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Meta-Analysis
. 2015 Aug 7;10(8):1380-8.
doi: 10.2215/CJN.05410514. Epub 2015 Jun 5.

Effect of Neutral-pH, Low-Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis

Seychelle Yohanna  1 , Ali M A Alkatheeri  2 , Scott K Brimble  3 , Brendan McCormick  4 , Arthur Iansavitchous  1 , Peter G Blake  1 , Arsh K Jain  5
Affiliations
Meta-Analysis

Effect of Neutral-pH, Low-Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis

Seychelle Yohanna et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Neutral-pH, low-glucose degradation products solutions were developed in an attempt to lessen the adverse effects of conventional peritoneal dialysis solutions. A systematic review was performed evaluating the effect of these solutions on residual renal function, urine volume, peritoneal ultrafiltration, and peritoneal small-solute transport (dialysate to plasma creatinine ratio) over time.

Design, setting, participants, & measurements: Multiple electronic databases were searched from January of 1995 to January of 2013. Randomized trials reporting on any of four prespecified outcomes were selected by consensus among multiple reviewers.

Results: Eleven trials of 643 patients were included. Trials were generally of poor quality. The meta-analysis was performed using a random effects model. The use of neutral-pH, low-glucose degradation products solutions resulted in better preserved residual renal function at various study durations, including >1 year (combined analysis: 11 studies; 643 patients; standardized mean difference =0.17 ml/min; 95% confidence interval, 0.01 to 0.32), and greater urine volumes (eight studies; 598 patients; mean difference =128 ml/d; 95% confidence interval, 58 to 198). There was no significant difference in peritoneal ultrafiltration (seven studies; 571 patients; mean difference =-110; 95% confidence interval, -312 to 91) or dialysate to plasma creatinine ratio (six studies; 432 patients; mean difference =0.03; 95% confidence interval, 0.00 to 0.06).

Conclusions: The use of neutral-pH, low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes. The effect on residual renal function occurred early and persisted beyond 12 months. Additional studies are required to evaluate the use of neutral-pH, low-glucose degradation products solutions on hard clinical outcomes.

Keywords: biocompatible; degradation products; glucose; peritoneal dialysis; residual renal function; urine volume.

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Figures

Figure 1.
Figure 1.
Study flow diagram indicating the number of citations retrieved by individual searches, the final number of included studies, and the reasons for exclusion. RCT, randomized, controlled trial.
Figure 2.
Figure 2.
Risk of bias summary of all included studies. balANZ, Balance in Australian and New Zealand Peritoneal Dialysis Patients.
Figure 3.
Figure 3.
Effect of neutral-pH, low–glucose degradation product (GDP) peritoneal dialysis solutions on residual renal function (RRF). (A) Pooled analysis of all study durations. (B) Up to and including 6 months duration of treatment. (C) Beyond 6 months and up to and including 12 months duration of treatment. (D) Beyond 12 months duration of treatment. 95% CI, 95% confidence interval; balANZ, Balance in Australian and New Zealand Peritoneal Dialysis Patients; df, degree of freedom.
Figure 4.
Figure 4.
Effect of neutral-pH, low–glucose degradation product (GDP) peritoneal dialysis solutions on 24-hour peritoneal ultrafiltration (milliliters per day). (A) Pooled analysis of all study durations. (B) Up to and including 6 months duration of treatment. (C) Twelve months duration of treatment. (D) Beyond 12 months duration of treatment. 95% CI, 95% confidence interval; balANZ, Balance in Australian and New Zealand Peritoneal Dialysis Patients; df, degree of freedom.
Figure 5.
Figure 5.
Effect of neutral-pH, low–glucose degradation product (GDP) peritoneal dialysis solutions on 24-hour urine volume (milliliters per day). (A) Pooled analysis of all study durations. (B) Up to and including 6 months duration of treatment. (C) Beyond 6 months and up to and including 12 months duration of treatment. (D) Beyond 12 months duration of treatment. 95% CI, 95% confidence interval; balANZ, Balance in Australian and New Zealand Peritoneal Dialysis Patients; df, degree of freedom.
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