Longitudinal changes in peritoneal solute transport rate and the impact of lower glucose degradation product glucose dialysates

Abstract

Introduction: Peritoneal solute transfer rates (PSTR) are reported to increase with time. Changes in PSTR were reviewed in long-term peritoneal dialysis (PD) patients to determine whether lower glucose degradation products (low GDP) dialysates prevented an increase in PSTR.

Methods: PSTR was determined with a 4-h peritoneal equilibrium test with a 2.0 L 22.7 g/L glucose dialysate.

Results: One hundred twenty-three PD patients treated for ≥4 years, 47.2% male, age 61 ± 16 years, 31.7% diabetic. Initially, 15.6% were treated with low GDP dialysates, which rose to 44.7% at 6 years. Creatinine PSTR increased with standard glucose dialysates (0.72 ± 0.1 at Year 3 to 0.79 ± 0.1 Year 5 and 0.82 ± 0.1 Year 6, p < 0.05), whereas PSTR was stable and lower with low GDP dialysates (0.71 ± 0.1, 0.65 ± 0.1, 0.68 ± 0.1); p < 0.001 for Years 5 and 6.

Conclusion: Exposure to standard glucose dialysates resulted in faster peritoneal solute transfer rates over time, whereas peritoneal solute transfer rates appeared more stable with lower glucose degradation products dialysates.

Keywords: bioimpedance; end stage kidney disease; glucose degradation products; icodextrin; peritoneal dialysis; peritoneal solute transport rate.

FIGURE 1

The 4‐h effluent dialysate to plasma serum creatinine (D4h D/P Creat) after a 4‐h 2.0 L 22.7 g/L comparing the result for the first assessment of peritoneal membrane function (peritoneal equilibrium test [PET]) over time. Median with interquartile and 10%–90% ranges. ***p < 0.001 vs. first PET. GDP, glucose degradation products.

FIGURE 2

The 4‐h effluent dialysate to plasma serum sodium (D4h D/P Na) after a 4‐h 2.0 L 22.7 g/L exchange comparing the results for the first assessment of peritoneal membrane function (peritoneal equilibrium test [PET]) over time. Median with interquartile and 10%–90% ranges. ***p < 0.001 vs. first PET. GDP, glucose degradation products.