Kidney Failure,Chronic Clinical Trial
Official title:
Comparison of Oxidative Stress and Insulin Resistance Before and After Using Physioneal in Peritoneal Dialysis Patients
Patients affected by end-stage renal disease (ESRD) are subjected to enhanced oxidative
stress, as a result of reduced anti-oxidant systems and increased pro-oxidant activity.
Besides, insulin resistance is also very common in ESRD patients. Both enhanced oxidative
stress and insulin resistance increase the risk of atherosclerosis and cardiovascular
mortality, and intention to reduce oxidative stress and insulin resistance is important in
ESRD patients who suffer from high cardiovascular risk.
The high concentration of glucose and glucose degradation products (GDP), high lactate, and
low pH in conventional peritoneal dialysis (PD) solutions are known as bioincompatible
factors, which are believed to increase oxidative stress in PD patients. Physioneal®, a more
biocompatible dialysis solution with neutral pH, physiologic bicarbonate concentration and
low GDP level, has been applied in Europe for several years. Previous studies of Physioneal®
have revealed advantages of improved infusion pain, more efficient acid-base control,
increased ultrafiltration, and reduced peritonitis duration. However, its effects on
oxidative stress and insulin resistance in peritoneal dialysis patients are not reported
yet. The comparison of oxidative stress and insulin resistance before and after using
Physioneal® may help to elucidate the possibly beneficial effects on uremic patients, which
frequently suffer from increased oxidative stress and insulin resistance.
Thirty continuous ambulatory peritoneal dialysis (CAPD) patients will be selected in this
study, and receive conventional solution (Dianeal® PD-2 or PD-4) for a baseline period of 3
months. Then Physioneal® will be used for 3 months. Clinical conditions, biochemical and
hematological parameters, oxidative markers in blood and effluent, and insulin resistance
will be measured at baseline, before and after Physioneal®, and some markers will be
measured 1 month after discontinuing Physioneal® and changing back to conventional solution.
The medication used in each patient will be recorded, and the dialysis prescription will be
adjusted by a nephrologist according to clinical data. The data collected before and after
Physioneal® will be analyzed by paired-t test.
Patients affected by end-stage renal disease (ESRD) are subjected to enhanced oxidative stress, as a result of reduced anti-oxidant systems and increased pro-oxidant activity. Enhanced oxidative stress in uremic patients increases the risk of atherosclerosis and cardiovascular mortality. Furthermore, bioincompatibility of dialysis therapy further increases oxidative stress. High concentration of glucose, high lactate, low pH, and/or high concentration of glucose degradation products (GDP) are known as bioincompatible factors and believed to increase oxidative stress in peritoneal dialysis patients. A more biocompatible dialysis solution, i.e., neutral pH, containing physiologic concentration of bicarbonate and low concentration of GDP has been developed. There is a growing body of in vitro studies showing this neutral bicarbonate containing dialysis solution more biocompatible compared to conventional solutions. However, its effects on oxidative stress in peritoneal dialysis patients are not reported yet. On the other hand, insulin resistance is associated with cardiovascular disease, and it is very common in uremic patients. Some animal studies suggested that reduced oxidative stress enhanced insulin sensitivity, and the effects of reduced oxidative stress in human have not been extensively investigated. Previous studies of Physioneal®, a kind of more biocompatible dialysis solution which contains bicarbonate, have revealed advantages of improved infusion pain, more efficient acid-base control, increased ultrafiltration, and reduced peritonitis duration. The comparison of oxidative stress and insulin resistance before and after using Physioneal®, may help to elucidate the possibly beneficial effects on uremic patients, which frequently suffer from increased oxidative stress and insulin resistance. ;
Allocation: Non-Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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