Biocompatible Solutions and Long-Term Changes in Peritoneal Solute Transport

Elphick, Emma; Teece, Lucy; Chess, James; Do, Jun‐Young; Kim, Yong-Lim; Lee, H. Bahl; Topley, Nicholas; Davies, Simon; Lambie, Mark

doi:10.2215/cjn.02380218

Cited by 37 publications

(29 citation statements)

References 28 publications

(27 reference statements)

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“…Alternatively, peritoneal clearance may be too insensitive as a marker of peritoneal membrane structure; there is evidence that the peritoneal solute transport rate is better. 134 Trial quality varied among included RCTs (Table S5). The patients analyzed here may not be representative of the true patient population due to our reliance on published RCTs, with restrictive selection criteria in some instances.…”

Section: Discussionmentioning

confidence: 99%

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

Goossen

Becker

Marshall

et al. 2020

American Journal of Kidney Diseases

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The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. Study Design: Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. Setting & Study Populations: Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. Selection Criteria for Studies: Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. Data Extraction: 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. Analytic Approach: Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. Results: 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24 h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, −40.84 [95% CI, −48.09 to −33.59] g/ long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (−0.50 [95% CI, −1.19 to 0.18] mmol/L; low certainty) and hemoglobin A 1c levels (−0.14% [95% CI, −0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. Limitations: Trial quality was variable. The followup period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. Conclusions: Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and costeffectiveness associated with icodextrin is needed. T he prevalence of kidney replacement therapy is expected to increase steeply. 1 Approximately 15% of dialysis patients globally use peritoneal dialysis (PD), and this proportion is increasing. 2 PD is probably associated with the same survival as hemodialysis (HD) 3-6 but pre...

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Section: Discussionmentioning

confidence: 99%

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

Goossen

Becker

Marshall

et al. 2020

American Journal of Kidney Diseases

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“…106,107 The more biocompatible PD solutions have also been associated with stable peritoneal membrane function and UF capacity over time, compared with conventional glucose-based solutions, which have been associated with a progressive decline in UF capacity over time. [108][109][110] Icodextrin. Moderate-certainty evidence indicates that icodextrin augments peritoneal UF compared with standard glucose solutions.…”

Section: Hypertension and The Pd Prescriptionmentioning

confidence: 99%

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

Flythe¹,

Chang²,

Gallagher³

et al. 2020

Kidney International

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158

163

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“…Moreover, the causative organisms and outcomes after the first peritonitis episode were comparable, although it is possible that the peritonitis episodes may have been less severe in patients receiving biocompatible solutions, such as was shown in the BalANZ Study (10). The authors concluded that the findings "add weight to the notion that biocompatible solutions may have long-term clinical benefits" on the peritoneal membrane compared with conventional solutions (9).…”

mentioning

confidence: 99%

“…In this issue of the Clinical Journal of the American Society of Nephrology, Elphick et al (9) examined the relationship between PD solution type and PSTR trajectory in 366 patients on incident and prevalent PD followed long term (mean, 12.8 years conventional; 7.5 years biocompatible) as part of the Global Fluid Study, a multinational, multicenter, prospective, observational cohort study involving ten centers in the United Kingdom, Canada, and South Korea. Of the 960 patients enrolled in the study, 366 (38%) had exclusively used either conventional (n=295) or biocompatible (n=71) solutions and had two or more PSTR measurements (performed on an approximately 6-month basis), with at least one measurement within the first 12 months after PD commencement.…”

mentioning

confidence: 99%