Clinical and biochemical profile of a low-glucose degradation product peritoneal dialysis fluid: a four-year study

Abstract

Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy, concerns remain regarding the bioincompatible nature of standard peritoneal dialysis fluid (PDF). Short-term studies of new biocompatible low glucose degradation products (GDP) peritoneal dialysis fluid reveal divergent results in patient survival, and peritoneal integrity. We recruited 125 patients on maintenance PD for at least 12 months. They were previously assigned to receive either conventional or low-GDP PDF at random. Two groups of patients were matched for gender, age, duration of dialysis and incidence of cardiovascular disease or diabetes. Serum samples and overnight effluent dialysate were simultaneously collected and assayed for different cytokines, chemokines, adipokines and cardiac biomarkers. After an average duration of CAPD treatment of 2.3 years, both groups had comparable weekly creatinine clearance, peritoneal clearance, total Kt/V or peritoneal Kt/V. However, patients receiving low-GDP PDF had better residual renal function with higher urine output. Compared with new patients receiving the first dialysis, higher concentrations of TNF-a, TGF-b, HGF, MIF, IL8, IL6, CRP and leptin comparable to serum level were found in effluent dialysate in both groups of patients on long-term PD. There was also decreased concentration of adiponectin in the effluent. The abnormally raised leptin and reduced adiponectin levels in serum and effluent were partially corrected in patients on low-GDP PDF when compared with the conventional PDF group. The effluent concentration of interleukin 8 was also significantly lower in those using low-GDP PDF. The survival rate and incidence of cardiovascular complications did not differ between two groups of patients after maintenance PD for an average of 3.6 years. It appears that low-GDP PDF results in an improvement in local peritoneal homeostasis and may potentially have a positive impact on long-term survival and cardiovascular complication by reducing the chronic inflammatory status in the peritoneum.