Optimised versus standard automated peritoneal dialysis regimens pilot study (OptiStAR) : A randomised controlled crossover trial
(2022) In Peritoneal Dialysis International 42(6). p.615-621- Abstract
Background: The continuous global rise of end-stage kidney disease creates a growing demand of economically beneficial home-based kidney replacement therapies such as peritoneal dialysis (PD). However, undesirable absorption and exposure of peritoneal tissues to glucose remain major limitations of PD. Methods: We compared a reference (standard) automated PD regimen 6 × 2 L 1.36% glucose (76 mmol/L) over 9 h with a novel, theoretically glucose sparing (optimised) prescription consisting of ‘ultrafiltration cycles’ with high glucose strength (126 mmol/L) and ‘clearance cycles’ with ultra-low, physiological glucose (5 mmol/L) for approximately 40% of the treatment time. Twenty-one prevalent PD patients underwent the optimised regimen (7 ×... (More)
Background: The continuous global rise of end-stage kidney disease creates a growing demand of economically beneficial home-based kidney replacement therapies such as peritoneal dialysis (PD). However, undesirable absorption and exposure of peritoneal tissues to glucose remain major limitations of PD. Methods: We compared a reference (standard) automated PD regimen 6 × 2 L 1.36% glucose (76 mmol/L) over 9 h with a novel, theoretically glucose sparing (optimised) prescription consisting of ‘ultrafiltration cycles’ with high glucose strength (126 mmol/L) and ‘clearance cycles’ with ultra-low, physiological glucose (5 mmol/L) for approximately 40% of the treatment time. Twenty-one prevalent PD patients underwent the optimised regimen (7 × 2 L 2.27% glucose + 5 × 2 L 0.1% glucose over 8 h) and the standard regimen in a crossover fashion. Six patients were excluded from data analysis. Results: Median glucose absorption was 43 g (IQR 41–54) and 44 g (40–55) for the standard and optimised intervention, respectively (p = 1). Ultrafiltration volume, weekly Kt/V creatinine and urea were significantly improved during optimised interventions, while no difference in sodium removal was detected. Post hoc analysis showed significantly improved ultrafiltration efficiency (ml ultrafiltration per gram absorbed glucose) during optimised regimens. No adverse events were observed except one incidence of drain pain. Conclusion: Optimised treatments were feasible and well tolerated in this small pilot study. Despite no difference in absorbed glucose, results indicate possible improvements of ultrafiltration efficiency and small solute clearances by optimised regimens. Use of optimised prescriptions as glucose sparing strategy should be evaluated in larger study populations.
(Less)
- author
- Bergling, Karin LU ; de Arteaga, Javier ; Ledesma, Fabián and Öberg, Carl M. LU
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Automatic peritoneal dialysis, glucose absorption, metabolic cost, peritoneal dialysis, zero-glucose fluid
- in
- Peritoneal Dialysis International
- volume
- 42
- issue
- 6
- pages
- 615 - 621
- publisher
- Multimed Inc.
- external identifiers
-
- pmid:35034532
- scopus:85122856320
- ISSN
- 0896-8608
- DOI
- 10.1177/08968608211069232
- language
- English
- LU publication?
- yes
- id
- ba51d295-72e0-45e7-9148-91ea967b8d71
- date added to LUP
- 2022-02-24 13:12:09
- date last changed
- 2024-04-06 11:58:08
@article{ba51d295-72e0-45e7-9148-91ea967b8d71,
abstract = {{<p>Background: The continuous global rise of end-stage kidney disease creates a growing demand of economically beneficial home-based kidney replacement therapies such as peritoneal dialysis (PD). However, undesirable absorption and exposure of peritoneal tissues to glucose remain major limitations of PD. Methods: We compared a reference (standard) automated PD regimen 6 × 2 L 1.36% glucose (76 mmol/L) over 9 h with a novel, theoretically glucose sparing (optimised) prescription consisting of ‘ultrafiltration cycles’ with high glucose strength (126 mmol/L) and ‘clearance cycles’ with ultra-low, physiological glucose (5 mmol/L) for approximately 40% of the treatment time. Twenty-one prevalent PD patients underwent the optimised regimen (7 × 2 L 2.27% glucose + 5 × 2 L 0.1% glucose over 8 h) and the standard regimen in a crossover fashion. Six patients were excluded from data analysis. Results: Median glucose absorption was 43 g (IQR 41–54) and 44 g (40–55) for the standard and optimised intervention, respectively (p = 1). Ultrafiltration volume, weekly Kt/V creatinine and urea were significantly improved during optimised interventions, while no difference in sodium removal was detected. Post hoc analysis showed significantly improved ultrafiltration efficiency (ml ultrafiltration per gram absorbed glucose) during optimised regimens. No adverse events were observed except one incidence of drain pain. Conclusion: Optimised treatments were feasible and well tolerated in this small pilot study. Despite no difference in absorbed glucose, results indicate possible improvements of ultrafiltration efficiency and small solute clearances by optimised regimens. Use of optimised prescriptions as glucose sparing strategy should be evaluated in larger study populations.</p>}},
author = {{Bergling, Karin and de Arteaga, Javier and Ledesma, Fabián and Öberg, Carl M.}},
issn = {{0896-8608}},
keywords = {{Automatic peritoneal dialysis; glucose absorption; metabolic cost; peritoneal dialysis; zero-glucose fluid}},
language = {{eng}},
number = {{6}},
pages = {{615--621}},
publisher = {{Multimed Inc.}},
series = {{Peritoneal Dialysis International}},
title = {{Optimised versus standard automated peritoneal dialysis regimens pilot study (OptiStAR) : A randomised controlled crossover trial}},
url = {{http://dx.doi.org/10.1177/08968608211069232}},
doi = {{10.1177/08968608211069232}},
volume = {{42}},
year = {{2022}},
}