Summary of findings for the main comparison. Low GDP (all buffer types) compared to standard glucose dialysate for peritoneal dialysis (PD).
| Neutral pH, low GDP PD solutions versus standard glucose PD solutions | ||||||
| Patient or population: PD patients Setting: community Intervention: neutral, low GDP dialysate (all buffer types) Comparison: standard glucose dialysate | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with standard glucose dialysate | Risk with low GDP dialysate (all buffer types) | |||||
|
Residual renal function (GFR; follow‐up 3 months to more than 3 years) |
The mean residual renal function (GFR) was 0.54 mL/min/1.73 m2 higher with low GDP dialysate (0.14 to 0.93 higher) compared to standard glucose dialysate | ‐ | 835 (15) | ⊕⊕⊕⊕ HIGH a | SMD 0.19 higher (0.05 to 0.33 higher) | |
|
Urine volume (follow‐up to more than 3 years) |
The mean urine volume was 114.37 mL/d higher with low GDP dialysate (47.09 to 181.65 higher) compared to standard glucose dialysate | ‐ | 791 (11) | ⊕⊕⊕⊕ HIGH b | ‐ | |
|
Peritoneal ultrafiltration: 4 hours (follow‐up to 24 months) |
The estimated mean peritoneal ultrafiltration 69.72 mL/4 hours lower with low GDP dialysate (16.60 to 122.84 lower) compared to standard glucose dialysate | ‐ | 414 (9) | ⊕⊕⊝⊝ LOW 1 | ‐ | |
|
Peritoneal solute transport rate (4‐hour dialysis:plasma creatinine) (follow‐up to more than 3 years) |
The mean peritoneal solute transport rate was 0.01 higher with low GDP dialysate (0 to 0.03 higher) compared to standard glucose dialysate | ‐ | 746 (10) | ⊕⊕⊝⊝ LOW 2 | SMD 0.42 lower (0.74 to 0.10 lower) | |
|
Peritonitis rate (episodes/total patient‐months) (up to 24 months) |
31 per 1,000 | 36 per 1,000 (26 to 51) | RR 1.18 (0.84 to 1.64) | 18,184 (10) | ⊕⊕⊝⊝ LOW 3 | ‐ |
|
Technique failure (death‐censored) (follow‐up to more than 3 years) |
74 per 1,000 | 81 per 1,000 (55 to 120) | RR 1.10 (0.75 to 1.63) | 1275 (15) | ⊕⊕⊝⊝ LOW 4 | ‐ |
|
Death (all causes) (follow‐up to more than 3 years) |
77 per 1,000 | 21 fewer per 1,000 (41 fewer to 11 more) | RR 0.73 (0.47 to 1.14) | 1229 (15 ) | ⊕⊕⊝⊝ LOW 4 | ‐ |
| In very low certainty evidence, it is uncertain whether neutral pH, low GDP solution use led to any differences in inflow pain compared with standard PD solution (1 studies, 58 participants) | ||||||
| In very low certainty evidence, it is uncertain whether neutral pH, low GDP solution use led to adverse events including exit site/tunnel infection, non‐PD related infection/general infection, inadequate dialysis, fluid overload/hypervolaemia, hypertension, hypotension, hernia, peritoneal leak, catheter blockage, malposition, gastrointestinal disorder, abdominal pain, pancreatitis, enteritis, vomiting, newly diagnosed cancer, arthritis, angina, apoplexy, hypercalcaemia, hypocalcaemia, hyperphosphataemia, and hyperglycaemia (6 studies, 519 participants). | ||||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio GFR: glomerular filtration rate | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
a Benefit was evident at all time points assessed
b Benefit was greater with longer follow‐up duration (i.e. longer than 12 months)
1 Downgraded two levels for moderate level of heterogeneity which could not be explained and indirectness
2 Downgraded two levels for very serious study limitation significantly different baseline peritoneal solute transport rate in 30% of studies
3 Downgraded two levels for study limitation (high risk of attrition bias amongst studies analysed) and moderate heterogeneity observed
4 Downgraded two levels for very serious study limitation (none of the studies were adequately powered and number after combining studies remained too small to accurately assess this outcome)