NDT Advance Access originally published online on March 3, 2009
Nephrology Dialysis Transplantation 2009 24(9):2899-2908; doi:10.1093/ndt/gfp054
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Benefits of biocompatible PD fluid for preservation of residual renal function in incident CAPD patients: a 1-year study
1 Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea 2 Department of Internal Medicine & Kidney Research Institute, Hallym University College of Medicine, Anyang, Korea 3 Department of Internal Medicine, Seoul National University College of Medicine 4 Kidney Research Institute, Medical Research Center, Seoul National University, Seoul, Korea 5 Transplantation Research Institute, Seoul National University, Seoul, Korea
Correspondence and offprint requests to: Kook-Hwan Oh; E-mail: khoh{at}snu.ac.kr
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Abstract |
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Background. In vitro studies of peritoneal dialysis (PD) solutions demonstrated that a biocompatible fluid with neutral-pH and low glucose degradation products (LF) has better biocompatibility than a conventional acidic lactate-buffered fluid (CF). However, few clinical trials have investigated the effects of the biocompatible solution on residual renal function (RRF). We performed a prospective, randomized trial with patients starting continuous ambulatory peritoneal dialysis (CAPD).
Methods. Ninety-one incident patients started CAPD for 12-month treatment with either LF (Balance®, Fresenius, n = 48) or CF (CAPD/DPCA®, Fresenius, n = 43). RRF, peritoneal solute transport rate and solute clearance were measured every 6 months.
Results. LF had a significant effect on the change of glomerular filtration rate (GFR) (P = 0.048 by the mixed model). In per-protocol analysis, GFR in the LF group did not decrease over a 12-month period, while GFR in the control group significantly decreased (0.13 ± 33.4 L/ week/1.73 m2 for LF versus –13.6 ± 19.4 L/week/1.73 m2 for CF, P = 0.049). Subgroup analysis for patients with initial GFR of 2 mL/min/1.73 m2 or above showed a significantly higher GFR for the LF group over the 12-month period. At Month 13, serum total CO2 levels were higher and serum albumin levels were lower in the LF group. No differences between the two groups were observed for the C-reactive protein. Over the 12-month period, effluent cancer antigen-125 levels significantly increased in the LF group, compared with those of the CF group, while effluent interleukin-6 levels were not different between the two groups.
Conclusion. Our study suggests that LF may better preserve RRF over the 12-month treatment period in incident CAPD patients.
Keywords: end-stage renal disease; glucose degradation products; peritoneal dialysis; randomized controlled trials; residual renal function
Received for publication: 13. 3.08
Accepted in revised form: 26. 1.09
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