Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution

Abstract

Background Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability. Objectives An evaluation of dialysate-to-plasma ratio (D/P) of urea, D/P creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Single-center prospective study with PG-DS; retrospective selection of the control group. Setting Peritoneal dialysis unit in a university hospital. Patients Fourteen patients (11 males; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPD duration and peritoneal permeability of the patients in the PG-DS group at the start of the study. Methods Standard PET was carried out at 1.6 ± 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 ± 0.6 months’ use of PG-DS (study period II, n = 14), after 4.4 ± 0.8 months’ use of PG-DS (study period III, n = 11), after 8.8 ± 2.2 months’ use of PG-DS (study period IV, n = 9), and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I – V). Results In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II – IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but KBD glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III. Conclusion Changes in peritoneal permeability are observed in CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.

PD solutions: New and old

“…Stabilization of peritoneal transport rates was shown in CCPD patients with RRF using a daytime polyglucose exchange, but there was no statistically signifi cant difference from the patients who used standard solutions for the daytime exchange. 85,86 The prospective European Automated Peritoneal Dialysis Outcomes Study (EAPOS) showed that polyglucose solution slows the development of high peritoneal membrane permeability in anuric patients. 87 This study, however, was not randomized.…”

Biocompatible peritoneal dialysis solutions: do they indeed affect the outcome?

“…It was also shown with the use of PG DS. 19,20 However, in pa tients treated with cyclic continuous PD (CCPD), having still preserved residual renal function, peritoneal transport measured using the mass transfer area coefficient (MTAC) for urea, creati nine, uric acid and glucose, remained unchanged during 2 years followup and was not significant between the groups treated using the PG DS for daytime exchange and the group using glucose solution for daytime exchange. 21,22 Moreover, accompanied by higher peritonitis rate in the stan dard group compared to the bic group.…”