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

Abstract

Background and objectives Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time.Design, setting, participants, & measurements Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers.Results Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including .1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =2110; 95% confidence interval, 2312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06).Conclusions The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.

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

“…However, the beneficial effects on RRF were mixed in a greater number of later studies and trials [75][76][77][78] . Yohanna et al [79] systematically reviewed 11 trials in which 643 patients were included. They reported that the use of a neutral-pH, low-GDP solution resulted in better preserved RRF after various study periods.…”

“…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] .…”

Recommendations for pathological diagnosis on biopsy samples from peritoneal dialysis patients

“…These ultrastructural findings might be linked not only to former pathological studies [16,[91][92][93] but also to clinical findings following the use of biocompatible solutions, for example, preserved UF capacity despite increasing small solute transport [94,95]. However, the impact on peritoneal membrane transport function has not been quantified by meta-analysis [96][97][98]. Last but not least, biocompatible PD solution is not fully biocompatible, and still needs to be improved to counter unsolved problems such as infection, PD membrane preservation, and patient survival (for review [57]).…”

Peritoneal dialysis practice in Australia and New Zealand: A call to sustain the action

“…Furthermore, based on two systematic reviews and meta‐analyses of randomized controlled trials, the ISPD guidelines recently provided a weak grade (2B) recommendation for biocompatible solutions for the purpose of preserving residual renal function when used for more than 12 months . Three subsequently published systematic reviews have further confirmed that biocompatible solutions preserve residual renal function better than conventional solutions, with one systematic review demonstrating a benefit within the first 12 months …”