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Biocompatible solutions and long-term changes in peritoneal solute transport

Elphick, Emma H., Teece, Lucy, Chess, James A., Do, Jun-Young, Kim, Yong-Lim, Lee, H. Bahl, Davison, Sara N., Topley, Nicholas, Davies, Simon J. and Lambie, Mark 2018. Biocompatible solutions and long-term changes in peritoneal solute transport. Clinical Journal of the American Society of Nephrology , CJN.02380218. 10.2215/CJN.02380218

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Background and objectives The inflammation-driven increase in peritoneal solute transport rate that occurs during long-term peritoneal dialysis is associated with higher mortality, hospitalization, and encapsulating peritoneal sclerosis. Because biocompatible solutions were developed to mitigate these effects, we examined the association with their use and longitudinal peritoneal solute transport rate. Design, setting, participants, & measurements We analyzed subjects from the multinational prospective Global Fluid Study with three or more peritoneal solute transport rate measurements >2 months from the start of peritoneal dialysis. Follow-up was for 7.5 years (median, 2.3 years; interquartile range, 1.8–3.6) in biocompatible solutions and 12.8 years (median, 3.2 years; interquartile range, 1.9–4.3) for standard solutions. Using a random intercept/slopes multilevel model, we examined the association of patients using biocompatible solutions and peritoneal solute transport rate over time, adjusting for center effects, dialysate dextrose concentration, baseline dialysate IL-6 concentration, icodextrin use, residual kidney function, and peritonitis. Results Of 366 patients, the 71 receiving biocompatible solutions throughout their time on peritoneal dialysis had a mean adjusted dialysate-to-plasma creatinine ratio of 0.67 compared with 0.72 for standard solutions (P=0.02). With duration of treatment, there was a continuous increase in peritoneal solute transport rate in patients using standard solutions (range, 2 months to 4 years). In contrast, patients using biocompatible solutions had peritoneal solute transport rates that plateaued after 2 years of therapy. These changes in peritoneal solute transport rate were independent of baseline inflammation and time-varying predictors of faster peritoneal solute transport rate. In patients suffering episodes of peritonitis while using standard solutions, there was an associated increase in peritoneal solute transport rate of 0.020 (95% confidence interval, 0.01 to 0.03) per episode, whereas in patients using biocompatible solutions, there was no change in this parameter (−0.014; 95% confidence interval, −0.03 to <0.01). Conclusions These data suggest that a different temporal pattern in changes in peritoneal solute transport rate occurs during the course of peritoneal dialysis according to solution type and that patients using biocompatible solutions may avoid the increase in solute transport associated with peritonitis.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Publisher: American Society of Nephrology
ISSN: 1555-9041
Date of First Compliant Deposit: 1 November 2018
Date of Acceptance: 27 July 2018
Last Modified: 02 Nov 2018 11:00

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