Effects of Low-glucose Degradation Product Solution on Peritoneal Membrane Characteristics in Peritoneal Dialysis Patients: a 3-year Follow-up Study

Changes in peritoneal membrane characteristics including epithelial-mesenchymal transition are an important problem in the maintenance of peritoneal dialysis (PD). This study reports a 3-year follow-up assessment of the effects of low-glucose degradation products (GDP) solution, including epithelial-mesenchymal transition. Adult patients who received continuous ambulatory PD between April 2001 and March 2007 were identified, and those who maintained on PD with the same solution for more than 3 years were included. Patients with an initial effluent score of 3 (fibroblastoid cells dominant in overnight effluent dialysate) were excluded. The patients were divided into two groups according to the dialysate: standard and low-GDP. The following were measured: cancer antigen-125, cell score, normalized protein equivalent of nitrogen appearance, dialysate-plasma creatinine and sodium ratios, and residual renal function. Cell score and peritoneal equilibration test were measured at 1, 6, 12, 18, and 24 months after the initiation of PD. Fifty patients were in the standard group and 76 in the low-GDP group. No significant difference in dialysate-plasma creatinine ratio was detected at baseline and at the end-point of follow-up between the two groups. Dialysate-plasma sodium ratio decreased significantly at the end-point of follow-up in the low-GDP group. Initial and follow-up cancer antigen-125 levels were higher in the low-GDP group. Multivariable analysis showed that low-GDP was associated with a higher cell score 3-free survival rate. The present study shows that a low-GDP solution may be associated with preserving the mesothelial cell and peritoneal membrane characteristics.