American Journal of Kidney Diseases

A Combination of Biocompatible Peritoneal Dialysis Solutions and Residual Renal Function, Peritoneal Transport, and Inflammation Markers: A Randomized Clinical Trial


      The benefits of biocompatible peritoneal dialysis (PD) fluids, particularly for residual renal function (RRF), are controversial. Moreover, the clinical effects of a PD regimen consisting of different biocompatible PD fluids have not been fully established.

      Study Design

      Prospective, randomized, controlled, open-label study.

      Setting & Participants

      Patients with end-stage kidney disease newly started on continuous ambulatory PD therapy (N = 150).


      A 12-month intervention with 3 biocompatible PD fluids (a neutral-pH, low glucose degradation product, 1.5% glucose solution; a solution with 1.1% amino acid; and a fluid with 7.5% icodextrin) or conventional PD fluid.


      The primary outcome was change in RRF and daily urine volume. Secondary outcomes were peritoneal transport and inflammation markers.


      RRF, daily urine volume, serum and dialysate cytokine levels.


      RRF(3.24 ± 1.98 vs 2.88 ± 2.43 mL/min/1.73 m2; P = 0.9) and rate of decline in RRF (−0.76 ± 1.77 vs −0.91 ± 1.92 mL/min/1.73 m2 per year; P = 0.6) did not differ between the biocompatible- and conventional-PD-fluid groups. However, patients using the biocompatible PD fluids had better preservation of daily urine volume (959 ± 515 vs 798 ± 615 mL/d in the conventional group, P = 0.02 by comparison of difference in overall change by repeated-measures analysis of variance). Their dialysate-plasma creatinine ratio at 4 hours was higher at 12 months (0.78 ± 0.13 vs 0.68 ± 0.12; P = 0.01 for comparison of the difference in overall change by repeated-measures analysis of variance). They also had significantly higher serum levels of adiponectin and overnight spent dialysate levels of cancer antigen 125, adiponectin, and interleukin 6 (IL-6). No differences between the 2 groups were observed for serum C-reactive protein and IL-6 levels.


      Unblinded, relatively short follow-up; no formal sample-size calculations.


      Use of a combination of 3 biocompatible PD fluids for 12 months compared with conventional PD fluid did not affect RRF, but was associated with better preservation of daily urine volume. The biocompatible PD fluids also lead to changes in small-solute transport and an increase in dialysate cancer antigen 125, IL-6, adiponectin, and systemic adiponectin levels, but have no effect on systemic inflammatory response. The clinical significance of these changes, while of great interest, remains to be determined by further studies.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Chaudhary K.
        • Khanna R.
        Biocompatible peritoneal dialysis solutions: do we have one?.
        Clin J Am Soc Nephrol. 2010; 5: 723-732
        • Justo P.
        • Sanz A.B.
        • Egido J.
        • Ortiz A.
        3,4-Dideoxyglucosone-3-ene induces apoptosis in renal tubular epithelial cells.
        Diabetes. 2005; 54: 2424-2429
        • Margetts P.J.
        • Brimble K.S.
        Peritoneal dialysis, membranes and beyond.
        Curr Opin Nephrol Hypertens. 2006; 15: 571-576
        • Cordeiro A.C.
        • Carrero J.J.
        • Abensur H.
        • Lindholm B.
        • Stenvinkel P.
        Systemic and local inflammation in peritoneal dialysis: mechanisms, biomarkers and effects on outcome.
        Contrib Nephrol. 2009; 163: 132-139
        • Krediet R.T.
        • Balafa O.
        Cardiovascular risk in the peritoneal dialysis patient.
        Nat Rev Nephrol. 2010; 6: 451-460
        • McIntyre C.W.
        Update on peritoneal dialysis solutions.
        Kidney Int. 2007; 71: 486-490
        • Perl J.
        • Bargman J.M.
        The importance of residual kidney function for patients on dialysis: a critical review.
        Am J Kidney Dis. 2009; 53: 1068-1081
        • Williams J.D.
        • Topley N.
        • Craig K.J.
        • et al.
        The Euro-Balance Trial: the effect of a new biocompatible peritoneal dialysis fluid (Balance) on the peritoneal membrane.
        Kidney Int. 2004; 66: 408-418
        • Szeto C.C.
        • Chow K.M.
        • Lam C.W.
        • et al.
        Clinical biocompatibility of a neutral peritoneal dialysis solution with minimal glucose-degradation products—a 1-year randomized control trial.
        Nephrol Dial Transplant. 2007; 22 (552-529)
        • Fan S.L.
        • Pile T.
        • Punzalan S.
        • Raftery M.J.
        • Yaqoob M.M.
        Randomized controlled study of biocompatible peritoneal dialysis solutions: effect on residual renal function.
        Kidney Int. 2008; 73: 200-206
        • Kim S.
        • Oh J.
        • Kim S.
        • et al.
        Benefits of biocompatible PD fluid for preservation of residual renal function in incident CAPD patients: a 1-year study.
        Nephrol Dial Transplant. 2009; 24: 2899-2908
        • Haag-Weber M.
        • Kramer R.
        • Haake R.
        • et al.
        Low-GDP fluid (Gambrosol trio) attenuates decline of residual renal function in PD patients: a prospective randomized study.
        Nephrol Dial Transplant. 2010; 25: 2288-2296
        • Davies S.J.
        • Russell L.
        • Bryan J.
        • Phillips L.
        • Russell G.I.
        Comorbidity, urea kinetics, and appetite in continuous ambulatory peritoneal dialysis patients: their interrelationship and prediction of survival.
        Am J Kidney Dis. 1995; 26: 353-361
        • Piraino B.
        • Bailie G.R.
        • Bernardini J.
        • et al.
        Peritoneal dialysis-related infections recommendations: 2005 update.
        Perit Dial Int. 2005; 25: 107-131
        • Davies S.J.
        Preserving residual renal function in peritoneal dialysis: volume or biocompatibility?.
        Nephrol Dial Transplant. 2009; 24: 2620-2622
        • Perl J.
        • Nessim S.J.
        • Bargman J.M.
        The biocompatibility of neutral pH, low-GDP peritoneal dialysis solutions: benefit at bench, bedside, or both?.
        Kidney Int. 2011; 79: 814-824
        • Krediet R.T.
        Dialysate cancer antigen 125 concentration as marker of peritoneal membrane status in patients treated with chronic peritoneal dialysis.
        Perit Dial Int. 2001; 21: 560-567
        • Zoccali C.
        • Mallamaci F.
        • Tripepi G.
        • et al.
        Adiponectin, metabolic risk factors, and cardiovascular events among patients with end-stage renal disease.
        J Am Soc Nephrol. 2002; 13: 134-141
        • Carrero J.J.
        • Cordeiro A.C.
        • Lindholm B.
        • Stenvinkel P.
        The emerging pleiotrophic role of adipokines in the uremic phenotype.
        Curr Opin Nephrol Hypertens. 2010; 19: 37-42
        • Yu Z.Z.
        • Ni Z.H.
        • Gu L.Y.
        • et al.
        Adiponectin is related to carotid artery plaque and a predictor of cardiovascular outcome in a cohort of non-diabetic peritoneal dialysis patients.
        Blood Purif. 2008; 26: 386-393
        • Diez J.J.
        • Estrada P.
        • Bajo M.A.
        • et al.
        High stable serum adiponectin levels are associated with a better outcome in prevalent dialysis patients.
        Am J Nephrol. 2009; 30: 244-252
        • Naka T.
        • Nishimoto N.
        • Kishimoto T.
        The paradigm of IL-6: from basic science to medicine.
        Arthritis Res. 2002; 4: S233-S242
        • Schindler R.
        • Mancilla J.
        • Endres S.
        • Ghorbani R.
        • Clarks C.
        • Dinarello C.A.
        Correlations and interactions in the production of interleukin-6 (IL-6), IL-1, and tumor necrosis factor (TNF) in human blood mononuclear cells: IL-6 suppresses IL-1 and TNF.
        Blood. 1990; 75: 40-47
        • Oh K.H.
        • Jung J.Y.
        • Yoon M.O.
        • et al.
        Intra-peritoneal interleukin-6 system is a potent determinant of the baseline peritoneal solute transport in incident peritoneal dialysis patients.
        Nephrol Dial Transplant. 2010; 25: 1639-1646
        • Martikainen T.
        • Ekstrand A.
        • Honkanen E.
        • Teppo A.M.
        • Gronhagen-Riska C.
        Do interleukin-6, hyaluronan, soluble intercellular adhesion molecule-1 and cancer antigen 125 in dialysate predict changes in peritoneal function?.
        Scand J Urol Nephrol. 2006; 39: 410-416
        • Witowski J.
        • Topley N.
        • Jorres A.
        • Liberek T.
        • Coles G.A.
        • Williams J.D.
        Effect of lactate-buffered peritoneal dialysis fluids on human peritoneal mesothelial cell interleukin-6 and prostaglandin synthesis.
        Kidney Int. 1995; 47: 282-293
        • Huang J.W.
        • Yen C.J.
        • Chiang H.W.
        • Hung K.Y.
        • Tsai T.J.
        • Wu K.D.
        Adiponectin in peritoneal dialysis patients: a comparison with hemodialysis patients and subjects with normal renal function.
        Am J Kidney Dis. 2004; 43: 1047-1055
        • Kolonko A.
        • Chudek J.
        • Wiecek A.
        Concentration of adipokines in peritoneal effluent: a new marker of acute peritonitis in peritoneal dialysis patients?.
        Perit Dial Int. 2008; 28: 527-532
        • Montenegro J.
        • Saracho R.
        • Gallardo I.
        • Martinez I.
        • Munoz R.
        • Quintanilla N.
        Use of pure bicarbonate-buffered peritoneal dialysis fluid reduces the incidence of CAPD peritonitis.
        Nephrol Dial Transplant. 2007; 22: 1703-1708
        • Furkert J.
        • Zeier M.
        • Schwenger V.
        Effects of peritoneal dialysis solutions low in GDPs on peritonitis and exit site infection rates.
        Perit Dial Int. 2008; 28: 637-640
        • Srivastava S.
        • Hildebrand S.
        • Fan S.L.
        Long-term follow-up of patients randomized to biocompatible or conventional peritoneal dialysis solutions show no difference in peritonitis or technique survival.
        Kidney Int. 2011; 80: 986-991