Influence of peritoneal dialysis solution biocompatibility on long-term survival of patients on continuous ambulatory peritoneal dialysis and the technique itself
Authors: Stankovic-Popovic Verica , Popovic Dragan , Dimkovic Nada , Maksic Djoko , Vasilijic Sasa , Colic Miodrag , Vucinic Zarko , Radjen Slavica , Milicic Biljana 
Published: April 2013

Background/Aim. Morbidity and mortality of continous ambulatory peritoneal
dialysis (CAPD) patients is still very high. The aim of the study was to
evaluate the effects of peritoneal dialysis (PD) solutions (standard vs
biocompatible) on long-term patients? and the techique survival. Methods. A
total of 42 stable patients on CAPD participated in this crosssectional
study. They were prospectively followed-up during the twelve years. Patients
with severe anemia (Hb < 10 g/L) and malignant disease ware excluded. Twenty
one (50%) patients were treated with the standard PD solutions (CAPDP- 1)
while the other 21 (50%) were treated with biocompatible PD solutions [(lower
level of glucose degradation products, lower concentration of Ca2+ and
neutral pH (CAPDP-2)]. All patients were analyzed for a presence of vascular
calcification, nutrition status, and parameters of inflammation after 2.5 ?
0.6 years of starting CAPD, and these variables considered in the analysis as
risk factors. Results. The patients from the group CAPDP-2 compared to those
from the group CAPDP-1 had lower level of high-sensitivity C-reactive protein
(hs-CRP) (p = 0.003), and better nutritional status as confirmed by the
mid-arm circumference (p = 0.015), and midarm muscle circumference (p =
0.002) and subjective global assessment (p = 0.000). Also, they had lower
vascular calcifications as confirmed by intima media thickness (IMT) (p =
0.003), degree of carotid narrowing (p = 0.001) and calcified plaques of
common carotid arteries (CCA) (p = 0.008). Kaplan- Meier analysis confirmed
better survival of patients from the group CAPDP-2 than those from the group
CAPDP-1 (1-, 5-, and 10-year patients survival rate was: 100%, 61.9% and
14.3% for the group CAPDP-1, and 100%, 85.7%, and 52.4% for the group
CAPDP-2, respectively; p = 0.0345). The 1-, 5-, and 10-year technique
survival rate was: 100%, 71.4%, and 38.1% for the group CAPDP-1, and 100%,
85.7%, and 76.2% for the group CAPDP-2, respectively; (p = 0.0719). Duration
of dialysis, serum triglyceride and cardiovascular score (quantitative
scoring system consisting of: ejection fraction (EF) of left ventricle < 50%;
IMT > 1 mm; carotid narrowing degree > 50%, presence of carotid plaques in
both common carotide, ischaemic heart disease, cerebrovascular event and
peripheral vascular disease with or without amputation) were independent
predictors of overall patient survival. Duration of dialysis was only
independent predictor of overall technique survival. Conclusion. Although
patients treated with biocompatible solutions showed significantly better
survival, the role of biocompatibility of CAPD solutions in patients and
technique survival have to be confirmed. Namely, multivariate analysis
confirmed that duration of dialysis, serum triglyceride and cardiovascular
score significantly predicted overall CAPD patients survival, while only
duration of dialysis was found to be independent predictor of overall
techique survival.