Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/91943
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Type: Journal article
Title: The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial
Author: Johnson, D.
Brown, F.
Clarke, M.
Boudville, N.
Elias, T.
Foo, M.
Jones, B.
Kulkarni, H.
Langham, R.
Ranganathan, D.
Schollum, J.
Suranyi, M.
Tan, S.
Voss, D.
Citation: Nephrology Dialysis Transplantation, 2012; 27(12):4445-4453
Publisher: Oxford University Press
Issue Date: 2012
ISSN: 0931-0509
1460-2385
Statement of
Responsibility: 
David W. Johnson, Fiona G. Brown, Margaret Clarke, Neil Boudville, Tony J. Elias, Marjorie W.Y. Foo, Bernard Jones, Hemant Kulkarni, Robyn Langham, Dwarakanathan Ranganathan, John Schollum, Michael G. Suranyi, Seng H. Tan, David Voss, on behalf of the balANZ Trial Investigators
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.
Keywords: biocompatibility; glucose degradation products; outcomes; peritoneal dialysis; peritoneal equilibration test
Rights: © The Author 2012. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
RMID: 0030026906
DOI: 10.1093/ndt/gfs314
Appears in Collections:Medicine publications

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