Keele Research Repository

Elphick, EH, Teece, L, Chess, JA, Do, J-Y, Kim, Y-L, Lee, HB, Davison, SN, Topley, N, Davies, SJ ORCID: https://orcid.org/0000-0001-5127-4755 and Lambie, MR ORCID: https://orcid.org/0000-0002-6285-5368 (2019) Biocompatible solutions and long-term changes in peritoneal solute transport (vol 13, pg 1526, 2018). Clinical Journal of the American Society of Nephrology, 14 (6). 909 - 909.

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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 article is a corrected version of a previously published article. The final version of the accepted manuscript can be found online at; https://cjasn.asnjournals.org/content/14/6/909
Uncontrolled Keywords:	Dialysis Solutions; Glucans; Glucose; IL6 protein, human; Inflammation; Interleukin-6; Peritoneal Fibrosis; Peritoneum; Peritonitis; creatinine; hospitalization; icodextrin; peritoneal dialysis; peritoneal membrane.
Subjects:	Q Science > Q Science (General) R Medicine > R Medicine (General) R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:	Author
Depositing User:	Symplectic
Date Deposited:	11 Dec 2020 11:30
Last Modified:	25 Mar 2021 11:27
URI:	https://eprints.keele.ac.uk/id/eprint/8961

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