Elphick, E, Teece, L, Chess, J, Do, J, Kim, Y, Lee, H, Davison, S, Topley, N, Davies, SJ and Lambie, MR (2018) Biocompatible Solutions and Long-Term Changes in Peritoneal Solute Transport. Clinical Journal of the American Society of Nephrology, 13 (10). pp. 1526-1533. ISSN 1555-9041

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Abstract

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
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via American Society of Nephrology at http://doi.org/10.2215/CJN.02380218 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: peritoneal membrane Peritoneal Fibrosis icodextrin creatinine IL6 protein, human Interleukin-6 Dialysis Solutions peritoneal dialysis Peritoneum Glucans Glucose Peritonitis Inflammation hospitalization
Subjects: Q Science > Q Science (General)
R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > Institute for Science and Technology in Medicine
Depositing User: Symplectic
Date Deposited: 09 Jul 2018 11:12
Last Modified: 25 Oct 2018 09:26
URI: http://eprints.keele.ac.uk/id/eprint/5115

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