The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial

Johnson, David W., Brown, Fiona G., Clarke, Margaret, Boudville, Neil, Elias, Tony J., Foo, Marjorie W. Y., Jones, Bernard, Kulkarni, Hemant, Langham, Robyn, Ranganathan, Dwarakanathan, Schollum, John, Suranyi, Michael G., Tan, Seng H. and Voss, David (2012) The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial. Nephrology Dialysis Transplantation, 27 12: 4445-4453. doi:10.1093/ndt/gfs314


Author Johnson, David W.
Brown, Fiona G.
Clarke, Margaret
Boudville, Neil
Elias, Tony J.
Foo, Marjorie W. Y.
Jones, Bernard
Kulkarni, Hemant
Langham, Robyn
Ranganathan, Dwarakanathan
Schollum, John
Suranyi, Michael G.
Tan, Seng H.
Voss, David
Total Author Count Override 14
Title The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial
Journal name Nephrology Dialysis Transplantation   Check publisher's open access policy
ISSN 0931-0509
1460-2385
Publication date 2012-12-01
Sub-type Article (original research)
DOI 10.1093/ndt/gfs314
Volume 27
Issue 12
Start page 4445
End page 4453
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2013
Language eng
Formatted abstract
Background The balANZ trial recently reported that neutral pH, low glucose degradation product (biocompatible) peritoneal dialysis (PD) solutions significantly delayed anuria and reduced peritonitis rates compared with conventional solutions. This article reports a secondary outcome analysis of the balANZ trial with respect to peritoneal membrane function.

Methods Adult, incident PD patients with residual renal function were randomized to receive either biocompatible or conventional (control) PD solutions for 2 years. Peritoneal equilibration tests were performed at 1, 6, 12, 18 and 24 months. Peritoneal small solute clearances and ultra-filtration (UF) were measured at 3, 6, 9, 12, 18 and 24 months.

Results Of the 185 patients recruited into the trial, 85 patients in the Balance group and 82 patients in the control group had peritoneal membrane function evaluated. Mean 4-h dialysate:plasma creatinine ratios (D:P Cr 4h) at 1 month were significantly higher in the Balance group compared with controls (0.67 ± 0.10 versus 0.62 ± 0.10, P = 0.002). Over the 2-year study period, mean D:P Cr 4 h measurements remained stable in the Balance group but increased significantly in controls [difference −0.004 per month, 95% confidence interval (95% CI) −0.005 to −0.002, P < 0.001]. Similar results were obtained for dialysate glucose ratios (D/D0 glucose). Peritoneal UF was significantly lower in the Balance group than in controls at 3 and 6 months. Over the 2-year study period, peritoneal UF increased significantly in the Balance group but remained stable in controls (difference 24 mL/day/month, 95% CI 9–39, P = 0.002). No differences in peritoneal small solute clearances, prescribed dialysate fill volumes or peritoneal glucose exposure were observed between the two groups.

Conclusions
Biocompatible and conventional PD solutions exert differential effects on peritoneal small solute transport rate and UF over time. Adequately powered trials assessing the impact of these differential membrane effects on PD technique and patient survival rates are warranted.
Keyword biocompatibility
glucose degradation products
outcomes
peritoneal dialysis
peritoneal equilibration test
Residual Renal-Function
Long-Term
Fluid
Biocompatibility
Hemodialysis
Benefits
Mortality
Transport
Exposure
Survival
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
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