***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 
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    ***EXAMPLES*** 
    Input: Acid-base balance and peritoneal membrane longevity are of utmost relevance for pediatric patients undergoing peritoneal dialysis ( PD ) . PD fluids with neutral pH and reduced glucose degradation product contents are considered more biocompatible , because they preserve peritoneal cell functions in vitro . To investigate the clinical effects of a novel PD fluid buffered with 34 mM pure bicarbonate at neutral pH , a r and omized , prospect i ve , crossover comparison with conventional , acidic , 35 mM lactate PD fluid was performed for two consecutive 12-wk periods with 28 children ( age , 6 mo to 15 yr ) undergoing automated PD ( APD ) .  Blood bicarbonate levels and arterial pH were significantly higher after 3 mo of bicarbonate PD ( 24.6 + /- 2.3 mM and 7.43 + /- 0.06 , respectively ) , compared with lactate PD ( 22.8 + /- 3.9 mM and 7.38 + /- 0.05 , respectively ; P < 0.05 ) . This effect was reversible among patients who returned from bicarbonate to lactate fluid . Low initial pH and young patient age independently predicted increased blood pH during bicarbonate APD . Peritoneal equilibration tests revealed subtle changes in solute transport , with a less steep creatinine equilibration curve during bicarbonate dialysis , suggesting reduced peritoneal vasodilation . The peritoneal release of carcinogen antigen-125 increased twofold during bicarbonate APD ( 29 + /- 15 versus 15 + /- 8 U/ml per 4 h , P < 0.01 ) , which is consistent with recovery of the mesothelial cell layer . This effect was fully reversed when the patients returned to lactate fluid . Effluent carcinogen antigen-125 levels were inversely correlated with peritoneal glucose exposure during lactate but not bicarbonate APD , indicating improved in vivo mesothelial cell tolerance of high-dose glucose with the neutral-pH PD fluid with reduced glucose degradation product content . Among children undergoing APD , neutral-pH , bicarbonate-buffered PD fluid provides more effective correction of metabolic acidosis and better preservation of peritoneal cell mass than do conventional , acidic , lactate-based fluids Background Novel peritoneal dialysis solutions are characterized by a minimal content of glucose degradation products and a neutral pH. Many studies have shown the biocompatibility of neutral lactate-buffered solutions ; however , until now , the effect of purely bicarbonate-buffered solutions has not been intensively studied in vivo . Methods This study was an open label , prospect i ve , crossover multicenter trial to investigate the biocompatibility of a purely bicarbonate-buffered solution ( bicPDF ) by measuring biocompatibility parameters such as cancer antigen 125 ( CA125 ) in peritoneal effluent .  55 patients were enrolled in the study . After a 2-week run-in phase , 53 patients could be r and omized into 2 groups , starting with either st and ard lactate-buffered peritoneal dialysis fluid ( SPDF ) for 12 weeks ( phase 1 ) and then switching to bicPDF for 12 weeks ( phase 2 ) , or vice versa . Overnight peritoneal effluents were collected at baseline and at the end of phases 1 and 2 and were tested for CA125 , hyaluronic acid , vascular endothelial growth factor ( VEGF ) , tumor necrosis factor-alpha ( TNF-α ) , interleukin 6 ( IL-6 ) , interferon gamma ( IFNγ ) , and transforming growth factor-beta1 ( TGF-β1 ) . Total ultrafiltration and residual renal function were also assessed . At the end of the study , pain during fluid exchange and dwell was evaluated using special question naires . Results 34 patients completed the study ; 27 of them provided data for analysis of the biocompatibility parameters . CA125 levels in overnight effluent were significantly higher with bicPDF ( 61.9 ± 33.2 U/L ) than with SPDF ( 18.6 ± 18.2 U/L , p < 0.001 ) . Hyaluronic acid levels were significantly lower after the use of bicPDF ( 185.0 ± 119.6 ng/mL ) than after SPDF ( 257.4 ± 174.0 ng/mL , p = 0.013 ) . Both TNF-α and TGF-β1 showed higher levels with the use of bicPDF than with SPDF . No differences were observed for IL-6 , VEGF , or IFNγ levels . We observed an improvement in the glomerular filtration rate with the use of bicPDF but no differences were observed for total fluid loss . Pain scores could be analyzed in 23 patients : there was no difference between the solutions . Conclusions The use of a purely bicarbonate-buffered low-glucose degradation product solution significantly changes most of the peritoneal effluent markers measured , suggesting an improvement in peritoneal membrane integrity . Additionally , it seems to have a positive effect on residual renal function ♦ Background : Peritoneal membrane damage induced by  peritoneal dialysis ( PD )  is largely associated with epithelial-to-mesenchymal transition ( EMT ) of mesothelial cells ( MCs ) , which is believed to be a result mainly of the glucose degradation products ( GDPs ) present in PD solutions . ♦ Objectives : This study investigated the impact of bicarbonate-buffered , low-GDP PD solution ( BicaVera : Fresenius Medical Care , Bad Homburg , Germany ) on EMT of MCs in vitro and ex vivo . ♦ Methods : In vitro studies : Omentum-derived MCs were incubated with lactate-buffered st and ard PD fluid or BicaVera fluid diluted 1:1 with culture medium . Ex vivo studies : From 31 patients r and omly distributed to either st and ard or BicaVera solution and followed for 24 months , effluents were collected every 6 months for determination of EMT markers in effluent MCs . ♦ Results : Culturing of MCs with st and ard fluid in vitro result ed in morphology change to a non-epithelioid shape , with downregulation of E-cadherin ( indicative of EMT ) and strong induction of vascular endothelial growth factor ( VEGF ) expression . By contrast , in vitro exposure of MCs to bicarbonate/low-GDP solution had less impact on both EMT parameters . Ex vivo studies partially confirmed the foregoing results . The BicaVera group , with a higher prevalence of the non-epithelioid MC phenotype at baseline ( for unknown reasons ) , showed a clear and significant trend to gain and maintain an epithelioid phenotype at medium- and longer-term and to show fewer fibrogenic characteristics . By contrast , the st and ard solution group demonstrated a progressive and significantly higher presence of the non-epithelioid phenotype . Compared with effluent MCs having an epithelioid phenotype , MCs with non-epithelioid morphology showed significantly lower levels of E-cadherin and greater levels of fibronectin and VEGF . In comparing the BicaVera and st and ard solution groups , MCs from the st and ard solution group showed significantly higher secretion of interleukin 8 and lower secretion of collagen I , but no differences in the levels of other EMT-associated molecules , including fibronectin , VEGF , E-cadherin , and transforming growth factor β1 . Peritonitis incidence was similar in both groups . Functionally , the use of BicaVera fluid was associated with higher transport of small molecules and lower ultrafiltration capacity . ♦ Conclusions : Effluent MCs grown ex vivo from patients treated with bicarbonate/low-GDP BicaVera fluid showed a trend to acquire an epithelial phenotype , with lower production of proinflammatory cytokines and chemokines ( such as interleukin 8) than was seen with MCs from patients treated with a lactate-buffered st and ard PD solution The clinical benefits of using " biocompatible " neutral pH solutions containing low levels of glucose degradation products for peritoneal dialysis compared with st and ard solutions are uncertain . In this multicenter , open-label , parallel-group , r and omized controlled trial , we r and omly assigned 185 incident adult peritoneal dialysis patients with residual renal function to use either biocompatible or conventional solution for 2 years . The primary outcome measure was slope of renal function decline . Secondary outcome measures comprised time to anuria , fluid volume status , peritonitis-free survival , technique survival , patient survival , and adverse events . We did not detect a statistically significant difference in the rate of decline of renal function between the two groups as measured by the slopes of GFR : -0.22 and -0.28 ml/min per 1.73 m(2 ) per month ( P=0.17 ) in the first year in the biocompatible and conventional groups , respectively , and , -0.09 and -0.10 ml/min per 1.73 m(2 ) per month ( P=0.9 ) in the second year . The biocompatible group exhibited significantly longer times to anuria ( P=0.009 ) and to the first peritonitis episode ( P=0.01 ) . This group also had fewer patients develop peritonitis ( 30 % versus 49 % ) and had lower rates of peritonitis ( 0.30 versus 0.49 episodes per year , P=0.01 ) . In conclusion , this trial does not support a role for biocompatible fluid in slowing the rate of GFR decline , but it does suggest that biocompatible fluid may delay the onset of anuria and reduce the incidence of peritonitis compared with conventional fluid in peritoneal dialysis Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The balANZ trial recently reported that neutral pH , low glucose degradation product ( biocompatible ) peritoneal dialysis ( PD ) solutions significantly delayed anuria and reduced peritonitis rates compared with conventional solutions . This article reports a secondary outcome analysis of the balANZ trial with respect to peritoneal membrane function . Methods Adult , incident PD patients with residual renal function were r and omized to receive either biocompatible or conventional ( control ) PD solutions for 2 years . Peritoneal equilibration tests were performed at 1 , 6 , 12 , 18 and 24 months . Peritoneal small solute clearances and ultra-filtration ( UF ) were measured at 3 , 6 , 9 , 12 , 18 and 24 months . Results Of the 185 patients recruited into the trial , 85 patients in the Balance group and 82 patients in the control group had peritoneal membrane function evaluated . Mean 4-h dialysate : plasma creatinine ratios ( D : P Cr 4h ) at 1 month were significantly higher in the Balance group compared with controls ( 0.67 ± 0.10 versus 0.62 ± 0.10 , P = 0.002 ) . Over the 2-year study period , mean D : P Cr 4 h measurements remained stable in the Balance group but increased significantly in controls [ difference −0.004 per month , 95 % confidence interval ( 95 % CI ) −0.005 to −0.002 , P < 0.001 ] . Similar results were obtained for dialysate glucose ratios ( D/D0 glucose ) . Peritoneal UF was significantly lower in the Balance group than in controls at 3 and 6 months . Over the 2-year study period , peritoneal UF increased significantly in the Balance group but remained stable in controls ( difference 24 mL/day/month , 95 % CI 9–39 , P = 0.002 ) . No differences in peritoneal small solute clearances , prescribed dialysate fill volumes or peritoneal glucose exposure were observed between the two groups . Conclusions Biocompatible and conventional PD solutions exert differential effects on peritoneal small solute transport rate and UF over time . Adequately powered trials assessing the impact of these differential membrane effects on PD technique and patient survival rates are warranted BACKGROUND In vitro studies of peritoneal dialysis ( PD ) solutions demonstrated that a biocompatible fluid with neutral-pH and low glucose degradation products ( LF ) has better biocompatibility than a conventional acidic lactate-buffered fluid ( CF ) . However , few clinical trials have investigated the effects of the biocompatible solution on residual renal function ( RRF ) . We performed a prospect i ve , r and omized trial with patients starting continuous ambulatory peritoneal dialysis ( CAPD ) . METHODS Ninety-one incident patients started CAPD for 12-month treatment with either LF ( Balance , Fresenius , n = 48 ) or CF ( CAPD/DPCA , Fresenius , n = 43 ) . RRF , peritoneal solute transport rate and solute clearance were measured every 6 months . RESULTS LF had a significant effect on the change of glomerular filtration rate ( GFR ) ( P = 0.048 by the mixed model ) . In per- protocol analysis , GFR in the LF group did not decrease over a 12-month period , while GFR in the control group significantly decreased ( 0.13 
    Output:
    
The use of neutral-pH , low-glucose degradation products solutions results in better preservation of residual renal function and greater urine volumes .