Authors' objectives: To assess the efficacy or effectiveness, safety, and cost-effectiveness of biocompatible PD solution.

Authors' results and conclusions: Effectiveness: The evidence showed that neutral pH, low GDP PD solution was better compared to conventional PD solution in improving the residual renal function (RRF) or urine volume. However, for icodextrin, the RRF showed no significant difference compared to conventional PD solution in SR and MA but a little increase and better improvement in another studies after 6 months. Another main outcome was on cardiovascular events, the icodextrin solution showed an improvement in coronary heart failure (CHF). The cumulative incident CHF was lower in Icodextrin users than non-users. Besides, the CHF incidence rate also greater in diabetic patient without using icodextrin subgroups than in diabetic patient who were using icodextrin PD solution. The hazard ratio of CHF in diabetes patient on icodextrin also lower compared to diabetes patient without icodextrin PD solution. On the other hand, icodextrin showed no significant difference in any changes in cardiovascular structure and function, however, this finding requires further study. On the other hand, for other outcomes the evidence varied and most of the findings was at low certainty evidence. The biocompatible or neutral pH, low GDP PD solution showed lower peritoneal ultrafiltration compared to conventional PD solution after four hours of PD, minimal changes in peritoneal membrane and MIA syndrome (chronic inflammation, malnutrition and atherosclerosis). However, for icodextrin, the included study showed there was an increase trend but not significant in ultrafiltration capacity. There was also no significant difference in peritoneal small solute clearance, peritonitis rate and patient survival between biocompatible or neutral pH, low GDP PD solution and icodextrin. Meanwhile, findings for inflow pain and hospitalisation was uncertain in all biocompatible PD solutions. Organisational: There was no difference to death-censored technique failure between neutral pH, low GDP PD solution and conventional PD solution. Meanwhile for icodextrin, the technique failure was uncertain except one study showed that non-compliance in icodextrin group was significantly lower that non-Icodextrin group. Safety: Safety issue for both neutral pH, low GDP and icodextrin PD solution was uncertain. Cost/ cost-effectiveness analysis: No economic evaluation comparing biocompatible PD solution and conventional PD solution retrieved. The economic evaluation papers retrieved showed that peritoneal dialysis was cost saving over haemodialysis.

Authors' recommendations: Neutral pH, low GDP and icodextrin solution may be used as an alternative to conventional PD solution in certain group of patients.

Authors' methods: Electronic databases were searched through Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) 1948 to present, EBM Reviews-Cochrane Database of Systematic review, EBM Reviews-Cochrane Methodology Register of Controlled Trials, EBM Reviews-Health Technology Assessment, EBM Reviews-NHS Economic Evaluation Database, and Embase 1996 to 2nd March 2020. Searches were also run in PubMed, FDA website and INAHTA for any published reports. Study was limited to 2000 onwards. Google and Google Scholar were also used to search for additional web-based materials and information about the technology. Besides, additional articles were also search by reviewing the references of retrieval articles.

Project Status: Completed

URL for project: https://www.moh.gov.my/index.php/database_stores/store_view/30?mid=609

Year Published: 2020

URL for published report: https://www.moh.gov.my/index.php/database_stores/store_view_page/30/339

Requestor: Ministry of Health

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Malaysia

Organisation Name: Malaysian Health Technology Assessment

Contact Address: Malaysian Health Technology Assessment Section, Ministry of Health Malaysia, Federal Government Administrative Centre, Level 4, Block E1, Parcel E, 62590 Putrajaya Malaysia Tel: +603 8883 1229

Contact Name: htamalaysia@moh.gov.my

Contact Email: htamalaysia@moh.gov.my

Copyright: Malaysian Health Technology Assessment Section (MaHTAS)