Effects of Biocompatible versus Standard Fluid on Peritoneal Dialysis Outcomes

• Published in: Journal of the American Society of Nephrology Vol. 23; no. 6; pp. 1097 - 1107
• Main Authors: JOHNSON, David W, BROWN, Fiona G, SCHOLLUM, John, SURANYI, Michael, TAN, Seng H, VOSS, David, CLARKE, Margaret, BOUDVILLE, Neil, ELIAS, Tony J, FOO, Marjorie W. Y, JONES, Bernard, KULKARNI, Hemant, LANGHAM, Robyn, RANGANATHAN, Dwarakanathan
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society of Nephrology 01.06.2012
• Subjects: Adult; Aged; Biocompatible Materials - pharmacology; Biological and medical sciences; Clinical Research; Confidence Intervals; Cross-Over Studies; Dialysis Solutions - pharmacology; Female; Follow-Up Studies; Glomerular Filtration Rate; Glucose - pharmacology; Humans; Hydrogen-Ion Concentration; Kaplan-Meier Estimate; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Kidney Function Tests; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - methods; Peritoneal Dialysis - mortality; Peritonitis - chemically induced; Peritonitis - epidemiology; Peritonitis - physiopathology; Reference Values; Risk Assessment; Severity of Illness Index; Survival Analysis; Time Factors; Treatment Outcome; Nephrology; Prognosis; Dialysis fluid; Biocompatibility; Standard; Comparative study; Standards; Urology; Peritoneal fluid
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/asn.2011121201

The clinical benefits of using "biocompatible" neutral pH solutions containing low levels of glucose degradation products for peritoneal dialysis compared with standard solutions are uncertain. In this multicenter, open-label, parallel-group, randomized controlled trial, we randomly assigned 185 incident adult peritoneal dialysis patients with residual renal function to use either biocompatible or conventional solution for 2 years. The primary outcome measure was slope of renal function decline. Secondary outcome measures comprised time to anuria, fluid volume status, peritonitis-free survival, technique survival, patient survival, and adverse events. We did not detect a statistically significant difference in the rate of decline of renal function between the two groups as measured by the slopes of GFR: -0.22 and -0.28 ml/min per 1.73 m(2) per month (P=0.17) in the first year in the biocompatible and conventional groups, respectively, and, -0.09 and -0.10 ml/min per 1.73 m(2) per month (P=0.9) in the second year. The biocompatible group exhibited significantly longer times to anuria (P=0.009) and to the first peritonitis episode (P=0.01). This group also had fewer patients develop peritonitis (30% versus 49%) and had lower rates of peritonitis (0.30 versus 0.49 episodes per year, P=0.01). In conclusion, this trial does not support a role for biocompatible fluid in slowing the rate of GFR decline, but it does suggest that biocompatible fluid may delay the onset of anuria and reduce the incidence of peritonitis compared with conventional fluid in peritoneal dialysis.