A New Peritoneal Dialysis Solution Containing L-Carnitine and Xylitol for Patients on Continuous Ambulatory Peritoneal Dialysis: First Clinical Experience

Abstract

Peritoneal dialysis (PD) is a feasible and effective renal replacement therapy (RRT) thanks to the dialytic properties of the peritoneal membrane (PM). Preservation of PM integrity and transport function is the key to the success of PD therapy, particularly in the long term, since the prolonged exposure to unphysiological hypertonic glucose-based PD solutions in current use is detrimental to the PM, with progressive loss of peritoneal ultrafiltration capacity causing technique failure. Moreover, absorbing too much glucose intraperitoneally from the dialysate may give rise to a number of systemic metabolic effects. Here we report the preliminary results of the first clinical experience based on the use in continuous ambulatory PD (CAPD) patients of novel PD solutions obtained through partly replacing the glucose load with other osmotically active metabolites, such as L-carnitine and xylitol. Ten CAPD patients were treated for four weeks with the new solutions. There was good tolerance to the experimental PD solutions, and no adverse safety signals were observed. Parameters of dialysis efficiency including creatinine clearance and urea Kt/V proved to be stable as well as fluid status, diuresis, and total peritoneal ultrafiltration. The promising tolerance and local/systemic advantages of using L-carnitine and xylitol in the PD solution merit further research.

Keywords: CAPD; PD fluid; carnitine; end-stage renal disease; peritoneal dialysis; peritoneum; solution; xylitol.

Figure 1

Individual data points and median (-) of peritoneal equilibration test (PET) and diuresis of group A and group B data lumped together. UF, ultrafiltration.

Figure 2

Individual data points and median (-) of dialysis efficiency parameters of group A and group B data lumped together. UF, ultrafiltration. * p < 0.02 vs. day 0.

Figure 3

Study design.

Figure 4

Study flowchart. a) Clinical parameters include diuresis. b) Clinical chemistry: serum sodium, potassium, calcium, phosphorus, total protein, albumin, GOT (AST), GPT (ALT), alkaline phosphatase, gamma-glutamyl transferase (GGT), total bilirubin, glucose, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, blood urea nitrogen (BUN), and creatinine. c) Hematology consists of hemoglobin, hematocrit, red blood cell count, white blood cell count and differential, and platelet count. * at day -28, determination of uric acid only.