***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Glycerol is a low molecular weight solute ( MW 92 D ) that can be used as an osmotic agent in continuous ambulatory peritoneal dialysis ( CAPD ) . Due to its low molecular weight , the osmotic gradient disappears rapidly . Despite the higher osmolality at the beginning of a dwell , ultrafiltration has been found to be lower for glycerol compared to glucose ( MW 180 D ) when equimolar concentrations are used . Previous studies have shown glycerol to be safe for long-term use , but some discrepancies have been reported in small solute transport and protein loss . Objective To assess permeability characteristics for a 1.4 % glycerol dialysis solution compared to 1.36 % glucose . Design Two st and ardized peritoneal permeability analyses ( SPA ) , one using 1.4 % glycerol and the other using 1.36 % glucose , in r and om order , were performed within a span of 2 weeks in 10 stable CAPD patients . The length of the study dwell was 4 hours . Fluid kinetics and solute transport were calculated and signs of cell damage were compared for the two solutions . Setting Peritoneal dialysis unit in the Academic Medical Center , Amsterdam . Results Median values for the 1.4 % glycerol SPA were as follows : net ultrafiltration 251 mL , which was higher than that for 1.36 % glucose ( 12 mL , p < 0.01 ) ; transcapillary ultrafiltration rate 2.12 mL/min , which was higher than that for glucose ( 1.52 mL/min , p = 0.01 ) ; and effective lymphatic absorption rate 1.01 mL/min , which was not different from the glucose-based solution . Calculation of peritoneal reflection coefficients for glycerol and glucose showed lower values for glycerol compared to glucose ( 0.03 vs 0.04 , calculated with both the convection and the diffusion models ) . A marked dip in dialysate-to-plasma ratio for sodium was seen in the 1.4 % glycerol exchange , suggesting uncoupled water transport through water channels . Mass transfer area coefficients for urea , creatinine , and urate were similar for both solutions . Also , clearances of the macromolecules P2-microglobulin , albumin , IgG , and α2-macroglobulin were not different for the two osmotic agents . The median absorption was higher for glycerol , 71 % compared to 49 % for glucose ( p < 0.01 ) , as could be expected from the lower molecular weight . The use of a 1.4 % glycerol solution during a 4-hour dwell caused a small but significant median rise in plasma glycerol , from 0.22 mmol/L to 0.45 mmol/L ( p = 0.02 ) . Dialysate cancer antigen 125 and lactate dehydrogenase ( LDH ) concentrations during the dwell were not different for both solutions . Conclusions These findings show that glycerol is an effective osmotic agent that can replace glucose in short dwells and show no acute mesothelial damage . The higher net ultrafiltration obtained with 1.4 % glycerol can be explained by the higher initial net osmotic pressure gradient . This was seen especially in the first hour of the dwell . Thereafter , the osmotic gradient diminished as a result of absorption . The dip in dialysate-to-plasma ratio for sodium seen in the glycerol dwell can also be explained by this high initial osmotic pressure gradient , implying that the effect of glycerol as an osmotic agent is more dependent on intact water channels than is glucose Peritoneal dialysis ( PD ) is a preferred home dialysis modality and has a number of added advantages including improved initial patient survival and cost effectiveness over haemodialysis . Despite these benefits , uptake of PD remains relatively low , especially in developed countries . Wider implementation of PD is compromised by higher technique failure from infections ( e.g. , PD peritonitis ) and ultrafiltration failure . These are inevitable consequences of peritoneal injury , which is thought to result primarily from continuous exposure to PD fluids that are characterised by their “ unphysiologic ” composition . In order to overcome these barriers , a number of more biocompatible PD fluids , with neutral pH , low glucose degradation product content , and bicarbonate buffer have been manufactured over the past two decades . Several pre clinical studies have demonstrated their benefit in terms of improvement in host cell defence , peritoneal membrane integrity , and cytokine profile . This paper aims to review r and omised controlled trials assessing the use of biocompatible PD fluids and their effect on clinical outcomes Objective Our study assessed the efficacy , safety , and biocompatibility of icodextrin ( I ) solution compared to glucose ( G ) solution as the daytime dwell in continuous cycling peritoneal dialysis ( CCPD ) . Design In a r and omized , open , prospect i ve , parallel group study of two years ’ duration , either I or G was used for the long daytime dwell in CCPD patients . Method The study was carried out in a university hospital and teaching hospital . Established CCPD patients and patients new to the modality were both included . Clinic visits were made at three-month intervals . In all patients , clinical data were gathered ; ultrafiltration ( UF ) was recorded ; and serum , urine , and dialysate sample s and effluents were collected . Peritoneal defense characteristics and mesothelial markers were determined . Every six months , peritoneal kinetics studies were performed , and serum sample s for icodextrin metabolites were taken . Results Thirty-eight patients ( 19 G , 19 I ) started the study . The median follow-up was 16 months and 17 months respectively ( range : 0.5 – 26 months and 3 – 26 months , respectively ) . Daytime UF volumes increased significantly ( p < 0.001 ) , and 24-hour UF tended to increase from baseline in the I group . Dialysate creatinine clearance increased non significantly in both groups over time . In I patients , serum disaccharides ( maltose ) concentration increased from 0.05 ± 0.01 mg/mL [ mean ± st and ard error of mean ( SEM ) ] at baseline , to an average concentration in the follow-up visits of 1.15 ± 0.04 mg/mL ( p < 0.001 ) . At the same time , serum sodium levels decreased from 138.1 ± 0.7 mmol/L to an average concentration in the follow-up visits of 135.9 ± 0.8 mmol/L ( p < 0.05 ) . At 12 months , the serum sodium concentration increased to a non significant difference from baseline . Serum osmolality increased , but did not differ significantly from G users at any visit . During peritonitis ( P ) , daytime dwell UF decreased significantly compared to non peritonitis ( NP ) episodes in G patients ( p < 0.001 ) , but remained stable in I patients . Total 24-hour UF also decreased in G patients ( p < 0.001 ) , but not in I patients . In these I patients , serum disaccharides increased from 0.05 ± 0.01 mg/mL to 1.26 ± 0.2 mg/mL during follow-up . During peritonitis , serum disaccharides concentration did not increase further ( 1.47 ± 0.2 mg/mL , p = 0.56 ) . Thirty P episodes occurred during follow-up : 16 in G patients and 14 in I patients ( 1 per 17.6 months and 1 per 21.9 months , respectively ) . After one year , absolute number and percentage of effluent peritoneal macrophages ( PMΦs ) were significantly higher in I patients than in G patients . The difference in percentage persisted after two years . The phagocytic capacity of PMΦs decreased over time , result ing in a borderline significant difference for coagulase-negative staphylococci phagocytosis ( p = 0.05 ) and a significant difference for E. coli phagocytosis ( p < 0.05 ) in favor of I patients . PMΦ oxidative metabolism , PMΦ cytokine production , and effluent opsonic capacity remained stable over time with no difference between the groups . Mass transfer area coefficients ( MTACs ) and clearances were stable and appeared unaffected by G or I treatment . Effluent cancer antigen 125 ( CA125 ) was stable in G users and tended to decrease in I users . Effluent interleukin-8 ( IL-8 ) , carboxy-terminal propeptide of type I procollagen ( PICP ) , and amino-terminal propeptide of type III procollagen ( PIIINP ) did not change over time and did not differ between the groups . Conclusions The use of I for the long daytime dwell in CCPD led to an increase in total UF of at least 261 mL per day , which was maintained over at least 24 months . During I treatment , serum I metabolites increased significantly and serum sodium concentrations decreased initially . As a result , serum osmolality increased slightly . Clinical adverse effects did not accompany these findings . The UF gain in the I patients was even higher during P , without a further increase in serum I metabolites . CCPD patients using I did equally well as G-treated patients with regard to clinical infections and most peritoneal defense characteristics . However , in a few peritoneal defense tests , I-treated patients did better . Peritoneal transport variables did not change over time . Peritoneal membrane markers did not change throughout the study and did not differ between the groups Worsening fluid balance results in reduced technique and patient survival in peritoneal dialysis . Under these conditions , the glucose polymer icodextrin is known to enhance ultrafiltration in the long dwell . A multicenter , r and omized , double-blind , controlled trial was undertaken to compare icodextrin versus 2.27 % glucose to establish whether icodextrin improves fluid status . Fifty patients with urine output < 750 ml/d , high solute transport , and either treated hypertension or untreated BP > 140/90 mmHg , or a requirement for the equivalent of all 2.27 % glucose exchanges , were r and omized 1:1 and evaluated at 1 , 3 , and 6 mo . Members of the icodextrin group lost weight , whereas the control group gained weight . Similar differences in total body water were observed , largely explained by reduced extracellular fluid volume in those receiving icodextrin , who also achieved better ultrafiltration and total sodium losses at 3 mo ( P < 0.05 ) and had better maintenance of urine volume at 6 mo ( P = 0.039 ) . In patients fulfilling the study 's inclusion criteria , the use of icodextrin , when compared with 2.27 % glucose , in the long exchange improves fluid removal and status in peritoneal dialysis . This effect is apparent within 1 mo of commencement and was sustained for 6 mo without harmful effects on residual renal function UNLABELLED Early quality of life benefits of icodextrin in peritoneal dialysis . BACKGROUND The impact of new therapies on patient quality of life ( QOL ) is emerging as an important indicator of the value of these therapies . In patients on dialysis , previous QOL evaluations have focused mainly on comparative approaches between modalities , or on longitudinal trends within a modality , but few have evaluated technical innovations or introduction of new therapies . The aim of the present study was to assess the early effects of a new dialysis solution ( icodextrin ) on the QOL of peritoneal dialysis patients . The QOL is compared with that of patients on dextrose , and the impact of demographic , and clinical characteristics on patients ' QOL is examined . METHODS The kidney disease quality of life question naire ( KDQOL ) was administered to patients who participated in a phase III double-blind , parallel group , active-controlled trial to evaluate the efficacy and safety of a peritoneal dialysis ( PD ) solution containing icodextrin in comparison with dextrose PD solution .  A total of 93 patients ( 58 icodextrin , and 35 dextrose ) completed the question naire at both baseline and after 13 weeks . In addition to patients QOL , patients ' demographic and clinical characteristics were recorded at both baseline and 13 weeks . RESULTS Mean change scores from baseline to 13 weeks of icodextrin patients were substantially higher ( > or = 5 ) than dextrose , particularly with respect to general health perception , physical functioning , role-physical , and many KDQOL symptom items such as lack of strength , washed out or drained , lack of appetite , faintness or dizziness , dry skin , cramps after an exchange or treatment , cramps during an exchange or treatment , and muscle spasms or twitching . At 13 weeks , icodextrin patients had significantly improved symptoms , and rated their health in general higher than those patients in the dextrose group . Upon multivariate analysis , icodextrin contributed significantly to the improvement of patients ' mental health , general health , and symptoms such as muscle spasms or twitching , cramps during an exchange or treatment , cramps after an exchange or treatment , itchy skin , and faintness or dizziness . CONCLUSIONS Peritoneal dialysis patients treated with icodextrin experienced substantial quality of life improvement at 13 weeks after the start of treatment when compared to dextrose patients . Further research is necessary to determine patients ' quality of life over time in a longitudinal study setting BACKGROUND In chronic ambulatory peritoneal dialysis , bicarbonate-buffered fluids , with their neutral pH and less advanced gly 
    Output:
    
Based on generally sub-optimal quality studies , use of neutral pH , low GDP PD solution led to greater urine output and higher residual renal function after use exceeded 12 months .
Icodextrin prescription improved peritoneal ultrafiltration and mitigated uncontrolled fluid overload .
There were no significant effects on peritonitis , technique survival , patient survival or harms identified with their use .
Based on the best available evidence , the use of these ' biocompatible ' PD solutions result ed in clinical ly relevant benefits without added risks of harm