Journal ArticleDOI
Biocompatible dialysis fluids for peritoneal dialysis
Yeoungjee Cho,David W. Johnson,Jonathan C. Craig,Jonathan C. Craig,Giovanni F.M. Strippoli,Sunil V. Badve,Kathryn J. Wiggins +6 more
TLDR
Use of neutral pH, low GDP PD solution led to greater urine output and higher residual renal function after use exceeded 12 months, and Icodextrin prescription improved peritoneal ultrafiltration and mitigated uncontrolled fluid overload.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 solution Use 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 m (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 solution In 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/1.73m 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.read more
Citations
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Journal ArticleDOI
The Current State of Peritoneal Dialysis
TL;DR: Technical innovations in peritoneal dialysis have significantly reduced therapy-related complications, allowing patients to be maintained on PD for longer periods, and the survival rate for patients treated with PD is now equivalent to that with in-center hemodialysis.
Journal ArticleDOI
International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis:
Edwina A. Brown,Peter G. Blake,Neil Boudville,Simon J. Davies,Javier de Arteaga,Jie Dong,Fred Finkelstein,Marjorie Foo,Helen Hurst,David W. Johnson,Mark Johnson,Adrian Liew,Thyago Proença de Moraes,Jeff Perl,Rukshana Shroff,Isaac Teitelbaum,Angela Yee-Moon Wang,Bradley A. Warady +17 more
TL;DR: This guideline is designed to establish realistic care goals that maintain quality of life for the person doing PD as much as possible by enabling them to meet their life goals, and minimize symptoms and treatment burden while ensuring high-quality care is provided.
Journal ArticleDOI
Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Jennifer E. Flythe,Tara I. Chang,Martin Gallagher,Elizabeth Lindley,Magdalena Madero,Pantelis Sarafidis,Mark Unruh,Angela Yee-Moon Wang,Daniel E. Weiner,Michael Cheung,Michel Jadoul,Wolfgang C. Winkelmayer,Kevan R. Polkinghorne +12 more
TL;DR: The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications.
Journal ArticleDOI
ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I – Assessment and Management of Various Cardiovascular Risk Factors
Angela Yee-Moon Wang,K. Scott Brimble,Gillian Brunier,Stephen G Holt,Vivekanand Jha,David W. Johnson,David W. Johnson,Shin Wook Kang,Jeroen P. Kooman,Mark Lambie,Christopher W. McIntyre,Rajnish Mehrotra,Roberto Pecoits-Filho +12 more
TL;DR: This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors and is intended to serve as a global clinical practice guideline for clinicians who look after PD patients.
Journal ArticleDOI
Deciphering the Contribution of Biofilm to the Pathogenesis of Peritoneal Dialysis Infections: Characterization and Microbial Behaviour on Dialysis Fluids
Joana Marisa Brito Sampaio,Diana Sofia Rodrigues Machado,Ana Marta Gomes,Idalina Machado,Cledir Santos,Nelson Lima,Maria João Carvalho,António Cabrita,Anabela Rodrigues,Margarida Isabel Barros Coelho Martins +9 more
TL;DR: It is shown that microbial biofilm is universal in PD catheters with the subclinical menace of Staphylococci and P. aeruginosa, and no major differences were observed between conventional and biocompatible solutions, although in icodextrin solution biofilm biomass was lower than in bicarbonate/lactate solution.
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