Biocompatibility and Tolerability of a Purely Bicarbonate-Buffered Peritoneal Dialysis Solution

Background Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions; however, until now, the effect of purely bicarbonate-buffered solutions has not been intensively studied in vivo. Methods This study was an open label, prospective, crossover multicenter trial to investigate the biocompatibility of a purely bicarbonate-buffered solution (bicPDF) by measuring biocompatibility parameters such as cancer antigen 125 (CA125) in peritoneal effluent. 55 patients were enrolled in the study. After a 2-week run-in phase, 53 patients could be randomized into 2 groups, starting with either standard lactate-buffered peritoneal dialysis fluid (SPDF) for 12 weeks (phase 1) and then switching to bicPDF for 12 weeks (phase 2), or vice versa. Overnight peritoneal effluents were collected at baseline and at the end of phases 1 and 2 and were tested for CA125, hyaluronic acid, vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), interferon gamma (IFNγ), and transforming growth factor-beta1 (TGF-β1). Total ultrafiltration and residual renal function were also assessed. At the end of the study, pain during fluid exchange and dwell was evaluated using special questionnaires. Results 34 patients completed the study; 27 of them provided data for analysis of the biocompatibility parameters. CA125 levels in overnight effluent were significantly higher with bicPDF (61.9 ± 33.2 U/L) than with SPDF (18.6 ± 18.2 U/L, p < 0.001). Hyaluronic acid levels were significantly lower after the use of bicPDF (185.0 ± 119.6 ng/mL) than after SPDF (257.4 ± 174.0 ng/mL, p = 0.013). Both TNF-α and TGF-β1 showed higher levels with the use of bicPDF than with SPDF. No differences were observed for IL-6, VEGF, or IFNγ levels. We observed an improvement in the glomerular filtration rate with the use of bicPDF but no differences were observed for total fluid loss. Pain scores could be analyzed in 23 patients: there was no difference between the solutions. Conclusions The use of a purely bicarbonate-buffered low-glucose degradation product solution significantly changes most of the peritoneal effluent markers measured, suggesting an improvement in peritoneal membrane integrity. Additionally, it seems to have a positive effect on residual renal function.

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Residual Renal Function and Effect of Low-Sodium Solution on Blood Pressure in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00120 ◽

2019 ◽

Vol 39 (4) ◽

pp. 335-343 ◽

Cited By ~ 4

Author(s):

Bolesław Rutkowski ◽

Paul Tam ◽

Frank M. van der Sande ◽

Andreas Vychytil ◽

Vedat Schwenger ◽

...

Keyword(s):

Blood Pressure ◽

Renal Function ◽

Peritoneal Dialysis ◽

Antihypertensive Medication ◽

Residual Renal Function ◽

Double Blind ◽

Low Sodium ◽

Peritoneal Dialysis Fluid ◽

Daily Dose ◽

The Impact

BackgroundResidual renal function (RRF) affects sodium and fluid balance. The aim of this analysis was to examine the impact of RRF on the effect of a sodium-reduced peritoneal dialysis fluid (PDF) on blood pressure (BP).MethodsThis is a post-hoc analysis of a prospective, randomized, controlled double-blind clinical trial with 82 patients on continuous ambulatory PD (CAPD) treated with a low-sodium (125 mmol/L Na) or a standard-sodium (134 mmol/L Na) PDF. Subgroups according to glomerular filtration rate (GFR) at baseline (≤ / > 6 mL/min/1.73 m2) were analyzed for BP and antihypertensive medication.ResultsIn the low-GFR group on low-sodium PDF ( N = 26), systolic BP was reduced from 152 ± 24 mmHg at baseline to 137 ± 21 mmHg at week 12, diastolic BP from 90 ± 16 mmHg to 83 ± 11 mmHg. In the low-GFR group on standard-sodium PDF and in the high-GFR group on both PDF types, only minor changes were observed. For the low-GFR subgroup, the confounder-adjusted mean study group difference in systolic BP at week 12 between low-sodium and standard-sodium PDF was -16.9 (95% confidence interval [CI] -27.2 to -6.6) mmHg, for diastolic BP, it was -7.0 (95% CI -12.6 to -1.4) mmHg. In both GFR subgroups, more patients had a reduced daily dose of antihypertensive medication and fewer patients an increased daily dose in the low-sodium compared with the standard-sodium group at week 12.ConclusionsThe reduction of BP with a sodium-reduced PDF seems to be more effective in patients with no or low RRF than in patients with residual capacity of renal sodium and fluid control.

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Relationship Between Residual Renal Function and Serum Fibroblast Growth Factor 23 in Patients on Peritoneal Dialysis

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.12170 ◽

2014 ◽

Vol 18 (5) ◽

pp. 383-390 ◽

Cited By ~ 7

Author(s):

Shunsuke Yamada ◽

Kazuhiko Tsuruya ◽

Masatomo Taniguchi ◽

Hisako Yoshida ◽

Masanori Tokumoto ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Growth Factor ◽

Fibroblast Growth Factor ◽

Fibroblast Growth Factor 23 ◽

Residual Renal Function ◽

Fibroblast Growth

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The excess weight gain in peritoneal dialysis in the first year and its consequences on the loss of residual renal function.

10.26226/morressier.59a56f96d462b8028d895cb9 ◽

2017 ◽

Author(s):

Lilia Ben Lasfar

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Weight Gain ◽

Residual Renal Function ◽

Excess Weight ◽

First Year ◽

Excess Weight Gain

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RESIDUAL RENAL FUNCTION IN PERITONEAL DIALYSIS PATIENTS

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2011.4.4 ◽

2011 ◽

pp. 30-34

Author(s):

Hoang Bui Bao Hoang ◽

Huu Loi Le ◽

Tam Vo ◽

Thi Anh Thu Tran

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Close Correlation ◽

Residual Renal Function ◽

Central Hospital ◽

Dialysis Patients

Background: Peritoneal dialysis is used regularlly in treatment of ESRDs. Residual renal function (RRF) in these patients helps the adequacy of PD therapy very much. Objectives: 1. Study RRF of PD patients at Department of Nephro – Rheumatology, Hue Central Hospital. 2. Search the correlation between RRF and Kt/V. Patients and methods: 35 PD patients at Department of Nephro – Rheumatology, Hue Central Hospital. Measure RRF and Kt/V by formulars that depend on blood, urine and PD fluid samples. Results: Mean RRF of PD patients is 4.36 ± 13.8 ml/minute. There is a close correlation between RRF and Kt/V (r=0.79, p<0.01). Conclusion: RRF in PD patients correlates with Kt/V.

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Predictors of Faster Decline of Residual Renal Function in Taiwanese Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080802803s35 ◽

2008 ◽

Vol 28 (3_suppl) ◽

pp. 191-195 ◽

Cited By ~ 3

Author(s):

Chia-Te Liao ◽

Chih-Chung Shiao ◽

Jenq-Wen Huang ◽

Kuan-Yu Hung ◽

Hsueh-Fang Chuang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Function ◽

Peritoneal Dialysis ◽

Clinical Laboratory ◽

Statistical Significance ◽

Univariate Analysis ◽

Residual Renal Function ◽

Measure Data ◽

Chi Square ◽

Artery Disease

⋄ Objective Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan. ⋄ Methods The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR. ⋄ Results All patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis. ⋄ Conclusions Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

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