Novel Peritoneal Dialysis Solutions – What Are the Clinical Implications?

Abstract

Novel low-glucose degradation products (GDP) peritoneal dialysis (PD) fluids have an improved biocompatibility profile as compared to standard fluids. Clinical studies suggest that their use may be associated with favorable clinical outcomes; however, large prospective randomized studies addressing clinical endpoints such as patient and technique survival are presently lacking. Nevertheless, as their only disadvantage is their cost, they are already being used as the standard treatment by many adult PD centers. This policy is also in line with the latest recommendations from the European Pediatric Dialysis Working Group which advises that conventional, single-chamber PD solutions should be replaced by PD solutions with reduced GDP content. The use of icodextrin, the glucose polymer PD solution, is recommended for patients with high or high-average peritoneal transport and/or ultrafiltration problems who otherwise would resort to hypertonic (3.86% glucose) exchanges.

Peritoneal ultrafiltration in end-stage congestive heart failure

“…Due to minimal diffusion into the systemic circulation it leads to constant high UF regardless of peritoneal membrane transportation properties. So far it has been the only substance that can provide UF when it stays in the peritoneal cavity for longer than 8 h. Experimental treatments in patients with end-stage renal disease indicate that icodextrin is more effective than glucose with regard to systemic extravascular water reduction and this effect is proportional the to state of hydration [19]. It is also more effective in removing medium-size compounds (e.g.…”

“…It is also more effective in removing medium-size compounds (e.g. leptin) and finally, as opposed to glucose, does not cause metabolic disorders (hyperinsulinemia, dyslipidemia) [19].…”

IL-17A as a Potential Therapeutic Target for Patients on Peritoneal Dialysis

“…Conventional PDF contain high glucose (ranging from 1.5% to 4.25%) and high lactate concentrations as an osmotic gradient enhancer and a buffering agent, respectively [ 4 ]. Importantly, glucose chemical instability during heat sterilization generates toxic glucose degradation products (GDP), including methylglyoxal; glyoxal; 3-deoxyglucosone; and above all, 3,4-dideoxyglucosone-3-ene [ 5 , 6 , 7 ]. Newer PDF, including biocompatible glucose-based solutions, icodextrin, and taurin solutions, have been developed to reduce the deleterious effects of PDF exposure on the peritoneal membrane (PM) [ 2 , 8 ].…”

Article Commentary: Hyperbranched Polyglycerol: A Future Alternative to Polyglucose in Peritoneal Dialysis Fluids?

“…Despite lower toxicity, the long-term beneficial effects of "GDP-free" PDFs have been hard to prove (6)(7)(8). However, the recently published balANZ study suggests that, compared with conventional PDFs, biocompatible PDFs may delay the onset of anuria and reduce the incidence of peritonitis (9).…”