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Fortes PC, Versari PH, Stinghen AE, Pecoits–Filho R. Controlling Inflammation in Peritoneal Dialysis: The Role of PD-Related Factors as Potential Intervention Targets. Perit Dial Int 2020. [DOI: 10.1177/089686080702702s14] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cardiovascular (CV) disease is the main cause of death in peritoneal dialysis (PD) patients, but the mechanisms mediating the increased CV risk observed in this group of patients are still largely unknown, which limits the perspective on effective therapeutic strategies. Patients on PD are already exposed to a number of traditional risk factors from the start of their chronic kidney disease (CKD), because many of those risk factors are common to CV disease and CKD alike. As renal dysfunction progresses, CKD-related risk factors are introduced, changing the profile of both the CV disease and the markers of risk. In this phase, which usually starts when glomerular filtration rate falls below 60 mL/min, the list of risk factors is expanded to include disturbances of mineral metabolism, anemia, fluid overload, uremic toxicity, and increased signs of oxidative stress and inflammation. Although many of the risk factors linked to CV burden are not related to the dialytic procedure, additional harm is introduced after the initiation of PD—with, for example, the presence of chronic infections and factors related to PD fluids, particularly reabsorption of glucose. In the present article, we review the impact of the novel risk factors introduced with the initiation of PD therapy, and we propose potential therapeutic strategies (which remain to be tested) for reducing CV mortality in this group of patients.
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Affiliation(s)
- Paulo C. Fortes
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Priscilla H. Versari
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Andréa E.M. Stinghen
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | - Roberto Pecoits–Filho
- Center for Health and Biological Sciences, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
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Goossen K, Becker M, Marshall MR, Bühn S, Breuing J, Firanek CA, Hess S, Nariai H, Sloand JA, Yao Q, Chang TI, Chen J, Paniagua R, Takatori Y, Wada J, Pieper D. Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis 2020; 75:830-846. [PMID: 32033860 DOI: 10.1053/j.ajkd.2019.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
Abstract
RATIONALE & OBJECTIVE The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD. STUDY DESIGN Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies. SETTING & STUDY POPULATIONS Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition. SELECTION CRITERIA FOR STUDIES Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports. DATA EXTRACTION 2 independent reviewers selected studies and extracted data using a prespecified extraction instrument. ANALYTIC APPROACH Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs. RESULTS 19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, -40.84 [95% CI, -48.09 to-33.59] g/long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (-0.50 [95% CI, -1.19 to 0.18] mmol/L; low certainty) and hemoglobin A1c levels (-0.14% [95% CI, -0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive. LIMITATIONS Trial quality was variable. The follow-up period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data. CONCLUSIONS Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and cost-effectiveness associated with icodextrin is needed.
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Affiliation(s)
- Käthe Goossen
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Monika Becker
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Mark R Marshall
- Baxter Healthcare (Asia) Pte Ltd, Singapore; School of Medicine, University of Auckland, New Zealand; Department of Renal Medicine, Counties Manukau District Health Board, New Zealand.
| | - Stefanie Bühn
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | - Jessica Breuing
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | | | - Simone Hess
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
| | | | | | - Qiang Yao
- Baxter (China) Investment Co. Ltd, China
| | - Tae Ik Chang
- Department of Internal Medicine, NHIS Medical Center, Ilsan Hospital, Korea
| | - JinBor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
| | - Ramón Paniagua
- Research Unit, Unidad de Investigación Médica en Enfermedades Nefrológicas, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México
| | - Yuji Takatori
- Internal Medicine, Rijinkai Medical Foundation, Socio-Medical Corporation, Kohsei General Hospital, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, Department of Medicine, Witten/Herdecke University, Cologne, Germany
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Dong J, Li YJ, Xu R, Ikizler TA, Wang HY. Ketoacid Supplementation Partially Improves Metabolic Parameters in Patients on Peritoneal Dialysis. Perit Dial Int 2015; 35:736-42. [PMID: 26374833 DOI: 10.3747/pdi.2014.00151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 12/12/2014] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND A low protein diet supplemented with ketoacids has been shown to improve the metabolic profile, including insulin resistance, in patients with chronic kidney disease (CKD), but whether ketoacids alone exert similar effects is unknown. In this prospective randomized controlled trial, we aimed to evaluate the effects of ketoacid supplementation on insulin resistance, systemic inflammation, oxidative stress and endothelial dysfunction among 100 CKD patients undergoing peritoneal dialysis (PD). ♦ METHODS Patients from one Chinese PD center were randomly assigned to take ketoacids (12 tablets per day) (n = 50) versus a control group (n = 50) for 6 months in an open-label parallelarm design. Daily protein intake of 0.8 - 1.2 g/kg/d and daily energy intake of 25 - 35 kcal/kg/d was prescribed to both groups. Insulin resistance was evaluated using homeostatic model assessment (HOMA-IR) index as the primary outcome. We assessed systemic inflammation using high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6), oxidative stress using plasma oxidized low density lipoprotein (oxLDL), adipokines using leptin and adiponectin and endothelial dysfunction using serum soluble intercellular adhesion molecule-1 (sICAM) and soluble vascular adhesion molecule-1 (sVCAM) as secondary outcomes. ♦ RESULTS There were no significant differences in baseline characteristics between the 2 groups except a slightly higher age in patients assigned to the intervention. A total of 89% of participants completed the 6-month intervention. There was no significant difference in the change of HOMA-IR values from baseline between groups after adjusting for baseline age, gender, body mass index and HOMA-IR. For secondary outcomes, hs-CRP varied significantly between groups (p = 0.02), increasing over time for the control group while remaining stable for the ketoacid group. Similarly, the leptin/adiponectin ratio (LAR) differed between groups (p < 0.001), remaining stable in the ketoacid group but increasing in the control group. ♦ CONCLUSION Ketoacid therapy administered for 6 months had no effect on HOMA-IR but resulted in improvements in hs-CRP and LAR, suggesting metabolic benefit. Future studies are needed to confirm these results and any potential benefit in vascular health of PD patients.
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Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, 100034, China
| | - Yan-Jun Li
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, 100034, China
| | - Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, 100034, China
| | - Talat Alp Ikizler
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN, United States Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Hai-Yan Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Beijing, 100034, China
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Cnossen TT, Konings CJ, van der Sande FM, Leunissen KM, Kooman JP. Clinical effects of icodextrin in peritoneal dialysis. NDT Plus 2015; 1:iv18-iv22. [PMID: 25983980 PMCID: PMC4421138 DOI: 10.1093/ndtplus/sfn119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 06/19/2008] [Indexed: 12/30/2022] Open
Abstract
Objective. This study reviews the relevant publications on the clinical effects of icodextrin in peritoneal dialysis (PD). Design. The study provides a systematic review of the literature (MEDLINE search with icodextrin as the keyword). Results. Icodextrin induces sustained transcapillary ultrafiltration during long dwell periods. It also stimulates increased removal of sodium by the peritoneal membrane, reduction of extracellular water (ECW) and total body water (TBW). Effects of icodextrin on blood pressure control and residual renal function are discrepant. Icodextrin induces a reduction in the formation of advanced glycation end-products, while the longitudinal changes in the peritoneal membrane transport are less prominent. Conclusions. Use of icodextrin in PD improves the sodium and fluid balance. Icodextrin is potentially more biocompatible, when compared with the conventional glucose solutions. The side effects are rare.
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Affiliation(s)
- Trijntje T Cnossen
- Department of Internal Medicine, Division of Nephrology , Maastricht University Medical Center , the Netherlands
| | | | - Frank M van der Sande
- Department of Internal Medicine, Division of Nephrology , Maastricht University Medical Center , the Netherlands
| | - Karel M Leunissen
- Department of Internal Medicine, Division of Nephrology , Maastricht University Medical Center , the Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology , Maastricht University Medical Center , the Netherlands
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Li PKT, Culleton BF, Ariza A, Do JY, Johnson DW, Sanabria M, Shockley TR, Story K, Vatazin A, Verrelli M, Yu AW, Bargman JM. Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients. J Am Soc Nephrol 2013; 24:1889-900. [PMID: 23949801 DOI: 10.1681/asn.2012100987] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Glucose-containing peritoneal dialysis solutions may exacerbate metabolic abnormalities and increase cardiovascular risk in diabetic patients. Here, we examined whether a low-glucose regimen improves metabolic control in diabetic patients undergoing peritoneal dialysis. Eligible patients were randomly assigned in a 1:1 manner to the control group (dextrose solutions only) or to the low-glucose intervention group (IMPENDIA trial: combination of dextrose-based solution, icodextrin and amino acids; EDEN trial: a different dextrose-based solution, icodextrin and amino acids) and followed for 6 months. Combining both studies, 251 patients were allocated to control (n=127) or intervention (n=124) across 11 countries. The primary endpoint was change in glycated hemoglobin from baseline. Mean glycated hemoglobin at baseline was similar in both groups. In the intention-to-treat population, the mean glycated hemoglobin profile improved in the intervention group but remained unchanged in the control group (0.5% difference between groups; 95% confidence interval, 0.1% to 0.8%; P=0.006). Serum triglyceride, very-low-density lipoprotein, and apolipoprotein B levels also improved in the intervention group. Deaths and serious adverse events, including several related to extracellular fluid volume expansion, increased in the intervention group, however. These data suggest that a low-glucose dialysis regimen improves metabolic indices in diabetic patients receiving peritoneal dialysis but may be associated with an increased risk of extracellular fluid volume expansion. Thus, use of glucose-sparing regimens in peritoneal dialysis patients should be accompanied by close monitoring of fluid volume status.
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Affiliation(s)
- Philip K T Li
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Chaudhary K, Khanna R. Biocompatible Peritoneal Dialysis Solutions: Do We Have One?: Table 1. Clin J Am Soc Nephrol 2010; 5:723-32. [DOI: 10.2215/cjn.05720809] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yi JH, Park JI, Choi HY, Lee HY, Han SW, Kim HJ. Icodextrin improves the serum potassium profile with the enhancement of nutritional status in continuous ambulatory peritoneal dialysis patients. Electrolyte Blood Press 2009; 7:79-86. [PMID: 21468190 PMCID: PMC3041488 DOI: 10.5049/ebp.2009.7.2.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 12/08/2009] [Accepted: 12/09/2009] [Indexed: 01/09/2023] Open
Abstract
The impact of glucose-free icodextrin (ID) for overnight dwell as compared to conventional glucose-containing dialysate (GD) on potassium (K+) metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients has not yet been investigated. Serum K+ in a total of 255 stable patients (116 on GD and 139 on ID) on CAPD for more than 6 months and in 139 patients on ID before and after ID use (Pre-ID and Post-ID) were observed along with nutritional markers in a 2-year study period (Jan. 2006 to Dec. 2007). The prevalence of hypokalemia was similar between patients on GD and ID (16.7% vs 17.3%), but was lower on Post-ID than Pre-ID (17.3% vs 20.5%) without statistic significance. The mean serum K+ level was higher on ID than on GD (P<0.05) as well as Post-ID than Pre-ID (P<0.001). In the multivariate analysis, serum K+ levels were positively correlated with serum albumin, and creatinine in all patients (P<0.05), and ID-use in younger patients (age≤56, P<0.001). Serum albumin, creatinine, total CO2, and body mass index were significantly higher on Post-ID than Pre-ID. Icodextrin dialysate for chronic overnight dwell could increase serum K+ levels and lower the prevalence of hypokalemia compared to conventional glucose-containing dialysate. The improved chronic K+ balance in CAPD patients on icodextrin could be related to enhanced nutritional status rather than its impact on acute intracellular K+ redistribution.
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Affiliation(s)
- Joo-Hark Yi
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
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Lin W, Chen YC, Wu MS, Hsu HJ, Sun CY, Lin YK, Wu IW. Icodextrin Dialysate Improves Nutritional and Inflammatory Profiles in Peritoneal Dialysis Patients. Ren Fail 2009; 31:98-105. [DOI: 10.1080/08860220802595500] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Floré KM, Delanghe JR. Analytical Interferences in Point-of-Care Testing Glucometers by Icodextrin and its Metabolites: An Overview. Perit Dial Int 2009. [DOI: 10.1177/089686080902900403] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Current point-of-care testing (POCT) glucometers are based on various test principles. Two major method groups dominate the market: glucose oxidase-based systems and glucose dehydrogenase-based systems using pyrroloquinoline quinone (GDH-PQQ) as a cofactor. The GDH-PQQ-based glucometers are replacing the older glucose oxidase-based systems because of their lower sensitivity for oxygen. On the other hand, the GDH-PQQ test method results in falsely elevated blood glucose levels in peritoneal dialysis patients receiving solutions containing icodextrin ( e.g., Extraneal; Baxter, Brussels, Belgium). Icodextrin is metabolized in the systemic circulation into different glucose polymers, but mainly maltose, which interferes with the GDH-PQQ-based method. Clinicians should be aware of this analytical interference. The POCT glucometers based on the GDH-PQQ method should preferably not be used in this high-risk population and POCT glucose results inconsistent with clinical suspicion of hypoglycemic coma should be retested with another testing system.
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Affiliation(s)
| | - Joris R. Delanghe
- Department of Clinical Chemistry, University Hospital Ghent, Belgium
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Niepolski L, Grzegorzewska AE, Młot-Michalska M. Visfatin and endogenous secretory receptor for advanced glycation end-products in diabetic type 2 and non-diabetic patients undergoing intermittent hemodialysis. Int Urol Nephrol 2009; 42:441-52. [DOI: 10.1007/s11255-009-9525-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/06/2009] [Indexed: 01/25/2023]
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Liu JH, Lin HH, Yang YF, Liu YL, Kuo HL, Wang IK, Chou CY, Huang CC. Subclinical Peripheral Artery Disease in Patients Undergoing Peritoneal Dialysis: Risk Factors and Outcome. Perit Dial Int 2009. [DOI: 10.1177/089686080902900110] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Peripheral artery disease (PAD) is highly prevalent among patients in end-stage renal disease. The ankle–brachial index (ABI) is believed to be highly correlated with the subclinical PAD of lower extremities but little is known about the associated risk factors and outcome for PAD and ABI in patients on peritoneal dialysis (PD). Methods We performed a cohort study of 153 patients from a single center receiving stable PD for more than 3 months. These patients were screened for subclinical PAD using the ABI measurement. The ABI was measured and a ratio of <0.9 was considered abnormal. Clinical outcomes included actuarial patient and technique survival in this study. Results 30 patients were classified into a subclinical PAD group. The prevalence of PAD (subclinical and overt) in our PD center was 19.61% (30/153). Advanced age, preexisting diabetes, preexisting cardiovascular and/or cerebrovascular disease (CVD), lower renal Kt/V urea, lower renal creatinine clearance (WCrCl), lower serum albumin level, and higher serum triglyceride level were risk factors for PAD in our PD center. Bivariate analysis showed that ABI was positively correlated with residual renal Kt/V urea and WCrCl, but was not correlated with peritoneal Kt/V urea and WCrCl. Patient and technique survival rates were significantly lower in the low ABI group than in the normal ABI group. Conclusions ABI is highly correlated with advanced age, preexisting diabetes, preexisting CVD, serum albumin, serum triglyceride, and residual renal clearance in PD patients. Also, lower ABI is independently associated with a high risk of patient mortality and PD technique failure.
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Affiliation(s)
- Jiung-Hsiun Liu
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsin-Hung Lin
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Fei Yang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yao-Lung Liu
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Huey-Liang Kuo
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Che-Yi Chou
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Ching Huang
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Pletinck A, Verbeke F, Van Bortel L, Dequidt C, Vijt D, Van Biesen W, Vanholder R. Acute central haemodynamic effects induced by intraperitoneal glucose instillation. Nephrol Dial Transplant 2008; 23:4029-35. [DOI: 10.1093/ndt/gfn384] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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The new peritoneal dialysis solutions: friends only, or foes in part? ACTA ACUST UNITED AC 2007; 3:604-12. [DOI: 10.1038/ncpneph0620] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 06/29/2007] [Indexed: 11/08/2022]
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