Effect of Biocompatible Peritoneal Dialysis Solution on Residual Renal Function: A Systematic Review of Randomized Controlled Trials

Abstract

♦ Introduction: Residual renal function (RRF) plays an important role in outcome of peritoneal dialysis (PD) including mortality. It is, therefore, important to provide a strategy for the preservation of RRF. The objective of this study was to evaluate relative protective effects of new glucose-based multicompartmental PD solution (PDS), which is well known to be more biocompatible than glucosebased conventional PDS, on RRF compared to conventional PDS by performing a systematic review (SR) of randomized controlled trials. ♦ Methods: We searched studies presented up to January 2014 in MEDLINE, EMBASE, the COCHRANE library, and local databases. Three independent reviewers reviewed and extracted prespecified data from each study. The random effects model, a more conservative analysis model, was used to combine trials and to perform stratified analyses based on the duration of follow-up. Study quality was assessed using the Cochrane Handbook for risk of bias. Eleven articles with 1,034 patients were identified for the SR.

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

“…Our meta-analysis differed from the analysis by Seo et al (25) in that we included two trials (studies by Fernández-Perpén et al [14] and Weiss et al [22]) not in their analysis. Also, we excluded two trials that the analysis by Seo et al (25) included; we excluded the study by Fan et al (27) for the reasons explained above, and also, we excluded the study by Williams et al (28) It is unclear why the use of neutral-pH, low-GDP solutions would result in improved RRF. Some have postulated that the reduced GDP content and the resultant lower levels of AGEs could prevent damage to the kidneys and thus, preserve RRF (4).…”

“…There have been two published meta-analyses comparing neutral-pH, low-GDP and conventional solutions by Cho et al (23,24) and Seo et al (25). Both have suggested that prolonged treatment (i.e., .12 months) with neutralpH, low-GDP solutions resulted in improved RRF.…”

A Patient on Peritoneal Dialysis with Refractory Volume Overload

“…This patient was maintained on ramipril and bumetanide throughout most of her clinical course. A meta-analysis of existing clinical trials provides evidence that the use of more biocompatible dialysate fluids is associated with better preservation of RRF, although the mechanism is not clear (5). Given that patients who are highly comorbid have a more rapid rate of decline of RRF, this may strengthen the argument to use such fluids, at least for this group.…”

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…”