids

Low

Liew

2022

Seminars in Dialysis

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There have been significant advances in the understanding of peritoneal dialysis (PD) in the last 40 years, and uptake of PD as a modality of kidney replacement therapy is increasing worldwide. PD fluids, therefore, remains the lifeline for patients on this treatment. Developing these fluids to be efficacious in solute clearance and ultrafiltration, with minimal adverse consequences to peritoneal membrane health and systemic effects is a key requirement. Since the first PD fluid produced in 1959, modifications to PD fluids have been made. Nonetheless, the search for that ideal PD fluid remains elusive. Understanding the components of PD fluids is a key aspect of optimizing the successful delivery of PD, allowing for individualized PD prescription. Glucose remains an integral component of PD fluids; however, its deleterious effects continue to be the impetus for the search of an alternative osmotic agent, and icodextrin remains the main alternative. More biocompatible PD fluids have been developed and have shown benefits in preserving residual kidney function. However, high cost and reduced accessibility remain deterrents to its widespread clinical use in many countries. Large‐scale clinical trials are necessary and very much awaited to improve the narrow spectrum of PD fluids available for clinical use.

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Is the Effect of Low-Gdp Solutions on Residual Renal Function Mediated by Fluid State? An Enigmatic Question which Still Needs to be Solved

Cited by 4 publications

References 36 publications

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Advances in Understanding and Management of Residual Renal Function in Patients with Chronic Kidney Disease

Coupling Osmotic Efficacy with Biocompatibility in Peritoneal Dialysis: A Stiff Challenge

Peritoneal dialysis fluids

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