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Article: A study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation products

TitleA study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation products
Authors
Issue Date2012
PublisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
Citation
Peritoneal Dialysis International, 2012, v. 32 n. 3, p. 280-291 How to Cite?
AbstractOBJECTIVE: Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy, concerns remain regarding the bioincompatible nature of standard PD fluid (PDF). Short-term studies of new biocompatible PDFs low in glucose degradation products (GDPs) reveal divergent results with respect to peritoneal integrity. METHODS: We studied 125 patients on maintenance PD who were assigned, by simple randomization, to receive either conventional or low-GDP PDF at PD initiation. Parameters of dialysis adequacy and peritoneal transport of small solutes were determined at initiation and after a period of maintenance PD at the time when serum and overnight effluent dialysate were simultaneously collected and assayed for various cytokines, chemokines, adipokines, and cardiac biomarkers. All patients were further followed prospectively for an average of 15 months from the day of serum and effluent collection to determine patient survival and cardiovascular events. RESULTS: Patients treated with conventional or low-GDP PDF were matched for sex, age, duration of dialysis, dialysis adequacy, and incidence of cardiovascular disease or diabetes. After an average of 2.3 years of PD treatment, the weekly total and peritoneal creatinine clearance, and the total and peritoneal Kt/V were comparable in the groups. However, urine output was higher in patients using low-GDP PDF despite there having been no difference between the groups at PD initiation. Patients using low-GDP PDF also experienced a slower rate of decline of residual glomerular filtration and urine output than did patients on conventional PDF. Compared with serum concentrations, effluent concentrations of tumor necrosis factor alpha, hepatocyte growth factor, macrophage migration inhibitory factor, interleukins 8 and 6, C-reactive protein, and leptin were found to be higher in both groups of patients after long-term PD, suggesting that the peritoneal cavity was the major source of those mediators. Compared with patients on low-GDP PDF, patients on conventional fluid showed elevated leptin and reduced adiponectin levels in serum and effluent. The effluent concentration of interleukin 8 was significantly lower in patients using low-GDP PDF. The survival rate and incidence of cardiovascular complications did not differ between these groups after maintenance PD for an average of 3.6 years. CONCLUSIONS: It appears that low-GDP PDF results in an improvement of local peritoneal homeostasis through a reduction of chronic inflammatory status in the peritoneum.
Persistent Identifierhttp://hdl.handle.net/10722/169242
ISSN
2015 Impact Factor: 1.298
2015 SCImago Journal Rankings: 0.683
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLai, KNen_US
dc.contributor.authorLam, MFen_US
dc.contributor.authorLeung, JCKen_US
dc.contributor.authorChan, LYYen_US
dc.contributor.authorLam, CWKen_US
dc.contributor.authorChan, IHSen_US
dc.contributor.authorChan, HWen_US
dc.contributor.authorLi, CSen_US
dc.contributor.authorWong, SSHen_US
dc.contributor.authorHo, YWen_US
dc.contributor.authorCheuk, Aen_US
dc.contributor.authorTang, MKLen_US
dc.contributor.authorTang, SCWen_US
dc.date.accessioned2012-10-18T08:47:04Z-
dc.date.available2012-10-18T08:47:04Z-
dc.date.issued2012en_US
dc.identifier.citationPeritoneal Dialysis International, 2012, v. 32 n. 3, p. 280-291en_US
dc.identifier.issn0896-8608en_US
dc.identifier.urihttp://hdl.handle.net/10722/169242-
dc.description.abstractOBJECTIVE: Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy, concerns remain regarding the bioincompatible nature of standard PD fluid (PDF). Short-term studies of new biocompatible PDFs low in glucose degradation products (GDPs) reveal divergent results with respect to peritoneal integrity. METHODS: We studied 125 patients on maintenance PD who were assigned, by simple randomization, to receive either conventional or low-GDP PDF at PD initiation. Parameters of dialysis adequacy and peritoneal transport of small solutes were determined at initiation and after a period of maintenance PD at the time when serum and overnight effluent dialysate were simultaneously collected and assayed for various cytokines, chemokines, adipokines, and cardiac biomarkers. All patients were further followed prospectively for an average of 15 months from the day of serum and effluent collection to determine patient survival and cardiovascular events. RESULTS: Patients treated with conventional or low-GDP PDF were matched for sex, age, duration of dialysis, dialysis adequacy, and incidence of cardiovascular disease or diabetes. After an average of 2.3 years of PD treatment, the weekly total and peritoneal creatinine clearance, and the total and peritoneal Kt/V were comparable in the groups. However, urine output was higher in patients using low-GDP PDF despite there having been no difference between the groups at PD initiation. Patients using low-GDP PDF also experienced a slower rate of decline of residual glomerular filtration and urine output than did patients on conventional PDF. Compared with serum concentrations, effluent concentrations of tumor necrosis factor alpha, hepatocyte growth factor, macrophage migration inhibitory factor, interleukins 8 and 6, C-reactive protein, and leptin were found to be higher in both groups of patients after long-term PD, suggesting that the peritoneal cavity was the major source of those mediators. Compared with patients on low-GDP PDF, patients on conventional fluid showed elevated leptin and reduced adiponectin levels in serum and effluent. The effluent concentration of interleukin 8 was significantly lower in patients using low-GDP PDF. The survival rate and incidence of cardiovascular complications did not differ between these groups after maintenance PD for an average of 3.6 years. CONCLUSIONS: It appears that low-GDP PDF results in an improvement of local peritoneal homeostasis through a reduction of chronic inflammatory status in the peritoneum.-
dc.languageengen_US
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.comen_US
dc.relation.ispartofPeritoneal Dialysis Internationalen_US
dc.subject.meshDialysis Solutions - chemistry-
dc.subject.meshGlucose - analysis - metabolism-
dc.subject.meshHumans-
dc.subject.meshPeritoneal Dialysis-
dc.subject.meshProspective Studies-
dc.titleA study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation productsen_US
dc.typeArticleen_US
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0896-8608&volume=32&issue=3&spage=280&epage=291&date=2011&atitle=A+study+of+the+clinical+and+biochemical+profile+of+peritoneal+dialysis+fluid+low+in+glucose+degradation+productsen_US
dc.identifier.emailLai, KN: knlai@hku.hken_US
dc.identifier.emailLam, MF: feimflam@hku.hken_US
dc.identifier.emailLeung, JCK: jckleung@hku.hken_US
dc.identifier.emailChan, LYY: yychanb@hkucc.hku.hken_US
dc.identifier.emailTang, SCW: scwtang@hku.hken_US
dc.identifier.authorityLai, KN=rp00324en_US
dc.identifier.authorityLeung, JCK=rp00448en_US
dc.identifier.authorityTang, SCW=rp00480en_US
dc.description.naturelink_to_OA_fulltext-
dc.identifier.doi10.3747/pdi.2010.00176-
dc.identifier.pmid22045098-
dc.identifier.pmcidPMC3525436-
dc.identifier.scopuseid_2-s2.0-84861685155-
dc.identifier.hkuros211512en_US
dc.identifier.volume32en_US
dc.identifier.issue3en_US
dc.identifier.spage280en_US
dc.identifier.epage291en_US
dc.identifier.isiWOS:000305215400010-
dc.publisher.placeCanada-

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