Impact of a low-glucose peritoneal dialysis regimen on inflammatory and fibrotic mediators in effluent dialysate

Abstract

BACKGROUND: Constant exposure of the peritoneum to bio-incompatible peritoneal dialysis fluids (PDF) results in deleterious changes to the peritoneal structure and function, which leads to technique failure and unfavorable clinical outcomes. While low-glucose PDF may have improved biocompatibility compared with conventional glucose based dialysates, their impact on biomarkers of inflammation, fibrosis and peritoneal membrane integrity remains to be investigated. METHODS: New PD patients who had entered the PD programme within 1 month were randomized to receive either a low-glucose regimen (1 exchange of Nutrineal®, 2-3 exchanges of Physioneal® and 1 overnight exchange of Extraneal®) for 12 months and then Dianeal® for 6 months (PEN Group, n=43), or 3 to 4 exchanges of Dianeal® for 18 months (Control Group, n=37). Overnight PDF was collected from all patients for the assessment of CA125, and inflammatory and fibrotic markers. RESULTS: Patients in the PEN Group showed a progressive increase in dialysate CA125 level, which was significantly higher than that in Controls after 12 months treatment [mean (range): 56.50 (16.00-166.00) IU/ml vs 20.50 (1.00-84.00) IU/ml, PEN vs Control, P<0.01)], and which reverted after switching back to Dianeal®. Similarly, dialysate levels of decorin, MMP-9, adiponectin, ICAM and VCAM were 1.35-, 2.52-, 1.79-, 1.93- and 1.59-folds respectively higher in the PEN Group compared to Controls after 12 months, but the two groups showed similar levels after the PEN Group changed back to Dianeal®. In contrast, dialysate MIF level was significantly lower in the PEN Group during the first 12 months [0.46 (0.06-1.22) pg/ml vs 0.77 (0.00-1.95) pg/ml, P<0.05], but was comparable between the two groups at 18 months. CONCLUSIONS: Our data demonstrate that the low-glucose dialysis regimen is associated with reduced intra-peritoneal inflammatory and fibrotic response, and thus potentially result in better preservation of the structural and functional property of the peritoneum during long-term peritoneal dialysis.