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Meta-Analysis
. 2018 Oct 26;10(10):CD007554.
doi: 10.1002/14651858.CD007554.pub3.

Biocompatible dialysis fluids for peritoneal dialysis

Htay Htay  1 , David W Johnson, Kathryn J Wiggins, Sunil V Badve, Jonathan C Craig, Giovanni Fm Strippoli, Yeoungjee Cho
Affiliations
Meta-Analysis

Biocompatible dialysis fluids for peritoneal dialysis

Htay Htay et al. Cochrane Database Syst Rev. .

Abstract

Background: Biocompatible peritoneal dialysis (PD) solutions, including neutral pH, low glucose degradation product (GDP) solutions and icodextrin, have previously been shown to favourably influence some patient-level outcomes, albeit based on generally sub-optimal quality studies. Several additional randomised controlled trials (RCT) evaluating biocompatible solutions in PD patients have been published recently. This is an update of a review first published in 2014.

Objectives: This review aimed to look at the benefits and harms of biocompatible PD solutions in comparison to standard PD solutions in patients receiving PD.

Search methods: The Cochrane Kidney and Transplant Specialised Register was searched up to 12 February 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov.

Selection criteria: All RCTs and quasi-RCTs in adults and children comparing the effects of biocompatible PD solutions (neutral pH, lactate-buffered, low GDP; neutral pH, bicarbonate(± lactate)-buffered, low GDP; glucose polymer (icodextrin)) in PD were included. Studies of amino acid-based solutions were excluded.

Data collection and analysis: Two authors extracted data on study quality and outcomes. Summary effect estimates were obtained using a random-effects model, and results were expressed as risk ratios and 95% confidence intervals (CI) for categorical variables, and mean differences (MD) or standardised mean differences (SMD) and 95% CI for continuous variables.

Main results: This review update included 42 eligible studies (3262 participants), including six new studies (543 participants). Overall, 29 studies (1971 participants) compared neutral pH, low GDP PD solution with conventional PD solution, and 13 studies (1291 participants) compared icodextrin with conventional PD solution. Risk of bias was assessed as high for sequence generation in three studies, allocation concealment in three studies, attrition bias in 21 studies, and selective outcome reporting bias in 16 studies.Neutral pH, low GDP versus conventional glucose PD solutionUse of neutral pH, low GDP PD solutions improved residual renal function (RRF) preservation (15 studies, 835 participants: SMD 0.19, 95% CI 0.05 to 0.33; high certainty evidence). This approximated to a mean difference in glomerular filtration rate of 0.54 mL/min/1.73 m2 (95% CI 0.14 to 0.93). Better preservation of RRF was evident at all follow-up durations with progressively greater preservation observed with increasing follow up duration. Neutral pH, low GDP PD solution use also improved residual urine volume preservation (11 studies, 791 participants: MD 114.37 mL/day, 95% CI 47.09 to 181.65; high certainty evidence). In low certainty evidence, neutral pH, low GDP solutions may make little or no difference to 4-hour peritoneal ultrafiltration (9 studies, 414 participants: SMD -0.42, 95% CI -0.74 to -0.10) which approximated to a mean difference in peritoneal ultrafiltration of 69.72 mL (16.60 to 122.00 mL) lower, and may increase dialysate:plasma creatinine ratio (10 studies, 746 participants: MD 0.01, 95% CI 0.00 to 0.03), technique failure or death compared with conventional PD solutions. It is uncertain whether neutral pH, low GDP PD solution use led to any differences in peritonitis occurrence, hospitalisation, adverse events (6 studies, 519 participants) or inflow pain (1 study, 58 participants: RR 0.51, 95% CI 0.24 to 1.08).Glucose polymer (icodextrin) versus conventional glucose PD solutionIn moderate certainty evidence, icodextrin probably reduced episodes of uncontrolled fluid overload (2 studies, 100 participants: RR 0.30, 95% CI 0.15 to 0.59) and augmented peritoneal ultrafiltration (4 studies, 102 participants: MD 448.54 mL/d, 95% CI 289.28 to 607.80) without compromising RRF (4 studies, 114 participants: SMD 0.12, 95% CI -0.26 to 0.49; low certainty evidence) which approximated to a mean creatinine clearance of 0.30 mL/min/1.73m2 higher (0.65 lower to 1.23 higher) or urine output (3 studies, 69 participants: MD -88.88 mL/d, 95% CI -356.88 to 179.12; low certainty evidence). It is uncertain whether icodextrin use led to any differences in adverse events (5 studies, 816 participants) technique failure or death.

Authors' conclusions: This updated review strengthens evidence that neutral pH, low GDP PD solution improves RRF and urine volume preservation with high certainty. These effects may be related to increased peritoneal solute transport and reduced peritoneal ultrafiltration, although the evidence for these outcomes is of low certainty due to significant heterogeneity and suboptimal methodological quality. Icodextrin prescription increased peritoneal ultrafiltration and mitigated uncontrolled fluid overload with moderate certainty. The effects of either neutral pH, low GDP solution or icodextrin on peritonitis, technique survival and patient survival remain uncertain and require further high quality, adequately powered RCTs.

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Conflict of interest statement

  1. Htay Htay: none known

  2. Professor David Johnson has previously received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care unrelated to the preparation of this review.

  3. Kathryn J Wiggins: none known

  4. Sunil V Badve: none known

  5. Jonathan C Craig: none known

  6. Giovanni FM Strippoli: none known

  7. Yeoungjee Cho: none known

Figures

1
1
Flow diagram. * Non‐RCTs excluded from the 2018 update
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Low GDP (all buffer types) versus standard glucose dialysate, outcome: 1.1 Residual renal function.
1.1
1.1. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 1 Residual renal function.
1.2
1.2. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 2 Residual renal function: up to 12 months.
1.3
1.3. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 3 Residual renal function: 12 months up to 24 months.
1.4
1.4. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 4 Residual renal function: 24 months and beyond.
1.5
1.5. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 5 Residual renal function: PD fluid types.
1.6
1.6. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 6 Urine volume.
1.7
1.7. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 7 Urine volume: up to 12 months.
1.8
1.8. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 8 Urine volume: 12 months up to 24 months.
1.9
1.9. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 9 Urine volume: 24 months and beyond.
1.10
1.10. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 10 Urine volume: PD fluid types.
1.11
1.11. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 11 Anuria.
1.12
1.12. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 12 Peritoneal ultrafiltration: 4 hours.
1.13
1.13. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 13 4‐hour dialysate:plasma creatinine (2.27%, 2.4%, or 2.5% glucose).
1.14
1.14. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 14 4‐hour dialysis:plasma creatinine (patient characteristics).
1.15
1.15. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 15 4‐hour dialysis:plasma creatinine (PD fluid types).
1.16
1.16. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 16 4‐hour dialysis:plasma creatinine (study design).
1.17
1.17. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 17 Peritoneal creatinine clearance [L/wk/1.73 m²].
1.18
1.18. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 18 Peritoneal Kt/V urea.
1.19
1.19. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 19 Incidence of peritonitis.
1.20
1.20. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 20 Peritonitis rate (episodes/total patient‐months).
1.21
1.21. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 21 Incidence of peritonitis: attrition bias risk.
1.22
1.22. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 22 Inflow pain.
1.23
1.23. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 23 Hospitalisation.
1.24
1.24. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 24 Technique failure (death‐censored).
1.25
1.25. Analysis
Comparison 1 Low GDP (all buffer types) versus standard glucose dialysate, Outcome 25 Death (all causes).
2.1
2.1. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 1 Daily ultrafiltration.
2.2
2.2. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 2 Uncontrolled fluid overload.
2.3
2.3. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 3 Residual renal function.
2.4
2.4. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 4 Urine volume.
2.6
2.6. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 6 Peritoneal creatinine clearance.
2.7
2.7. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 7 Episodes of peritonitis.
2.8
2.8. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 8 Rash.
2.9
2.9. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 9 Technique failure (death‐censored).
2.10
2.10. Analysis
Comparison 2 Glucose polymer (icodextrin) versus standard glucose dialysate, Outcome 10 Death (all causes).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Cnossen 2011 {published data only}
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Davies 2003 {published data only (unpublished sought but not used)}
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di Paolo 2000 {published data only}
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DIUREST 2010 {published data only (unpublished sought but not used)}
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EURO‐BALANCE 2004 {published data only (unpublished sought but not used)}
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Finkelstein 2005 {published data only (unpublished sought but not used)}
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Fusshoeller 2004 {published data only}
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Kim 2003 {published data only}
    1. Do J, Cho K, Park J, Yoon K, Cho D, Kim Y. Local and systemic effects of neutral pH, low GDP dialysate in CAPD patients [abstract no: SA‐FC202]. Journal of the American Society of Nephrology 2002;13(September, Program & Abstracts):41A. [CENTRAL: CN‐00445121]
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Konings 2003 {published data only}
    1. Konings CJ, Kooman JP, Schonck M, Gladziwa U, Wirtz J, Wall Bake AW, et al. Effect of icodextrin on volume status, blood pressure and echocardiographic parameters: a randomized study. Kidney International 2003;63(4):1556‐63. [MEDLINE: ] - PubMed
    1. Konings CJ, Kooman JP, Schonck M, Sande FM, Hoorntje SJ, Leunissen KM. Effect of icodextrin on volume status, blood pressure and echocardiographic parameters [abstract no: F‐PO719]. Journal of the American Society of Nephrology 2002;13(September, Program & Abstracts):206A. [CENTRAL: CN‐00446147]
    1. Konings CJ, Schalkwijk CG, Sande FM, Leunissen KM, Kooman JP. Influence of icodextrin on plasma and dialysate levels of NƐ‐(carboxymethyl)lysine and NƐ‐(carboxyethyl)lysine. Peritoneal Dialysis International 2005;25(6):591‐5. [MEDLINE: ] - PubMed
    1. Kooman JP, Schalkwijk CG, Konings CJ. The increase in plasma levels of NƐ‐(carboxymethyl)lysine during icodextrin treatment of peritoneal dialysis patients is not associated with increased plasma levels of vascular cell adhesion molecule‐1. Peritoneal Dialysis International 2006;26(3):410‐1. [MEDLINE: ] - PubMed
Lai 2012a {published data only}
    1. Lai KN, Lam MF, Leung JC, Chan LY, Lam CW, Chan IH, et al. A study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation products. Peritoneal Dialysis International 2012;32(3):280‐91. [MEDLINE: ] - PMC - PubMed
Lin 2009a {published and unpublished data}
    1. Lin A, Qian J, Li X, Yu X, Liu W, Sun Y, et al. Randomized controlled trial of icodextrin versus glucose containing peritoneal dialysis fluid. Clinical Journal of The American Society of Nephrology: CJASN 2009;4(11):1799‐804. [MEDLINE: ] - PMC - PubMed
Mactier 1998 {published data only}
    1. Mactier RA, Sprosen TS, Gokal R, Williams PF, Lindbergh M, Naik RB, et al. Bicarbonate and bicarbonate/lactate peritoneal dialysis solutions for the treatment of infusion pain. Kidney International 1998;53(4):1061‐7. [MEDLINE: ] - PubMed
    1. Sprosen TS, Mactier RA, Gokal R, Lindbergh M, Tranaeus A, Faict D. Treatment of infusion pain (InP) with novel bicarbonate containing PD solutions [abstract]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):273A. [CENTRAL: CN‐00447821]
MIDAS 1994 {published data only (unpublished sought but not used)}
    1. Armstrong A, Sayers JA, Scrimgeour AC. Reduction in the prevalence of CAPD symptoms during 6 months treatment with icodextrin [abstract]. Nephrology Dialysis Transplantation 1996;11(6):A240. [CENTRAL: CN‐00261303]
    1. Gokal R, Mistry CD, Peers EM. Peritonitis occurrence in a multicenter study of icodextrin and glucose in CAPD. MIDAS Study Group. Multicenter Investigation of Icodextrin in Ambulatory Dialysis. Peritoneal Dialysis International 1995;15(6):226‐30. [MEDLINE: ] - PubMed
    1. Gokal R, Moberly J, Ogrinc F, Gordon A, Peers E, MIDAS Study Group. Improvement of hyperlipidemia with icodextrin use in CAPD patients [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):283A. [CENTRAL: CN‐00445499]
    1. Mistry CD, Gokal R, Peers E. A randomized multicenter clinical trial comparing isosmolar icodextrin with hyperosmolar glucose solutions in CAPD. MIDAS Study Group. Multicenter Investigation of Icodextrin in Ambulatory Peritoneal Dialysis. Kidney International 1994;46(2):496‐503. [MEDLINE: ] - PubMed
Pajek 2008 {published and unpublished data}
    1. Pajek J, Kveder R, Bren A, Gucek A, Bucar M, Skoberne A, et al. Short‐term effects of bicarbonate/lactate‐buffered and conventional lactate‐buffered dialysis solutions on peritoneal ultrafiltration: a comparative crossover study. Nephrology Dialysis Transplantation 2009;24(5):1617‐25. [MEDLINE: ] - PubMed
    1. Pajek J, Kveder R, Bren A, Gucek A, Ihan A, Osredkar J, et al. Short‐term effects of a new bicarbonate/lactate‐buffered and conventional peritoneal dialysis fluid on peritoneal and systemic inflammation in CAPD patients: a randomized controlled study. Peritoneal Dialysis International 2008;28(1):44‐52. [MEDLINE: ] - PubMed
    1. Pajek J, Kveder R, Gucek A, Skoberne A, Bren A, Bucar M, et al. Cell‐free DNA in the peritoneal effluent of peritoneal dialysis solutions. Therapeutic Apheresis & Dialysis 2010;14(1):20‐6. [MEDLINE: ] - PubMed
Paniagua 2008 {published data only (unpublished sought but not used)}
    1. Orihuela O, Jesus V, Avila‐Diaz M, Cisneros A, Vicente‐Martinez M, Furlong MD, et al. Effect of icodextrin on heart rate variability in diabetic patients on peritoneal dialysis. Peritoneal Dialysis International 2014;34(1):57‐63. [MEDLINE: ] - PMC - PubMed
    1. Paniagua R, Orihuela O, Ventura MD, Avila‐Diaz M, Cisneros A, Vicente‐Martinez M, et al. Echocardiographic, electrocardiographic and blood pressure changes induced by icodextrin solution in diabetic patients on peritoneal dialysis. Kidney International ‐ Supplement 2008;73(108):S125‐30. [MEDLINE: ] - PubMed
    1. Paniagua R, Ventura MD, Avila‐Diaz M, Cisneros A, Vicente‐Martinez M, Furlong MD, et al. Icodextrin improves metabolic and fluid management in high and high‐average transport diabetic patients. Peritoneal Dialysis International 2009;29(4):422‐32. [MEDLINE: ] - PubMed
Park 2012a {published data only}
    1. Park SH, Do JY, Kim YH, Lee HY, Kim BS, Shin SK, et al. Effects of neutral pH and low‐glucose degradation product‐containing peritoneal dialysis fluid on systemic markers of inflammation and endothelial dysfunction: a randomized controlled 1‐year follow‐up study. Nephrology Dialysis Transplantation 2012;27(3):1191‐9. [MEDLINE: ] - PubMed
Plum 2002 {published data only}
    1. Plum J, Gentile S, Verger C, Brunkhorst R, Bahner U, Faller B, et al. Efficacy and safety of a 7.5% icodextrin peritoneal dialysis solution in patients treated with automated peritoneal dialysis. American Journal of Kidney Diseases 2002;39(4):862‐71. [MEDLINE: ] - PubMed
Posthuma 1997 {published data only}
    1. Peers E. Icodextrin plus glucose combinations for use in CAPD. Peritoneal Dialysis International 1997;17 Suppl 2:S68‐9. [MEDLINE: ] - PubMed
    1. Posthuma N, Verbrugh HA, Donker AJ, Dorp W, Dekker HA, Peers EM, et al. Peritoneal kinetics and mesothelial markers in CCPD using icodextrin for daytime dwell for two years. Peritoneal Dialysis International 2000;20(2):174‐80. [MEDLINE: ] - PubMed
    1. Posthuma N, ter Wee P, Donker AJ, Dekker HA, Oe PL, Verbrugh HA. Peritoneal defense using icodextrin or glucose for daytime dwell in CCPD patients. Peritoneal Dialysis International 1999;19(4):334‐42. [MEDLINE: ] - PubMed
    1. Posthuma N, ter Wee PM. Icodextrin (I) use in CCPD patients during peritonitis: serum disaccharide levels and ultrafiltration (UF) [abstract]. Nephrology Dialysis Transplantation 1997;12(9):A184. [CENTRAL: CN‐00261438] - PubMed
    1. Posthuma N, ter Wee PM, Donker AJ, Dekker HAT, Oe PL, Verhoef J, et al. Ex vivo peritoneal defense characteristics and peritonitis rate in CCPD patients using glucose or icodextrin as daytime dwell [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):223A. [CENTRAL: CN‐00447263]
Rippe 2001 {published data only}
    1. Rippe B, Christensson A, Haraldsson B, Simonsen O, Stelin G, Weiss L, et al. More Ca125 in dialysate after long‐term treatment with a new, less toxic PD‐fluid (PD‐bio) [abstract]. Nephrology Dialysis Transplantation 1997;12(9):A180. [CENTRAL: CN‐00509439]
    1. Rippe B, Christensson A, Haraldsson B, Simonsen O, Stelin G, Weiss L, et al. Patient dialysate CA 125 and hyaluronan (HA) after 1, 6 and 12 months of treatment with a PD‐fluid containing less cytotoxic glucose degradation products [abstract]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):182A. [CENTRAL: CN‐00447414]
    1. Rippe B, Simonsen O, Heimburger O, Christensson A, Haraldsson B, Stelin G, et al. Long‐term clinical effects of a peritoneal dialysis fluid with less glucose degradation products. Kidney International 2001;59(1):348‐57. [MEDLINE: ] - PubMed
    1. Rippe B, Wieslander A. Biologic significance of reduced levels of glucose degradation products. Peritoneal Dialysis International 2001;21 Suppl 3:S114‐8. [MEDLINE: ] - PubMed
    1. Rippe B, Wieslander A, Musi B. Long‐term results with low glucose degradation product content in peritoneal dialysis fluids. Contributions to Nephrology 2003;140:47‐55. [MEDLINE: ] - PubMed
Schmitt 2002 {published and unpublished data}
    1. Haas S, Schmitt CP, Arbeiter K, Bonzel KE, Fischbach M, John U, et al. Improved acidosis correction and recovery of mesothelial cell mass with neutral‐pH bicarbonate dialysis solution among children undergoing automated peritoneal dialysis. Journal of the American Society of Nephrology 2003;14(10):2632‐8. [MEDLINE: ] - PubMed
    1. Haas S, Schmitt CP, Schaefer F, Schaub T, Mid European Pediatric Peritoneal Dialysis Study Group (MEPPS). Randomized cross‐over evaluation of bicarbonate‐vs lactate buffered PD solutions in children on APD [abstract]. Pediatric Nephrology 2002;17(Suppl):C53. [CENTRAL: CN‐00445609]
    1. Haas S, Schmitt CP, Schaub T, Schaefer F. Better biocompatibility and correction of acidosis using bicarbonate vs lactate buffered PD fluid in children on APD: a randomized cross‐over clinical trial [abstract]. Journal of the American Society of Nephrology 2002;13(September, Program & Abstracts):202A. [CENTRAL: CN‐00445610]
    1. Schmitt C, Haas S, Schaub T, Schaefer F. Randomized cross‐over administration of pH‐neutral, bicarbonate buffered PD solution in children on APD [abstract no: O51]. Nephrology Dialysis Transplantation 2002;17(Suppl 12):17.
    1. Schmitt CP, Doetschmann R, Kirchgessner J, Mehls O, Schaefer F. Comparison of solute and acid‐base transport kinetics in children using bicarbonate‐ vs. lactate‐buffered PD solutions [abstract]. Journal of the American Society of Nephrology 1998;9(Program & Abstracts):193A. [CENTRAL: CN‐00447630]
STARCH 2015 {published data only}
    1. Moraes TP, Andreoli MC, Canziani ME, Silva DR, Caramori JC, Ponce D, et al. Icodextrin reduces insulin resistance in non‐diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH). Nephrology Dialysis Transplantation 2015;30(11):1905‐11. [MEDLINE: ] - PubMed
Szeto 2007 {published data only}
    1. Szeto C, Chow K, Leung C, Lam CWK, Kwan BCH, Chung K, et al. Clinical biocompatibility of a neutral peritoneal dialysis solution with minimal glucose‐degradation‐product ‐ a randomized control trial [abstract no: SA‐FC137]. Journal of the American Society of Nephrology 2005;16:112A.
    1. Szeto CC, Chow KM, Lam CW, Leung CB, Kwan BC, Chung KY, et al. Clinical biocompatibility of a neutral peritoneal dialysis solution with minimal glucose‐degradation products‐‐a 1‐year randomized control trial. Nephrology Dialysis Transplantation 2007;22(2):552‐9. [MEDLINE: ] - PubMed
Szeto 2015 {published data only}
    1. Szeto CC, Kwan BC, Chow KM, Cheng PM, Kwong VW, Choy AS, et al. The effect of neutral peritoneal dialysis solution with low glucose‐degradation‐product on the fluid status and body composition‐‐a randomized control trial. PLoS ONE [Electronic Resource] 2015;10(10):e0141425. [MEDLINE: ] - PMC - PubMed
Takatori 2011 {published and unpublished data}
    1. Akagi S, Sugiyama H, Takatori Y, Takiue K, Inoue J, Kojo S, et al. Effect of icodextrin on the fluid status in diabetic peritoneal dialysis patients ‐ an interim report [abstract no: SA443]. World Congress of Nephrology; 2009 May 22‐26; Milan, Italy. 2009.
    1. Takatori Y, Akagi S, Sugiyama H, Inoue J, Kojo S, Morinaga H, et al. Icodextrin increases technique survival rate in peritoneal dialysis patients with diabetic nephropathy by improving body fluid management: a randomized controlled trial. Clinical Journal of The American Society of Nephrology: CJASN 2011;6(6):1337‐44. [MEDLINE: ] - PMC - PubMed
Tranaeus 2000 {published data only}
    1. Cooker LA, Luneburg P, Holmes CJ, Jones S, Topley N, Bicarbonate/Lactate Study Group. Interleukin‐6 levels decrease in effluent from patients dialyzed with bicarbonate/lactate‐based peritoneal dialysis solutions. Peritoneal Dialysis International 2001;21 Suppl 3:S102‐7. [MEDLINE: ] - PubMed
    1. Holmes CJ, Jones S, Mackenzie R, Coles GA, Williams JD, Tranaeus A, et al. Bicarbonate/lactate‐buffered (TBL) peritoneal dialysis fluid (PDF) decreases pro‐collagen I levels in peritoneal dialysis effluent (PDE) [abstract no: A1214]. Journal of the American Society of Nephrology 1997;8(Program & Abstracts):264A. [CENTRAL: CN‐00445763]
    1. Jones S, Holmes CJ, Krediet RT, Mackenzie R, Faict D, Tranaeus A, et al. Bicarbonate/lactate‐based peritoneal dialysis solution increases cancer antigen 125 and decreases hyaluronic acid levels. Kidney International 2001;59(4):1529‐38. [MEDLINE: ] - PubMed
    1. Jones S, Holmes CJ, Mackenzie RK, Stead R, Coles GA, Williams JD, et al. Continuous dialysis with bicarbonate/lactate‐buffered peritoneal dialysis fluids results in a long‐term improvement in ex vivo peritoneal macrophage function. Journal of the American Society of Nephrology 2002;13(Suppl 1):S97‐S103. [PUBMED: 11792769] - PubMed
    1. O'Donoghue DJ, Bicarbonate/Lactate Study Group. A long term study of a bicarbonate‐lactate based peritoneal dialysis solution [abstract]. Journal of the American Society of Nephrology 1999;10(Program & Abstracts):266A.
TRIO 2016 {published data only}
    1. Sikaneta T, Wu G, Abdolell M, Ng A, Mahdavi S, Svendrovski A, et al. The Trio Trial ‐ a randomized controlled clinical trial evaluating the effect of a biocompatible peritoneal dialysis solution on residual renal function. Peritoneal Dialysis International 2016;36(5):526‐32. [MEDLINE: ] - PMC - PubMed
Weiss 2009 {published and unpublished data}
    1. Weiss L, Stegmayr B, Malmsten G, Tejde M, Hadimeri H, Siegert CE, et al. Biocompatibility and tolerability of a purely bicarbonate‐buffered peritoneal dialysis solution. Peritoneal Dialysis International 2009;29(6):647‐55. [MEDLINE: ] - PubMed
Wolfson 2002 {published data only (unpublished sought but not used)}
    1. Guo A, Just P. Quality of life of peritoneal dialysis patients on icodextrin: a longitudinal study [abstract]. Quality of Life Research 2002;11(7):667. [CENTRAL: CN‐00493774]
    1. Guo A, Wolfson M, Holt R. Early quality of life benefits of icodextrin in peritoneal dialysis. Kidney International ‐ Supplement 2002;81:S72‐9. [MEDLINE: ] - PubMed
    1. Wolfson M, Hagen T, Ogrinc F, Martis L, Icodextrin Study Group. One year results‐icodextrin vs dextrose for the long dwell in peritoneal dialysis [abstract]. Journal of the American Society of Nephrology 2001;12(Program & Abstracts):317A.
    1. Wolfson M, Hagen T, Ogrinc F, Martis L, Icodextrin Study Group. Effects of icodextrin on ultrafiltration (UF) and small solute clearance in continuous ambulatory dialysis patients (CAPD) [abstract]. Journal of the American Society of Nephrology 2001;12(Program & Abstracts):317A. [CENTRAL: CN‐00653810]
    1. Wolfson M, Piraino B, Hamburger RJ, Morton AR, Icodextrin Study Group. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. American Journal of Kidney Diseases 2002;40(5):1055‐65. [MEDLINE: ] - PubMed
Yoo 2015 {published data only}
    1. Yoo TH, Lee MJ, Oh HJ, Park JT, Han SH, Kang SW, et al. Is It beneficial to convert to a neutral‐pH bicarbonate/lactate‐buffered PD solution in long‐term CAPD patients? A single‐center prospective study. Peritoneal Dialysis International 2015;35(3):366‐9. [MEDLINE: ] - PMC - PubMed
Zeier 2003 {published data only}
    1. Zeier M, Deppisch R, Haug U, Schwenger V, Henle T, Bahner U, et al. Resorption of age‐promoting glucose degradation products (GDP) from peritoneal dialysis (PD) fluids leads to increased levels of age in plasma [abstract]. Journal of the American Society of Nephrology 2000;11(Sept):223A. [CENTRAL: CN‐00583875]
    1. Zeier M, Schwenger V, Deppisch R, Haug U, Weigel K, Bahner U, et al. Glucose degradation products in PD fluids: do they disappear from the peritoneal cavity and enter the systemic circulation?. Kidney International 2003;63(1):298‐305. [MEDLINE: ] - PubMed

References to studies excluded from this review

BIOKID 2004 {published data only}
    1. Nau B, Schmitt CP, Almeida M, Arbeiter K, Ardissino G, Bonzel KE, et al. BIOKID: randomized controlled trial comparing bicarbonate and lactate buffer in biocompatible peritoneal dialysis solutions in children [ISRCTN81137991]. BMC Nephrology 2004;5(1):14. [MEDLINE: ] - PMC - PubMed
    1. Schmitt CP, Gemulla G, Bonzel KE, Holtta T, Testa S, Fischbach M, et al. BIOKID: randomized controlled trial comparing bicarbonate and lactate buffer in biocompatible peritoneal dialysis solutions in children [abstract no: SU‐PO519]. Journal of the American Society of Nephrology 2007;18(Abstracts Issue):696A.
    1. Schmitt CP, Nau B, Gemulla G, Bonzel KE, Holtta T, Testa S, et al. Effect of the dialysis fluid buffer on peritoneal membrane function in children. Clinical Journal of the American Society of Nephrology: CJASN 2013;8(1):108‐15. [MEDLINE: ] - PMC - PubMed
Braide 2009 {published data only}
    1. Braide M, Haraldsson B, Persson U. Citrate supplementation of PD fluid: effects on net ultrafiltration and clearance of small solutes in single dwells. Nephrology Dialysis Transplantation 2009;24(1):286‐92. [MEDLINE: ] - PubMed
Chang 2016 {published data only}
    1. Chang TI, Ryu DR, Yoo TH, Kim HJ, Kang EW, Kim H, et al. Effect of icodextrin solution on the preservation of residual renal function in peritoneal dialysis patients: a randomized controlled study. Medicine 2016;95(13):e2991. [MEDLINE: ] - PMC - PubMed
Chow 2014 {published data only}
    1. Chow KM, Szeto CC, Kwan BC, Pang WF, Ma T, Leung CB, et al. Randomized controlled study of icodextrin on the treatment of peritoneal dialysis patients during acute peritonitis. Nephrology Dialysis Transplantation 2014;29(7):1438‐43. [MEDLINE: ] - PubMed
Coester 2006 {published data only}
    1. Coester AM, Speake M, Summers AM, Parikova A, Hutchison AJ, Krediet RT. Effect of biocompatible peritoneal dialysis on transport status: the nutrineal, extraneal, physioneal (NEP) study [abstract no: TH‐PO812]. Journal of the American Society of Nephrology 2006;17(Abstracts):279A.
Dallas 2004 {published data only}
    1. Dallas F, Jenkins SB, Wilkie ME. Enhanced ultrafiltration using 7.5% icodextrin/1.36% glucose combination dialysate: a pilot study. Peritoneal Dialysis International 2004;24(6):542‐6. [MEDLINE: ] - PubMed
de Fijter 1993 {published data only}
    1. Fijter CW, Verbrugh HA, Oe LP, Heezius E, Donker AJ, Verhoef J, et al. Biocompatibility of a glucose‐polymer‐containing peritoneal dialysis fluid. American Journal of Kidney Diseases 1993;21(4):411‐8. [MEDLINE: ] - PubMed
    1. Fijter CWH, Oe PL, Verbrugh HA, Peters EDJ, Meulen J, Donker AJM, et al. Glucose polymers as osmotic agent in CAPD fluids: a more favorable effect on peritoneal macrophage (PMO) function than glucose‐based solutions [abstract]. Kidney International 1991;40(5):978.
EDEN 2013 {published data only}
    1. Bargman JM, Culleton BF, Do JY, Gomez RA, Yu AW, Prichard SS, et al. The impact of a low glucose peritoneal dialysis solution regimen on serum lipids and lipoproteins in diabetic patients: The IMPENDIA and EDEN randomized, controlled clinical trials [abstract no: FR‐OR027]. Journal of the American Society of Nephrology 2012; Vol. 23:37A.
    1. Li PK, Culleton BF, Ariza A, Do JY, Johnson DW, Sanabria M, et al. Randomized, controlled trial of glucose‐sparing peritoneal dialysis in diabetic patients. Journal of the American Society of Nephrology 2013; Vol. 24:1889‐900. [MEDLINE: ] - PMC - PubMed
    1. Sniderman AD, Sloand JA, Li PK, Story K, Bargman JM. Influence of low‐glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials. Journal of Clinical Lipidology 2014; Vol. 8, issue 4:441‐7. [MEDLINE: ] - PubMed
Fang 2008 {published data only}
    1. Fang W, Mullan R, Shah H, Mujais S, Bargman JM, Oreopoulos DG. Comparison between bicarbonate/lactate and standard lactate dialysis solution in peritoneal transport and ultrafiltration: a prospective, crossover single‐dwell study. Peritoneal Dialysis International 2008;28(1):35‐43. [MEDLINE: ] - PubMed
Feriani 1993 {published data only}
    1. Feriani M, Dissegna D, Greca G, Passlick‐Deetjen J. Continuous ambulatory peritoneal dialysis with bicarbonate buffer‐‐a pilot study. Peritoneal Dialysis International 1993;13 Suppl 2:S88‐91. [MEDLINE: ] - PubMed
    1. Feriani M, Dissegna D, Greca G, Passlick‐Deetjen J. Short‐term clinical study with bicarbonate‐containing peritoneal dialysis solution. Peritoneal Dialysis International 1993;13(4):296‐301. [MEDLINE: ] - PubMed
Fischbach 2004 {published data only}
    1. Fischbach M, Terzic J, Chauve S, Laugel V, Muller A, Haraldsson B. Effect of peritoneal dialysis fluid composition on peritoneal area available for exchange in children. Nephrology Dialysis Transplantation 2004;19(4):925‐32. [MEDLINE: ] - PubMed
Hiss 2013 {published data only}
    1. Hiss M, Gerstein F, Haller H, Gueler F. Randomised prospective clinical study on outcome of peritoneal dialysis in patients using normal versus reduced glucose dialysis solution [abstract]. Nephrology Dialysis Transplantation 2013;28(Suppl 1):i437. [EMBASE: 71076352]
Hwang 2006 {published data only}
    1. Hwang JC, Wang HY, Wang CT, Chen HC. Comparison of peritoneal equilibrium test with icodextrin and 2.5% glucose dialysis solutions. Journal of Nephrology 2006;19(6):758‐63. [MEDLINE: ] - PubMed
IMPENDIA 2013 {published data only}
    1. Bargman JM, Culleton BF, Do JY, Gomez RA, Yu AW, Prichard SS, et al. The impact of a low glucose peritoneal dialysis solution regimen on serum lipids and lipoproteins in diabetic patients: The IMPENDIA and EDEN randomized, controlled clinical trials [abstract no: FR‐OR027]. Journal of the American Society of Nephrology 2012; Vol. 23, issue Abstracts:37A.
    1. Li PK, Culleton BF, Ariza A, Do JY, Johnson DW, Sanabria M, et al. Randomized, controlled trial of glucose‐sparing peritoneal dialysis in diabetic patients. Journal of the American Society of Nephrology 2013; Vol. 24, issue 11:1889‐900. [MEDLINE: ] - PMC - PubMed
    1. Li PK, Dorval M, Johnson DW, Rutherford P, Shutov E, Story K, et al. The benefit of a glucose‐sparing PD therapy on glycemic control measured by serum fructosamine in diabetic patients in a randomized, controlled trial (IMPENDIA). Nephron 2015; Vol. 129, issue 4:233‐40. [MEDLINE: ] - PubMed
    1. Sniderman AD, Sloand JA, Li PK, Story K, Bargman JM. Influence of low‐glucose peritoneal dialysis on serum lipids and apolipoproteins in the IMPENDIA/EDEN trials. Journal of Clinical Lipidology 2014; Vol. 8, issue 4:441‐7. [MEDLINE: ] - PubMed
Jenkins 2003 {published data only}
    1. Jenkins SB, Tindale W, Wilkie ME. Sodium and water clearance during peritoneal dwells with a novel combination dialysate (1.36% glucose/7.5% Icodextrin) [abstract]. Peritoneal Dialysis International 2002;22(1):114. [CENTRAL: CN‐00401399]
    1. Jenkins SB, Wilkie ME. An exploratory study of a novel peritoneal combination dialysate (1.36% glucose/7.5% icodextrin), demonstrating improved ultrafiltration compared to either component studied alone. Peritoneal Dialysis International 2003;23(5):475‐80. [MEDLINE: ] - PubMed
John 2008 {published data only}
    1. John SG, Selby NM, McIntyre CW. Effects of peritoneal dialysis fluid biocompatibility on baroreflex sensitivity. Kidney International ‐ Supplement 2008;108:S119‐24. [MEDLINE: ] - PubMed
le Poole 2004 {published data only}
    1. Poole CY, Ittersum FJ, Valentijn RM, Ter Wee PM, Schalk C. PD regimen contributes to the blood concentration of glucose degradation products (GDP) in new CAPD patients [abstract no: SA‐PO820]. Journal of the American Society of Nephrology 2003;14(Nov):478A.
    1. Welten A, Poole K, ter Wee P, Ittersum F, Valentijn R, Beelen RH, et al. Biocompatibility markers of standard versus high‐glucose regimen of CAPD patients in a multi‐centered, cross‐over study [abstract no: SA‐PO812]. Journal of the American Society of Nephrology 2003;14(Abstracts):476a.
    1. Welten AG, Poole C, ter Wee PM, Ittersum FJ, Beelen RH, Born J. The effects of a high‐versus low‐glucose regime on cell recruitment and biomarkers of CAPD patients. A multi‐center, prospective cross‐over study [abstract]. Nephrology Dialysis Transplantation 2003;18(Suppl 4):214‐5. [CENTRAL: CN‐00448337]
    1. Welten AG, Poole C, Ittersum FJ, ter Wee PM, Beelen RH, Born J. Biocompatibility of high versus low glucose regime on peritoneal cells of CAPD patients in a multicenter cross‐over study [abstract]. Peritoneal Dialysis International 2002;22(1):111. [CENTRAL: CN‐00403070]
    1. Welten AG, Poole C, Ittersum FJ, ter Wee PM, Beelen RH, Born J. Biocompatibility of high‐ versus low‐glucose regime on peritoneal cells of CAPD patients in a multi‐centered cross‐over study [abstract no: F‐PO698]. Journal of the American Society of Nephrology 2002;13(September, Program & Abstracts):202A. [CENTRAL: CN‐00448338]
Liberek 2002 {published data only}
    1. Liberek T, Lichodziejewska‐Niemierko M, Knopinska‐Posluszny W, Schaub TP, Kirchgessner J, Passlick‐Deetjen J, et al. Generation of TNFalpha and interleukin‐6 by peritoneal macrophages after overnight dwells with bicarbonate‐ or lactate‐buffered dialysis fluid. Peritoneal Dialysis International 2002;22(6):663‐9. [MEDLINE: ] - PubMed
Lui 2012 {published data only}
    1. Lui SL, Lui S, Yung S, Tang C, Ng F, Lo WK, et al. Effect of biocompatible peritoneal dialysis fluids on daily urine volume, serum adiponectin levels, small solute permeability and mesothelial cell integrity six months after conversion back to conventional peritoneal dialysis fluids [abstract]. Nephrology Dialysis Transplantation 2012;27(Suppl 2):ii460. [EMBASE: 70766678]
    1. Lui SL, Yung S, Yim A, Wong KM, Tong KL, Wong KS, et al. A combination of biocompatible peritoneal dialysis solutions and residual renal function, peritoneal transport, and inflammation markers: a randomized clinical trial. American Journal of Kidney Diseases 2012;60(6):966‐75. [MEDLINE: ] - PubMed
    1. Yung S, Lui SL, Ng CK, Yim A, Ma MK, Lo KY, et al. Impact of a low‐glucose peritoneal dialysis regimen on fibrosis and inflammation biomarkers. Peritoneal Dialysis International 2015;35(2):147‐58. [MEDLINE: ] - PMC - PubMed
Martikainen 2005 {published data only}
    1. Martikainen TA, Teppo AM, Gronhagen‐Riska C, Ekstrand AV. Glucose‐free dialysis solutions: inductors of inflammation or preservers of peritoneal membrane?. Peritoneal Dialysis International 2005;25(5):453‐60. [MEDLINE: ] - PubMed
Parikova 2007 {published data only}
    1. Parikova A, Struijk DG, Zweers MM, Langedijk M, Schouten N, Berg N, et al. Does the biocompatibility of the peritoneal dialysis solution matter in assessment of peritoneal function?. Peritoneal Dialysis International 2007;27(6):691‐6. [MEDLINE: ] - PubMed
Pedersen 1985 {published data only}
    1. Pedersen FB, Ryttov N, Deleuran P. Acetate versus lactate in peritoneal dialysis solutions. Nephron 1985;39(1):55‐8. [MEDLINE: ] - PubMed
Peers 1997 {published data only}
    1. Peers E. Icodextrin plus glucose combinations for use in CAPD. Peritoneal Dialysis International 1997;17 Suppl 2:S68‐9. [MEDLINE: ] - PubMed
Plum 1997 {published data only}
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References to studies awaiting assessment

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References to ongoing studies

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References to other published versions of this review

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