Peritoneal dialysis with solutions low in glucose degradation products is associated with improved biocompatibility profile towards peritoneal mesothelial cells

Witowski, Janusz; Korybalska, Katarzyna; Książek, Krzysztof; Wiśniewska-Elnur, Justyna; Jörres, Achim; Lage, Cristina; Schaub, Thomas P.; Passlick–Deetjen, Jutta; Bręborowicz, Andrzej; Grzegorzewska, Alicja E.; Książek, Andrzej; Liberek, Tomasz; Lichodziejewska‐Niemierko, Monika; Majdan, Maria; Rutkowski, Bolesław; Stompór, Tomasz; Sułowicz, Władysław

doi:10.1093/ndt/gfh013

Cited by 63 publications

(41 citation statements)

References 18 publications

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“…Dialytic glucose exposure increased from 113646 to 126650 g/m 2 per day in the L-PDF group and from 100626 to 116628 g/m 2 per day in the B-PDF group (P=0.25 for group, P,0.001 for time, P=0.27 for interaction), whereas the number of cycles remained constant. Likewise, there were no statistically significant differences regarding total daily dwell time (7.861.7 and 7.861.3 hours at visit 0 and 7.060.7 and 8.061.1 hours at visit 10) and dwell volume (10076131 and 9936164 ml/m 2 at visit 0 and 10366166 and 10076157 ml/m 2 at visit 10 with L-PDF and B-PDF, respectively).…”

Section: Biochemistry and Dialysis Prescription During The Studymentioning

confidence: 95%

“…The final fluid instilled after mixing is buffered at a neutral pH in contrast to the acidic milieu of conventional solutions. Numerous in vitro and animal studies showed superior biocompatibility of multichamber PD solutions (1)(2)(3)(4)(5). Recent randomized controlled trials suggest improved preservation of residual renal function (6,7) and ultrafiltration capacity (8) and lowering of systemic concentrations of advanced glycation end products (9,10), which contribute to accelerated vasculopathy and amyloidosis.…”

Section: Introductionmentioning

confidence: 99%

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Effect of the Dialysis Fluid Buffer on Peritoneal Membrane Function in Children

Schmitt

Nau

Gemulla

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Double-chamber peritoneal dialysis fluids exert less toxicity by their neutral pH and reduced glucose degradation product content. The role of the buffer compound (lactate and bicarbonate) has not been defined in humans.Design, setting, participants, & measurements A multicenter randomized controlled trial in 37 children on automated peritoneal dialysis was performed. After a 2-month run-in period with conventional peritoneal dialysis fluids, patients were randomized to neutral-pH, low-glucose degradation product peritoneal dialysis fluids with 35 mM lactate or 34 mM bicarbonate content. Clinical and biochemical monitoring was performed monthly, and peritoneal equilibration tests and 24-hour clearance studies were performed at 0, 3, 6, and 10 months.Results No statistically significant difference in capillary blood pH, serum bicarbonate, or oral buffer supplementation emerged during the study. At baseline, peritoneal solute equilibration and clearance rates were similar. During the study, 4-hour dialysis to plasma ratio of creatinine tended to increase, and 24-hour dialytic creatinine and phosphate clearance increased with lactate peritoneal dialysis fluid but not with bicarbonate peritoneal dialysis fluid. Daily net ultrafiltration, which was similar at baseline (lactate fluid=5.462.6 ml/g glucose exposure, bicarbonate fluid=4.961.9 ml/g glucose exposure), decreased to 4.661.0 ml/g glucose exposure in the lactate peritoneal dialysis fluid group, whereas it increased to 5.161.7 ml/g glucose exposure in the bicarbonate content peritoneal dialysis fluid group (P=0.006 for interaction).Conclusions When using biocompatible peritoneal dialysis fluids, equally good acidosis control is achieved with lactate and bicarbonate buffers. Improved long-term preservation of peritoneal membrane function may, however, be achieved with bicarbonate-based peritoneal dialysis fluids.

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Section: Biochemistry and Dialysis Prescription During The Studymentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Effect of the Dialysis Fluid Buffer on Peritoneal Membrane Function in Children

Schmitt

Nau

Gemulla

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The term GDP represents a number of GDPs, such as acetaldehyde, formaldehyde, furaldehyde, glyoxal, methylglyoxal, and 5-hydroxymethylfuraldehyde [6]. Many publications describe an unfavorable effect of GDP on mesothelial cells of the peritoneum by impairing its proliferation and viability [3,7,8,9,10,11,12,13,14]. Furthermore, pH-neutral solutions are described as subjectively more tolerable [14].…”

Section: Discussionmentioning

confidence: 99%

Continuous Ambulatory Peritoneal Dialysis – Developments during Changing Times

Furkert

Zeier²,

Schwenger³

2008

Nephron Clin Pract

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Introduction: Continuous ambulatory peritoneal dialysis (CAPD) treatment is subject to constant changes. Departing from this thesis, it should be analyzed in which respects CAPD treatment at the Heidelberg outpatient clinic has changed when considering demographic data, and CAPD-specific data including infection rates and clinical parameters. Materials and Methods: A retrospective study was carried out in the course of which a cohort of 67 CAPD patients treated before the year 2000 was compared with a cohort of 53 patients treated from the year 2000 on. Demographic data, CAPD-specific and clinical data at the commencement of treatment and data gathered during the observation period thereafter were recorded. Results: The patients of the more recent cohort were 5 years older. At the initiation of treatment, the volume of residual diuresis was higher in the patients treated from 2000 on than in those treated before. The blood pressure in patients belonging to the more recently treated group was also lower than the blood pressure of those treated before. The incidence of peritonitis and exit-site infections has decreased. On the other hand, the hemoglobin level has risen. Discussion: Compared to the past, many parameters have improved. Above all, the findings suggest that medical care and treatment have become better, probably as a result of the modified guidelines. The significant decrease in infections is probably also due to the use of the new dialysis fluids.

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“…net açık ortaya konulabilmiş değildir (1). 2010 yı-lında yapılan 1 yıllık gözlemsel prospektif ça-lışmada geleneksel ve düşük GDPli solüsyonlar kullanan hastalarda diyalizat TGF β, VEGF, IL6 oluşumu incelenmiştir (30 (34)(35)(36). Diyalizat IL6 dü-zeyleri bazal peritoneal transport durumu ve inflamatuvar faktörler ile ilişkili bulunmuştur.…”

Section: Periton Zarı üZerindeki Lokal Etkileriunclassified

Peri̇ton Di̇yali̇z Sıvıları (Peritoneal Dialysis Solutions)

Dinçel¹,

Bulut²,

Mır³

2014

ZKTB

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ÖZETPeriton diyalizi (PD) son dönem böbrek hastaları için önemli bir renal replasman tedavi yöntemi-dir. Hastalar evde uygulanan PD tedavisine kolayca uyum sağlarlar. Geleneksel standart periton diyaliz solüsyonları osmotic ajan olarak glukoz kullanırlar. Glukoz içeren diyaliz sıvıları yüksek konsantrasyonda glukoz içerirler. Laktat ve glukoz yıkım ürünleri-nin oluşmasına neden olurlar. Yüksek osmolalite ve düşük pH'a sahiptirler. Tüm bu sayılan özellikler peritona zarar verir (fibrosis, neoanjiogenez). Yeni PD solüsyonları alternatif tampon sistemleri ve ozmotik ajan kullanırlar (ikodekstrin ve aminoasitler). Yük-sek pH'ya sahip olup daha az glukoz yıkım ürünleri-nin oluşumuna neden olurlar. Yeni PD solüsyonları-nın kullanımı ile daha iyi metabolic kontrol ve vücut kompozisyonu sağlanabilir. Yeni solüsyonların kullanımı daha az fibrozise yol açar ve antiinflamatuvar özelliklerinden dolayı da periton zarı viabilitesini arttırırlar. Ama hasta sağ kalımını artırdıklarına dair kanıt yoktur. Bu derlemenin ile PD için kullanılan farklı tipte periton diyaliz sıvılarının tanımlaması ve gözden geçirilmesi amaçlanmıştır.Anahtar kelimeler: kronik böbrek yetmezliği, periton diyalizi, periton diyaliz solüsyonu ABSTRACT Peritoneal dialysis (PD) is an important kidney replacement therapy for end stage renal disease (ESRD) patients. Patients easily adapt at home based treatment of PD. Standard traditional solutions uses glucose as an osmotic agent. Glucose based dialysis solutions contains high concentrations of glucose. They cause production of glucose degradation products and lactate. They have high osmolality, and low pH. All these features damage to the peritoneum by fibrosis and neoangiogenesis. Newer PD solutions were produced with alternative buffers and osmotic agents (icodextrin or amino acids). They have a higher pH and causes production of fewer glucose degradation products. With the usage of newer PD solutions we can achieve better metabolic controls of patients and body compositions. Peritoneal membrane viability increases by their less fibrotic and less inflammatory features of new solutions. But their effect on patient survival is not clearly identified yet. The aim of this review is to describe and to overview the different types of peritoneal dialysissolutions used during PD.

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Peritoneal dialysis with solutions low in glucose degradation products is associated with improved biocompatibility profile towards peritoneal mesothelial cells

Abstract: These results suggest that therapy with new pH-neutral low-GDP solutions contribute to an intraperitoneal milieu that improves mesothelial cell proliferation and viability. It may positively impact on the preservation of the peritoneal membrane integrity during long-term dialysis.

Cited by 63 publications

References 18 publications

Effect of the Dialysis Fluid Buffer on Peritoneal Membrane Function in Children

Effect of the Dialysis Fluid Buffer on Peritoneal Membrane Function in Children

Continuous Ambulatory Peritoneal Dialysis – Developments during Changing Times

Peri̇ton Di̇yali̇z Sıvıları (Peritoneal Dialysis Solutions)

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