NDT Advance Access published online on September 6, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl393
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1 Department of Internal Medicine, College of Medicine Yonsei University, Seoul, Korea
* To whom correspondence should be addressed. Background. Novel, biocompatible peritoneal dialysis (PD) solutions have become available in recent years. In 2001, low glucose degradation products (GDP), neutral pH solutions became commercially available in Korea. To date, there are no reports regarding the large scale adoption of these solutions in clinical practice and regarding what, if any, impact these solutions have on patient outcomes. Methods. Using a database of almost 4000 patients treated by PD in Korea, we conducted a prospective, longitudinal observational study documenting the patterns of use of one novel low GDP solution (balance®, Fresenius Medical Care, St Wendel, Germany) in 1909 PD incident patients between 1 January 2002 and midyear 2005. Outcomes including patient and technique survival and peritonitis rates were analysed using univariate and multivariate analysis. Results. Prescription of low GDP solutions reached between 70 and 80% by the year 2003 and persisted at this level. Patients prescribed low GDP PD solution tended to be younger and were more likely to be treated in centres with larger enrolment in the database. Survival of diabetic patients treated with the new PD solution was identical to that of the non-diabetic patients treated with standard PD fluids (PDF) and treatment with low GDP PDF independently reduced the relative risk (RR) of death (RR = 0.613; CI 0.50-0.74; P < 0.00001) in a proportional hazards model which included age, diabetes and centre experience. In a univariate analysis, low GDP PD solution was associated with a longer technique survival (P = 0.049) but this effect was not significant in multivariate analysis. No significant differences in peritonitis-free interval or peritonitis rate could be attributed to the prescribed PDF. Conclusion. Prescription of low GDP, pH-neutral PD solutions has rapidly increased in Korea. This change has resulted in a significant improvement in patient and technique survival without any measurable change in peritonitis incidence or rate. Reasons for the improved patient survival cannot be determined from this analysis and require further study.
Received January 17, 2006
Accepted June 6, 2006
Original Article
Changing prescribing practice in CAPD patients in Korea: increased utilization of low GDP solutions improves patient outcome
Ho Yung Lee 1 *, Hoon Young Choi 1, Hyeong Cheon Park 1, Bo Jeung Seo 2, Jun Young Do 3, Sung Ro Yun 4, Hyun Yong Song 4, Yeong Hoon Kim 5, Yong-Lim Kim 6, Dae Joong Kim 7, Yong Soo Kim 8, Moon Jae Kim 9, and Sug Kyun Shin 10
2 Wallace Memorial Baptist Hospital, Pusan, Korea
3 Yeungnam University, Daegu, Korea
4 Konyang University, Daejeon, Korea
5 Inje University, Pusan, Korea
6 Kyungpook National University, Daegu, Korea
7 Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
8 The Catholic University, Seoul, Korea
9 Inha University, Incheon, Korea
10 National Health Insurance Corporation Ilsan Hospital, Seoul, Korea
Ho Yung Lee, E-mail: hyl{at}yumc.yonsei.ac.kr
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