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

Title
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
Author(s)
도준영박선희[박선희]김영훈[김영훈]이호영[이호영]김범석[김범석]신석균[신석균]김현철[김현철]장윤경[장윤경]양종호[양종호]정현철[정현철]김찬덕[김찬덕]이원기[이원기]김종연[김종연]김용림[김용림]
Keywords
ADVANCED GLYCATION ENDPRODUCTS; RESIDUAL RENAL-FUNCTION; CIRCULATING ADHESION MOLECULES; CORONARY-HEART-DISEASE; HEMODIALYSIS-PATIENTS; ASSOCIATION; ATHEROSCLEROSIS; EXPRESSION; BALANCE; VCAM-1
Issue Date
201203
Publisher
OXFORD UNIV PRESS
Citation
NEPHROLOGY DIALYSIS TRANSPLANTATION, v.27, no.3, pp.1191 - 1199
Abstract
Background. The local peritoneal effects of low-glucose degradation product (GDP)-containing peritoneal dialysis fluid (PDF) have been extensively described. However, the systemic effects of prolonged prescription of these solutions are unknown. This study aimed to evaluate the effects of neutral pH and low-GDP PDF on systemic inflammation and endothelial dysfunction markers in peritoneal dialysis (PD) patients. Methods. This is a multicenter, open labeled, randomized controlled trial including one hundred fifty-two patients initiating continuous ambulatory peritoneal dialysis for end-stage renal disease from seven centers in Korea. Participants were randomly allocated to conventional PDF (Stay safe (R); Fresenius Medical Care, Bad Homburg, Germany) or low-GDP PDF (Balance (R); Fresenius Medical Care) and were followed for 1 year. Primary outcome variable was the inflammation and endothelial dysfunction index (IEDI), a composite score derived from serum levels of soluble intercellular adhesion molecule (sICAM)-1, soluble vascular cellular adhesion molecule (sVCAM)-1 and high-sensitivity C-reactive protein (hs-CRP). sICAM-1, sVCAM-1, residual renal function (RRF), peritoneal membrane transport characteristics, ultrafiltration volume and nutritional parameters were measured as secondary outcome variables. Results. Of 152 patients randomized, 146 (low-GDP: conventional PDF, 79:67) patients entered the trial (46% male, 53% with diabetes mellitus). At 12-month follow-up, the low-GDP group had significantly lower levels of IEDI, sICAM-1 and sVCAM-1 compared to the conventional group; hs-CRP was not different between groups. Peritoneal transport characteristics, RRF, nutritional parameters, incidence of peritonitis and death-censored technique survival were not different between groups. Conclusion. Neutral pH and low-GDP PDF likely produce fewer changes in markers of endothelial dysfunction compared to conventional PDF in incident PD patients.
URI
http://hdl.handle.net/YU.REPOSITORY/29511http://dx.doi.org/10.1093/ndt/gfr451
ISSN
0931-0509
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의과대학 > 내과학교실 > Articles
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