The impact of neutral-pH peritoneal dialysates with reduced glucose degradation products on clinical outcomes in peritoneal dialysis patients

Abstract

Neutral-pH peritoneal dialysates, with reduced glucose degradation products (GDPs), have been developed to reduce peritoneal membrane damage. Here our review evaluated the impact of these solutions on clinical outcomes using data from The Cochrane CENTRAL Registry, MEDLINE, Embase, and reference lists for randomized trials of biocompatible solutions. Summary estimates of effect were obtained using a random-effects model of 20 eligible trials encompassing 1383 patients. The quality of studies was generally poor, such that 13 studies had greater than a 20% loss to follow-up and only 3 trials reported adequate concealment of allocation. Use of neutral-pH dialysates with reduced GDPs resulted in larger urine volumes (7 trials; 520 patients; mean difference 126 ml/day, 95% CI 27-226), improved residual renal function after 12 months (6 trials; 360 patients; standardized mean difference 0.31, 95% confidence interval 0.10-0.52), and a trend to reduced inflow pain (1 trial; 58 patients; relative risk 0.51, 95% CI 0.24-1.08). However, there was no significant effect on body weight, hospitalization, peritoneal solute transport rate, peritoneal small-solute clearance, peritonitis, technique failure, patient survival, or adverse events. No significant harms were identified. Thus, based on generally poor quality trials, the use of neutral-pH peritoneal dialysates with reduced GDPs resulted in greater urine volumes and residual renal function after 12 months, but without other clinical benefits. Larger, better-quality studies are needed for accurate evaluation of the impact of these newer dialysates on patient-level hard outcomes.

Effect of Neutral-pH, Low–Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration

“…The differences between our results and those of the prior published metaanalyses are likely caused by study selection. We included two large trials in our analysis that were not included in the analysis by Cho et al (23,24) (studies by Cho et al [12] and Park et al [20]). These studies (12,20) were published after the meta-analysis by Cho et al (23,24) was published and added over 200 patients.…”

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

“…In the balANZ trial, the slope of the decline in RRF was not significantly different between the low-GDP and the conventional group, but the time to anuria was longer in the group treated with low-GDP solutions (17). In a subsequent meta-analysis, RRF and urine volume 12 months after the start of PD were significantly higher in patients treated with low-GDP as compared to conventional solutions (21,22). Whereas the beneficial effect of low-GDP solutions on peritoneal membrane function has strong theoretical underpinnings, the effects on RRF and/or diuresis are more enigmatic, although it has been proposed that the…”

Is it Beneficial to Convert to a Neutral-pH Bicarbonate/Lactate-Buffered PD Solution in Long-Term CAPD Patients? A Single-Center Prospective Study

“…Moreover, recent reports showed that bio-compatible PD solutions improved clinical outcomes in PD patients (5,6), although a recent meta-analysis revealed controversial results (7). However, most studies have focused on short-term or incident PD patients, and little is known about the effect of bio-compatible PD solutions on long-term PD patients who are anuric and have been treated with conventional PD solutions for several years.…”