Balance vs Conventional Peritoneal Dialysis Fluid: Are there measurable benefits?
Balance is a low glucose degradation (GDP) product peritoneal dialysis fluid that may be less damaging to the peritoneal membrane than conventional dialysis fluids.
Twenty-six patients commencing ambulatory peritoneal dialysis were randomized to either Balance or conventional dialysis fluid for 6 months and then the alternative for 6 months. Here we present the 6 month analysis. Urine output (UO), dialysate transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) were assessed at baseline, 3 and 6 months and peritoneal membrane transport (dialysate to plasma creatinine ratio (D/P-Cr), D/P urea (D/P-Ur) and 0 to 4 hour dialysate glucose ratio (D0/D4-Glu)) was assessed at baseline and 6 months.
Baseline criteria were matched equally for gender and age, but the Balance group had significantly more diabetics (10 vs 4) and higher body mass indices (BMI) (28.6 vs 23.7). The baseline D/P-Cr was also higher (0.76 vs 0.64) and D0/D4-Glu lower (0.35 vs 0.43) in the Balance group.
Over 6 months, TGF-β1 increased significantly, but VEGF, UO, D/P-Cr, D/P-Ur and D0/D4-Glu were unchanged. Comparing the Balance to the conventional group there was a non-significant trend for lower TGF-β1 (p=0.283) and no difference in VEGF and UO. D/P-Cr remained higher in the Balance group (p=0.034), but D/P-Ur and D0/D4-Glu were similar for both.
Comparing low-GDP vs conventional dialysis fluid over 6 months, we found no difference in dialysate TGF-β1 or VEGF, UO or membrane characteristics. The 12 month cross-over data will be analyzed at completion of the study.