Clinical biocompatibility of a neutral peritoneal dialysis solution with minimal glucose-degradation products - A 1-year randomized control trial

Abstract

Background. Chronic utilization of a bio-incompatible peritoneal dialysis (PD) solution with acidic pH and a high content of glucose degradation product (GDP) has been implicated as a contributing cause of peritoneal failure. We compared a newly formulated solution of neutral pH and low levels of GDP to a standard PD solution. Methods. Fifty new PD patients were randomized to a conventional lactate-buffered fluid (control) and a pH neutral, lactate-buffered, low GDP solution (balance). Patients were followed for 12 months. Serum samples were assayed for C-reactive protein (CRP). PD effluent was collected and assayed for cancer antigen-125 (CA125) and hyaluronan (HA). Clinical end points were the residual renal function and dialysis adequacy indices. Results. After 52 weeks of treatment, PD fluid CA125 rose from 2.45 ± 0.96 to 14.30 ± 2.17U/ml (P < 0.001), and HA declined from 2.26 ± 0.60 to 1.45 ± 0.32μg/ml (P = 0.07) in the balance group. The balance group had a higher PD fluid CA-125 (14.30 ± 2.17 vs 7.36 ± 2.23U/ml, P = 0.007), lower HA (1.45 ± 0.32 vs 2.55 ± 0.32μg/ml, P = 0.007), and lower serum CRP level (1.77 ± 0.42 vs 7.73 ± 2.42mg/l, P = 0.026) than the control group at 52 weeks. There was no difference in dialysis adequacy indices, ultrafiltration volume, urine output, residual renal function, peritonitis rate or need of hospitalization in 1 year. Conclusion. As compared to conventional PD solution, the use of balance, a neutral pH, low GDP solution resulted in a superior profile of PDE mesothelial cell marker and a lower degree of systemic inflammation, and the difference was maintained for 1 year. It remains to be determined whether these effects could result in better long-term clinical outcome. © 2007 Oxford University Press.