Low- verus conventional-level of glucose peritoneal dialysis regimes: comparison of inflammatory and fibrotic mediators in peritoneal dialysate

Abstract

INTRODUCTION AND AIMS: New peritoneal dialysis fluids (PDF) such as Extraneal, Nutrineal, and Physioneal offer the advantages of reduced glucose exposure and improved biocompatibility, compared with conventional glucose-based PDF. We investigated the effect of these new PDFs on peritoneal inflammation, fibrosis, and clinical parameters. METHODS: Eighty new PD patients were randomized to receive PD treatment with either a low-glucose regimen comprising Physioneal, Nutrineal, and Extraneal (PEN) or with conventional glucose-based dialysate (Dianeal) (Controls) for 12 months. PDF and serum samples were collected at baseline then every 6 months, and the levels of hyaluronan (HA), nitric oxide (NO) and CA125 determined. Residual renal function, dialysis adequacy and peritoneal solute transport rate were also measured. RESULTS: Dialysate CA125 levels increased over time in PEN group, and were significantly higher than those in Controls (p<0.01). Dialysate NO level decreased in the PEN group but rose in Controls over the 12 month period (p<0.05). Both groups showed increasing dialysate HA levels over time, but in the PEN group this increase occurred predominantly in the first 6 months, and dialysate HA levels remained relatively stable subsequently. PEN group showed significantly increased ultrafiltration over time (p=0.05), while residual renal function was comparable in the two groups (p=0.186). Mean total Kt/V at 12-month was 2.44 (2.17-2.70) and 2.18 (1.99-2.36) in the PEN group and Controls respectively (p=0.148). CONCLUSIONS: The data on CA125 and NO suggest better preservation of peritoneal mesothelial cell mass and reduced peritoneal inflammation in patients treated with the PEN regimen compared with Controls on Dianeal dialysis. The serial profile of dialysate HA levels also suggests an amelioration in peritoneal inflammation with increasing duration of PEN dialysis. These data imply improved peritoneal preservation with long-term PEN dialysis compared with conventional PDF.