Associations of neutral pH, low GDP peritoneal dialysis solutions with patient survival, transfer to haemodialysis, and peritonitis.

BACKGROUND

Peritoneal dialysis (PD) solutions containing low levels of glucose degradation products (GDPs) are associated with attenuation of peritoneal membrane injury and vascular complications. However, clinical benefits associated with neutral pH, low GDP (N-pH/L-GDP) solutions remain unclear.

METHODS

Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the associations between N-pH/L-GDP solutions and all-cause mortality, cause-specific mortality, transfer to haemodialysis (TTH) for ≥ 30 days, and PD peritonitis in adult incident PD patients in Australia and New Zealand between January 1, 2005, and December 31, 2020, using adjusted Cox regression analyses.

RESULTS

Of 12 814 incident PD patients, 2282 (18%) were on N-pH/L-GDP solutions. The proportion of patients on N-pH/L-GDP solutions each year increased from 11% in 2005 to 33% in 2017. During the study period, 5330 (42%) patients died, 4977 (39%) experienced TTH, and 5502 (43%) experienced PD peritonitis. Compared to use of conventional solutions only, use of any form of N-pH/L-GDP solution was associated with reduced risks of all-cause mortality (adjusted hazard ratio [aHR] 0.67, 95% confidence interval [CI] 0.61-0.74), cardiovascular mortality (aHR 0.65, 95%CI 0.56-0.77), infection-related mortality (aHR 0.62, 95%CI 0.47-0.83) and TTH (aHR 0.79, 95%CI 0.72-0.86), but an increased risk of PD peritonitis (aHR 1.16, 95%CI 1.07-1.26).

CONCLUSIONS

Patients who received N-pH/L-GDP solutions had decreased risks of all-cause and cause-specific mortality despite an increased risk of PD peritonitis. Studies assessing the causal relationships are warranted to determine the clinical benefits of N-pH/L-GDP solutions.

Informations de copyright

© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.