{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T22:31:27Z","timestamp":1773095487728,"version":"3.50.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,31]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Peritoneal dialysis (PD) solutions containing low levels of glucose degradation products (GDPs) are associated with attenuation of peritoneal membrane injury and vascular complications. However, clinical benefits associated with neutral-pH, low-GDP (N-pH\/L-GDP) solutions remain unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the associations between N-pH\/L-GDP solutions and all-cause mortality, cause-specific mortality, transfer to haemodialysis (HD) for \u226530\u00a0days and PD peritonitis in adult incident PD patients in Australia and New Zealand between 1 January 2005 and 31 December 2020 using adjusted Cox regression analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 12\u00a0814 incident PD patients, 2282 (18%) were on N-pH\/L-GDP solutions. The proportion of patients on N-pH\/L-GDP solutions each year increased from 11% in 2005 to 33% in 2017. During the study period, 5330 (42%) patients died, 4977 (39%) experienced transfer to HD and 5502 (43%) experienced PD peritonitis. Compared with the use of conventional solutions only, the use of any form of N-pH\/L-GDP solution was associated with reduced risks of all-cause mortality {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61\u20130.74]}, cardiovascular mortality [aHR 0.65 (95% CI 0.56\u20130.77)], infection-related mortality [aHR 0.62 (95% CI 0.47\u20130.83)] and transfer to HD [aHR 0.79 (95% CI 0.72\u20130.86)] but an increased risk of PD peritonitis [aHR 1.16 (95% CI 1.07\u20131.26)].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Patients who received N-pH\/L-GDP solutions had decreased risks of all-cause and cause-specific mortality despite an increased risk of PD peritonitis. Studies assessing the causal relationships are warranted to determine the clinical benefits of N-pH\/L-GDP solutions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ndt\/gfad153","type":"journal-article","created":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T01:31:05Z","timestamp":1689039065000},"page":"222-232","source":"Crossref","is-referenced-by-count":6,"title":["Associations of neutral pH, low-GDP peritoneal dialysis solutions with patient survival, transfer to haemodialysis and peritonitis"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8900-2819","authenticated-orcid":false,"given":"Jenny H C","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Wollongong Hospital , Wollongong , NSW, Australia"},{"name":"School of Medicine, University of Wollongong , Wollongong , NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Kidney and Transplant Services, Princess Alexandra Hospital , Brisbane , QLD, Australia"},{"name":"Centre for Health Services Research, University of Queensland , Brisbane , QLD, Australia"},{"name":"Translational Research Institute, University of Queensland , Brisbane , QLD, Australia"},{"name":"Australasian Kidney Trials Network , Brisbane , QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeoungjee","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Kidney and Transplant Services, Princess Alexandra Hospital , Brisbane , QLD, Australia"},{"name":"Centre for Health Services Research, University of Queensland , Brisbane , QLD, Australia"},{"name":"Australasian Kidney Trials Network , Brisbane , QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5776-6160","authenticated-orcid":false,"given":"Melissa","family":"Cheetham","sequence":"additional","affiliation":[{"name":"Centre for Health Services Research, University of Queensland , Brisbane , QLD, Australia"},{"name":"Department of Nephrology, Sunshine Coast University Hospital , Sunshine Coast , QLD, Australia"},{"name":"Sunshine Coast Health Institute , Birtinya, QLD , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamal","family":"Sud","sequence":"additional","affiliation":[{"name":"Nepean Kidney Research Centre, Department of Renal Medicine, Nepean Hospital , Sydney, NSW , Australia"},{"name":"Faculty of Medicine and Health, University of Sydney , Sydney, NSW , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashik","family":"Hayat","sequence":"additional","affiliation":[{"name":"Department of Kidney and Transplant Services, Princess Alexandra Hospital , Brisbane , QLD, Australia"},{"name":"Centre for Health Services Research, University of Queensland , Brisbane , QLD, Australia"},{"name":"Australasian Kidney Trials Network , Brisbane , QLD, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Belinda","family":"Stallard","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Tweed Hospital , Tweed Heads, NSW, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Clayton","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Royal Adelaide Hospital , Adelaide , SA, Australia"},{"name":"Australia and New Zealand Dialysis and Transplant Registry , Adelaide , SA, Australia"},{"name":"Adelaide Medical School, University of Adelaide , Adelaide , SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher E","family":"Davies","sequence":"additional","affiliation":[{"name":"Australia and New Zealand Dialysis and Transplant Registry , Adelaide , SA, Australia"},{"name":"Adelaide Medical School, University of Adelaide , Adelaide , SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"Borlace","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Royal Adelaide Hospital , Adelaide , SA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Boudville","sequence":"additional","affiliation":[{"name":"Medical School, University of Western Australia , Perth , WA, Australia"},{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital , Perth , WA, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"2024041014182874100_bib1","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1111\/sdi.12579","article-title":"\u201cBiocompatible\u201d neutral pH low-GDP peritoneal dialysis solutions: much ado about nothing?","volume":"30","author":"Misra","year":"2017","journal-title":"Semin Dial"},{"key":"2024041014182874100_bib2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1038\/ki.1991.182","article-title":"Toxicity of peritoneal dialysis fluids on cultured fibroblasts, L-929","volume":"40","author":"Wieslander","year":"1991","journal-title":"Kidney Int"},{"key":"2024041014182874100_bib3","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1681\/ASN.V114729","article-title":"Effect of glucose degradation products on human peritoneal mesothelial cell function","volume":"11","author":"Witowski","year":"2000","journal-title":"J Am Soc Nephrol"},{"key":"2024041014182874100_bib4","doi-asserted-by":"crossref","first-page":"S148","DOI":"10.1046\/j.1523-1755.63.s84.18.x","article-title":"Glucose degradation products in peritoneal dialysis fluids: do they harm?","volume":"63","author":"Witowski","year":"2003","journal-title":"Kidney Int Suppl"},{"key":"2024041014182874100_bib5","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1038\/ki.2010.515","article-title":"The biocompatibility of neutral pH, low-GDP peritoneal dialysis solutions: benefit at bench, bedside, or both?","volume":"79","author":"Perl","year":"2011","journal-title":"Kidney Int"},{"key":"2024041014182874100_bib6","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1111\/j.1523-1755.2004.00747.x","article-title":"The Euro-Balance Trial: the effect of a new biocompatible peritoneal dialysis fluid (balance) on the peritoneal membrane","volume":"66","author":"Williams","year":"2004","journal-title":"Kidney Int"},{"key":"2024041014182874100_bib7","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1093\/ndt\/gfq357","article-title":"Low-GDP peritoneal dialysis fluid (\u2018balance\u2019) has less impact in vitro and ex vivo on epithelial-to-mesenchymal transition (EMT) of mesothelial cells than a standard fluid","volume":"26","author":"Bajo","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"2024041014182874100_bib8","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.3389\/fphys.2018.01853","article-title":"Biocompatible peritoneal dialysis: the target is still way off","volume":"9","author":"Bartosova","year":"2018","journal-title":"Front Physiol"},{"key":"2024041014182874100_bib9","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1177\/08968608211027008","article-title":"Do low GDP neutral pH solutions prevent or retard peritoneal membrane alterations in long-term peritoneal dialysis?","volume":"42","author":"Parikova","year":"2022","journal-title":"Perit Dial Int"},{"key":"2024041014182874100_bib10","first-page":"1","article-title":"Biocompatible dialysis fluids for peritoneal dialysis","volume":"10","author":"Htay","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2024041014182874100_bib11","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.2215\/CJN.05410514","article-title":"Effect of neutral-pH, low-glucose degradation product peritoneal dialysis solutions on residual renal function, urine volume, and ultrafiltration: a systematic review and meta-analysis","volume":"10","author":"Yohanna","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024041014182874100_bib12","doi-asserted-by":"crossref","first-page":"724","DOI":"10.3747\/pdi.2012.00331","article-title":"Effect of biocompatible peritoneal dialysis solution on residual renal function: a systematic review of randomized controlled trials","volume":"34","author":"Seo","year":"2014","journal-title":"Perit Dial Int"},{"key":"2024041014182874100_bib13","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/0896860819895364","article-title":"International Society for Peritoneal Dialysis practice recommendations: prescribing high-quality goal-directed peritoneal dialysis","volume":"40","author":"Brown","year":"2020","journal-title":"Perit Dial Int"},{"key":"2024041014182874100_bib14","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1681\/ASN.2011121201","article-title":"Effects of biocompatible versus standard fluid on peritoneal dialysis outcomes","volume":"23","author":"Johnson","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"2024041014182874100_bib15","article-title":"Chapter 6: Peritoneal Dialysis","volume-title":"36th Annual Report","author":"ANZDATA Registry","year":"2013"},{"key":"2024041014182874100_bib16","article-title":"Chapter 5: Peritoneal Dialysis","volume-title":"44th Annual Report","author":"ANZDATA Registry","year":"2021"},{"key":"2024041014182874100_bib17","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"147","author":"von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"2024041014182874100_bib18","volume-title":"Socio-Economic Indexes for Areas: SEIFA Provides Measures of Socio-economic Conditions by Geographic Area","author":"Australian Bureau of Statistics","year":"2021"},{"key":"2024041014182874100_bib19","author":"ANZDATA Registry","year":"2023","journal-title":"AUS. & N.Z. Dialysis and Transplant Survey"},{"key":"2024041014182874100_bib20","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"2024041014182874100_bib21","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A proportional hazards model for the subdistribution of a competing risk","volume":"94","author":"Fine","year":"1999","journal-title":"J Am Stat Assoc"},{"key":"2024041014182874100_bib22","doi-asserted-by":"crossref","first-page":"864","DOI":"10.1038\/ki.2013.303","article-title":"Biocompatible peritoneal dialysis solutions: many questions but few answers","volume":"84","author":"Blake","year":"2013","journal-title":"Kidney Int"},{"key":"2024041014182874100_bib23","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.1093\/ndt\/gfl393","article-title":"Changing prescribing practice in CAPD patients in Korea: increased utilization of low GDP solutions improves patient outcome","volume":"21","author":"Lee","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"2024041014182874100_bib24","doi-asserted-by":"crossref","first-page":"2684","DOI":"10.1093\/ndt\/gfl460","article-title":"Peritoneal dialysis solutions and patient survival: does wishing make it so?","volume":"21","author":"Bargman","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"2024041014182874100_bib25","doi-asserted-by":"crossref","first-page":"S42","DOI":"10.1038\/sj.ki.5002600","article-title":"Benefits of preserving residual renal function in peritoneal dialysis","volume":"73","author":"Marr\u00f3n","year":"2008","journal-title":"Kidney Int Suppl"},{"issue":"Suppl 3","key":"2024041014182874100_bib26","doi-asserted-by":"crossref","first-page":"S102","DOI":"10.1177\/089686080102103S17","article-title":"Interleukin-6 levels decrease in effluent from patients dialyzed with bicarbonate\/lactate-based peritoneal dialysis solutions","volume":"21","author":"Cooker","year":"2001","journal-title":"Perit Dial Int"},{"key":"2024041014182874100_bib27","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3747\/pdi.2010.00176","article-title":"A study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation products","volume":"32","author":"Lai","year":"2012","journal-title":"Perit Dial Int"},{"key":"2024041014182874100_bib28","first-page":"II2","article-title":"Inflammation as a cardiovascular risk factor","volume":"109","author":"Willerson","year":"2004","journal-title":"Circulation"},{"key":"2024041014182874100_bib29","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1038\/s41591-019-0675-0","article-title":"Chronic inflammation in the etiology of disease across the life span","volume":"25","author":"Furman","year":"2019","journal-title":"Nat Med"},{"key":"2024041014182874100_bib30","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1007\/s11255-004-1392-1","article-title":"Glucose degradation products (GDP's) and peritoneal changes in patients on chronic peritoneal dialysis: will new dialysis solutions prevent these changes?","volume":"37","author":"Krishnan","year":"2005","journal-title":"Int Urol Nephrol"},{"key":"2024041014182874100_bib31","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1038\/ki.2011.244","article-title":"Long-term follow-up of patients randomized to biocompatible or conventional peritoneal dialysis solutions show no difference in peritonitis or technique survival","volume":"80","author":"Srivastava","year":"2011","journal-title":"Kidney Int"},{"key":"2024041014182874100_bib32","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.2215\/CJN.12361212","article-title":"Association of biocompatible peritoneal dialysis solutions with peritonitis risk, treatment, and outcomes","volume":"8","author":"Cho","year":"2013","journal-title":"Clin J Am Soc Nephrol"},{"key":"2024041014182874100_bib33","doi-asserted-by":"crossref","first-page":"526","DOI":"10.3747\/pdi.2015.00090","article-title":"The Trio Trial \u2013 a randomized controlled clinical trial evaluating the effect of a biocompatible peritoneal dialysis solution on residual renal function","volume":"36","author":"Sikaneta","year":"2016","journal-title":"Perit Dial Int"},{"key":"2024041014182874100_bib34","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1111\/jgs.16875","article-title":"Recruitment and retention of older people in clinical research: a systematic literature review","volume":"68","author":"Forsat","year":"2020","journal-title":"J Am Geriatr Soc"}],"container-title":["Nephrology Dialysis Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ndt\/advance-article-pdf\/doi\/10.1093\/ndt\/gfad153\/51052592\/gfad153.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/39\/2\/222\/57206578\/gfad153.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ndt\/article-pdf\/39\/2\/222\/57206578\/gfad153.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,10]],"date-time":"2024-04-10T14:33:46Z","timestamp":1712759626000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ndt\/article\/39\/2\/222\/7222382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,10]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,7,10]]},"published-print":{"date-parts":[[2024,1,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ndt\/gfad153","relation":{},"ISSN":["0931-0509","1460-2385"],"issn-type":[{"value":"0931-0509","type":"print"},{"value":"1460-2385","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2]]},"published":{"date-parts":[[2023,7,10]]}}}