NDT Advance Access published online on September 27, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl559
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1 Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
* To whom correspondence should be addressed. Background. Chronic utilization of a bio-incompatible peritoneal dialysis (PD) solution with acidic pH and a high content of glucose degradation product (GDP) has been implicated as a contributing cause of peritoneal failure. We compared a newly formulated solution of neutral pH and low levels of GDP to a standard PD solution. Methods. Fifty new PD patients were randomized to a conventional lactate-buffered fluid (control) and a pH neutral, lactate-buffered, low GDP solution (balance). Patients were followed for 12 months. Serum samples were assayed for C-reactive protein (CRP). PD effluent was collected and assayed for cancer antigen-125 (CA125) and hyaluronan (HA). Clinical end points were the residual renal function and dialysis adequacy indices. Results. After 52 weeks of treatment, PD fluid CA125 rose from 2.45 ± 0.96 to 14.30 ± 2.17 U/ml (P < 0.001), and HA declined from 2.26 ± 0.60 to 1.45 ± 0.32 µg/ml (P = 0.07) in the balance group. The balance group had a higher PD fluid CA-125 (14.30 ± 2.17 vs 7.36 ± 2.23 U/ml, P = 0.007), lower HA (1.45 ± 0.32 vs 2.55 ± 0.32 µg/ml, P = 0.007), and lower serum CRP level (1.77 ± 0.42 vs 7.73 ± 2.42 mg/l, P = 0.026) than the control group at 52 weeks. There was no difference in dialysis adequacy indices, ultrafiltration volume, urine output, residual renal function, peritonitis rate or need of hospitalization in 1 year. Conclusion. As compared to conventional PD solution, the use of balance, a neutral pH, low GDP solution resulted in a superior profile of PDE mesothelial cell marker and a lower degree of systemic inflammation, and the difference was maintained for 1 year. It remains to be determined whether these effects could result in better long-term clinical outcome.
Received May 22, 2006
Accepted August 18, 2006
Original Article
Clinical biocompatibility of a neutral peritoneal dialysis solution with minimal glucose-degradation products--A 1-year randomized control trial
Cheuk-Chun Szeto 1 *, Kai-Ming Chow 1, Christopher Wai-Kei Lam 2, Chi-Bon Leung 1, Bonnie Ching-Ha Kwan 1, Kwok-Yi Chung 1, Man-Ching Law 1, and Philip Kam-Tao Li 1
2 Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
Cheuk-Chun Szeto, E-mail: ccszeto{at}cuhk.edu.hk
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