Seychelle Yohanna1, Ali M A Alkatheeri2, Scott K Brimble3, Brendan McCormick4, Arthur Iansavitchous1, Peter G Blake1, Arsh K Jain5. 1. Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; 2. Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; Department of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia; 3. Division of Nephrology, McMaster University, Hamilton, Ontario, Canada; and. 4. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. 5. Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; arsh.jain@lhsc.on.ca.
Abstract
BACKGROUND AND OBJECTIVES: Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers. RESULTS: Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including >1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =-110; 95% confidence interval, -312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06). CONCLUSIONS: The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.
BACKGROUND AND OBJECTIVES: Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers. RESULTS: Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including >1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =-110; 95% confidence interval, -312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06). CONCLUSIONS: The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.
Authors: Martin Erixon; Anders Wieslander; Torbjörn Lindén; Ola Carlsson; Gunita Forsbäck; Eva Svensson; Jan Ake Jönsson; Per Kjellstrand Journal: Perit Dial Int Date: 2006 Jul-Aug Impact factor: 1.756
Authors: Lars Weiss; Bernd Stegmayr; Gudrun Malmsten; Mattias Tejde; Henrik Hadimeri; Carl E Siegert; Jarl Ahlmén; Rutger Larsson; Bo Ingman; Ole Simonsen; Henk W van Hamersvelt; Ann C Johansson; Britta Hylander; Michael Mayr; Per-Henrik Nilsson; Per O Andersson; Tatiana De los Ríos Journal: Perit Dial Int Date: 2009 Nov-Dec Impact factor: 1.756
Authors: Maria Bartosova; Betti Schaefer; Justo Lorenzo Bermejo; Silvia Tarantino; Felix Lasitschka; Stephan Macher-Goeppinger; Peter Sinn; Bradley A Warady; Ariane Zaloszyc; Katja Parapatics; Peter Májek; Keiryn L Bennett; Jun Oh; Christoph Aufricht; Franz Schaefer; Klaus Kratochwill; Claus Peter Schmitt Journal: J Am Soc Nephrol Date: 2017-10-18 Impact factor: 10.121
Authors: Emma H Elphick; Lucy Teece; James A Chess; Jun-Young Do; Yong-Lim Kim; H Bahl Lee; Sara N Davison; Nicholas Topley; Simon J Davies; Mark Lambie Journal: Clin J Am Soc Nephrol Date: 2018-08-31 Impact factor: 8.237
Authors: Graham Woodrow; Stanley L Fan; Christopher Reid; Jeannette Denning; Andrew Neil Pyrah Journal: BMC Nephrol Date: 2017-11-16 Impact factor: 2.388
Authors: Htay Htay; David W Johnson; Kathryn J Wiggins; Sunil V Badve; Jonathan C Craig; Giovanni Fm Strippoli; Yeoungjee Cho Journal: Cochrane Database Syst Rev Date: 2018-10-26