Could Solutions Low in Glucose Degradation Products Preserve Residual Renal Function in Incident Peritoneal Dialysis Patients? A 1-Year Multicenter Prospective Randomized Controlled Trial (Balnet Study)
Could Solutions Low in Glucose Degradation Products Preserve Residual Renal Function in Incident Peritoneal Dialysis Patients? A 1-Year Multicenter Prospective Randomized Controlled Trial (Balnet Study)
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低葡萄糖降解产物的溶液能否保留腹膜透析患者的残余肾功能？
DOI：
10.1177/089686080802803s22
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发表时间：
2008
影响因子：
2.8
通讯作者：
Hyung Jik Kim
中科院分区：
文献类型：
--
作者：
Sung Gyun Kim;Sejoong Kim;Y. Hwang;Kiwon Kim;Jieun Oh;W. Chung;K. Oh;Hyung Jik Kim
腹膜透析（PD）溶液的体外研究表明，具有中性pH和低糖降解产物（LF）的乳酸缓冲液比传统的酸性乳酸缓冲液（CF）具有更好的生物相容性。然而，很少有临床试验评估生物相容性溶液对残余肾功能（RRF）的长期益处。为了比较LF和CF，我们对开始PD的患者进行了一项前瞻性随机研究。1个月的磨合期后，91名新的PD患者被随机分组，接受12个月的LF （Balance: Fresenius Medical Care, Bad Homburg, Germany; n = 48）或CF （Stay•Safe: Fresenius; n = 43）治疗。我们在磨合期后每6个月测量RRF、酸碱平衡、腹膜平衡试验和透析充分性。结果治疗12个月后，使用LF的患者的残余肾小球滤过率（GFR）倾向于高于使用CF的患者（重复测量方差分析p = 0.057）。我们观察到两组之间的剩余GFR变化有显著差异（p = 0.009），在基线剩余GFR大于2 mL/min/1.73 m2的亚组中差异尤其显著。此外，LF组血清总CO2水平较高（p = 0.001），血清阴离子间隙较低（p = 0.019）。我们观察到各组之间的Kt/V、c反应蛋白或氮外观的标准化蛋白质当量没有差异。结论：在GFR显著残留的PD患者中，LF可以在12个月的治疗期间更好地保存RRF。此外，与CF相比，ph中性的PD液可以改善酸碱平衡。
⋄ Objectives In vitro studies of peritoneal dialysis (PD) solutions demonstrated that a lactate-buffered fluid with neutral pH and low glucose degradation products (LF) has better biocompatibility than a conventional acidic lactate-buffered fluid (CF). However, few clinical trials have evaluated the long-term benefit of the biocompatible solution on residual renal function (RRF). To compare LF with CF, we performed a prospective, randomized study with patients starting PD. ⋄ Patients and Methods After 1-month run-in period, 91 new PD patients were randomized for 12 months of treatment with either LF (Balance: Fresenius Medical Care, Bad Homburg, Germany; n = 48) or CF (Stay•Safe: Fresenius; n = 43). We measured RRF, acid–base balance, peritoneal equilibration test, and adequacy of dialysis every 6 months after the run-in period. ⋄ Results After 12 months of treatment, the residual glomerular filtration rate (GFR) in patients using LF tended to be higher than that of patients on CF (p = 0.057 by repeated-measures analysis of variance). We observed a significant difference in the changes of residual GFR between the two groups (p = 0.009), a difference that was especially marked in the subgroup whose baseline residual GFR was more than 2 mL/min/1.73 m2. In addition, serum total CO2 levels were higher (p = 0.001) and serum anion gap was lower (p = 0.019) in the LF group. We observed no differences between groups for Kt/V, C-reactive protein, or normalized protein equivalent of nitrogen appearance. ⋄ Conclusions In incident PD patients with significant residual GFR, LF may better preserve RRF over a 12-month treatment period. Additionally, pH-neutral PD fluid may improve acid–base balance as compared with CF.