Glucose 4.25%, calcium 1.25 mmol/L, solution for peritoneal dialysis

Package leaflet: Information for the user

Introduction

Package leaflet: information for the user

balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis

Read this entire leaflet carefully before you start using this medicine, because it contains important information for you.

• Keep this leaflet, as you may need to read it again.
• If you have any questions, ask your doctor, pharmacist or nurse.
• This medicine has been prescribed for you only and must not be given to other people, even if they have the same symptoms as you, because it may harm them.
• If you experience any adverse effects, consult your doctor, pharmacist or nurse, even if these effects are not listed in this leaflet. See section 4.

Contents of this leaflet:

1. What balance is and what it is used for
2. What you need to know before using balance
3. How to use balance
4. Possible side effects
5. How to store balance
6. Contents of the pack and other information

1. What balance is and what it is used for

balance is used to clean the blood through the peritoneum in patients with end-stage chronic renal failure. This type of blood cleaning is known as peritoneal dialysis.

2. What you need to know before using balance

Do not use balance 4.25% glucose, 1.25 mmol/l calcium

• if your blood potassium level is very low
• if your blood calcium level is very low
• if your body fluid volume is too low
• if your blood pressure is low
• if you have a metabolic disorder known as lactic acidosis

Peritoneal dialysis must not be started if you have:

• abdominal disorders such as

• wounds, or after surgical operation

• burns

• extensive inflammatory skin reactions

• peritonitis

• non-healing suppurative wounds

• umbilical, inguinal or diaphragmatic hernias

• abdominal or intestinal tumors

• inflammatory bowel diseases

• intestinal obstruction

• lung disease, especially pneumonia

• systemic blood infection caused by bacteria

• very high levels of fat in the blood

• accumulation in the blood of toxins originating from urine that cannot be removed by blood cleansing

• severe malnutrition and weight loss, especially if adequate protein nutrition is not possible.

Warnings and precautions

Contact your doctor immediately:

• in case of hyperparathyroidism (increased activity of the parathyroid gland). It may be necessary to take calcium binders containing additional phosphates and/or vitamin D.
• in case of calcium levels being too low. It may be necessary to take calcium binders containing additional phosphates and/or vitamin D or to use a peritoneal dialysis solution with a higher calcium concentration.
• in case of severe loss of electrolytes (salts) caused by vomiting and/or diarrhoea.
• in case of abnormal kidneys (polycystic kidneys)
• in case of peritonitis, recognizable because the peritoneal dialysis fluid draining from your abdomen is cloudy and/or you have abdominal pain. Show the drainage bag to your doctor.
• in case of severe abdominal pain, abdominal distension or vomiting. This may be a sign of encapsulating peritoneal sclerosis, a complication of peritoneal dialysis treatment which may become life-threatening.

Peritoneal dialysis may cause loss of proteins and water-soluble vitamins.

A proper diet or nutritional supplements are recommended to prevent nutritional deficiencies.

Your doctor should monitor your electrolyte (salt) balance, kidney function, body weight and nutritional status.

Due to the high glucose concentration in balance 4.25% glucose, 1.25 mmol/l calcium, it must be used with caution and under the supervision of your doctor.

Use of balance with other medicines

Inform your doctor or pharmacist if you are taking, have recently taken or might need to take any other medicines.

Peritoneal dialysis may alter the effect of certain medicines, so your doctor may need to adjust the dose of some of them, especially the following:

• medicines for heart failure, such as digoxin.

Your doctor will check your blood potassium level and, if necessary, take appropriate measures.

• medicines that increase urine excretion, such as diuretics.
• medicines taken orally that lower blood sugar levels or insulin. Blood sugar levels should be monitored regularly. Diabetic patients may require adjustment of their daily insulin dose.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you might be pregnant or are planning to become pregnant, consult your doctor before using this medicine. There are no adequate data on the use of balance in pregnant or breastfeeding women.

If you are pregnant or breastfeeding, you should use balance only if your doctor considers it absolutely necessary.

Driving and using machines

The influence of balance on the ability to drive or use machines is none or negligible.

3. How to use balance

Follow exactly the administration instructions for this medicine given by your doctor. If in doubt, consult your doctor or pharmacist again.

Your doctor will determine the method, duration and frequency of use, as well as the required volume of solution and dwell time in the peritoneal cavity.

If you experience abdominal discomfort or fullness, your doctor may reduce the volume.

Continuous Ambulatory Peritoneal Dialysis (CAPD)

• Adults: The usual dose is 2000 – 3000 ml of solution four times daily, depending on body weight and renal function.

The solution is drained after a dwell time of 2 to 10 hours.

• Children: The physician will determine the required volume of dialysis solution based on the child's tolerance, age, and body surface area.

The recommended initial dose is 600 – 800 ml/m² of body surface area four times daily (up to 1000 ml/m² at night).

Automated Peritoneal Dialysis (APD)

For this type of dialysis, the sleep•safe or Safe•Lock system is used. Bag exchanges are automatically controlled by the cycler during the night.

• Adults: The usual prescription is 2000 ml (maximum 3000 ml) per exchange, with 3–10 exchanges during the night (cycler time 8–10 hours), and one or two exchanges during the day.

• Children: The volume per exchange should be 800–1000 ml/m² (up to 1400 ml/m²) of body surface area, with 5–10 exchanges during the night.

Use balance only in the peritoneal cavity.

Use balance only if the solution is clear and the container is undamaged.

balance is supplied in a dual-chamber bag. Before using the solution, mix the contents of the two chambers as described below.

Instructions for use:

stay•safe system for Continuous Ambulatory Peritoneal Dialysis (CAPD)

First, warm the solution bag to body temperature. This should be done using an appropriate bag warmer. Warming time depends on the bag volume and the type of bag warmer used (for a 2000 ml bag starting at 22°C, warming typically takes 120 minutes). Refer to your warmer’s instruction manual for more detailed information. Do not use microwave ovens to warm the solution, due to the risk of local overheating. Bag exchange can be performed after warming the solution.

1. Preparation of the solution

? Check the tempered solution bag (label, expiry date, clarity of solution, integrity of bag and overpouch, integrity of seals). ? Place the bag on a solid surface. ? Open the overpouch and remove the disinfection cap/closing cap seal. ? Wash your hands using an antimicrobial hand wash. ? Roll the bag, placed horizontally on the overpouch, from one side edge until the intermediate seal opens. The solutions from the two chambers will mix automatically. ? Now roll the bag from the top edge until the lower triangular seal is fully opened. ? Check that all seals are completely open. ? Check that the solution is clear and the bag is leak-free.

1. Preparation for bag exchange

? Hang the solution bag on the upper hanger of the infusion stand. Unroll the tubing from the solution bag and place the DISC connector in the organizer. After unrolling the tubing from the drain bag, hang the drain bag on the lower hanger of the infusion stand. ? Place the catheter connector into one of the two organizer ports. ? Screw the new disinfection cap/closing cap onto the free port. ? Disinfect your hands and remove the protective cap from the DISC connector. ? Connect the catheter connector to the DISC connector.

1. Drainage flow

? Open the clamp on the extension set. Drainage begins. ? Position ?

1. Purge

? After drainage is complete, purge the drain bag with fresh solution (approximately 5 seconds). ? Position ??

1. Infusion flow

? Start infusion by turning the rotary switch to ?Position ???

1. Safety step

? Automatic closure of the catheter extension set with the PIN. ? Position ????

1. Disconnection

? Remove the protective cap from the new disinfection cap/closing cap and screw it onto the old one. ? Unscrew the catheter connector from the DISC connector and screw it onto the new disinfection cap/closing cap.

1. Closing the DISC connector

? Close the DISC connector with the used protective cap’s open end, placing it into the other hole of the organizer.

1. Check the clarity and weight of the drained dialysate. If the effluent is clear, discard it.

sleep•safe system for Automated Peritoneal Dialysis (APD)

For setup of the sleep•safe system, refer to its instruction manual.

sleep•safe system 3000 ml

1. Preparation of the solution: see stay•safe system

2. Unroll the tubing from the bag

3. Remove the protective cap

4. Place the connector into the free port of the sleep•safe cycler tray

5. The bag is ready for use with the sleep•safe cycler

sleep•safe system 3000 ml

1. Preparation of the solution

? Check the solution bag (label, expiry date, clarity of solution, integrity of bag and overpouch, integrity of seals). ? Place the bag on a solid surface. ? Open the overpouch. ? Wash your hands using an antimicrobial hand wash. ? Unfold the intermediate seal and the bag connector. ? Roll the bag, placed horizontally on the overpouch, from the diagonal end toward the bag connector. The intermediate seal will open. ? Continue until the seal of the small chamber also opens. ? Check that all seals are fully open. ? Check that the solution is clear and the bag is leak-free.

Steps 2–5: see sleep•safe system 3000 ml.

Safe•Lock system for Automated Peritoneal Dialysis (APD)

For setup of the Safe•Lock system, refer to its instruction manual.

1. Preparation of the solution: see sleep•safe system 5000 and 6000 ml
2. Remove the protective cap from the connection line connector.
3. Connect the lines to the bag.
4. Break the internal lock by bending the line and the PIN more than 90° on both sides.
5. The bag is ready for use.

Bags are for single use only, and any unused solution must be discarded.

After proper training, balance may be used independently at home. Be sure to follow all steps learned during training and maintain appropriate hygiene when exchanging bags.

Always check for cloudiness in the drained dialysate. See section 2.

If you use morebalance than you should

If an excess of dialysis solution is infused into the peritoneal cavity, it can be drained out. If you have used too many bags, contact your doctor, as this may cause electrolyte and/or fluid imbalance.

If you forget to usebalance

Try to achieve the total prescribed volume within each 24-hour period to avoid potentially life-threatening consequences. Consult your doctor if you have any doubts.

If you have any further questions about the use of this medicine, ask your doctor, pharmacist, or nurse.

4. Possible adverse effects

Like all medicines, this medicine can cause adverse effects, although not everyone will experience them.

You may experience the following adverse effects as a result of peritoneal dialysis treatment in general:

Very common (may affect more than 1 in 10 people)

• Peritonitis (inflammation of the peritoneum), indicated by cloudy dialysis fluid drained from your peritoneum, abdominal pain, fever, malaise, or, very rarely, blood infection.

Show the bag containing the drainage fluid to your doctor.

• Inflammation of the skin at the catheter exit site or along the length of the catheter, recognizable by redness, swelling, pain, discharge, or crusting.
• Abdominal wall hernia

Contact your doctor immediately if you experience any of these adverse effects.

Other adverse effects of the treatment include:

Common (may affect up to 1 in 10 people)

• Problems with inflow or outflow of dialysate
• Sensation of abdominal stretching or fullness
• Shoulder pain

Uncommon (may affect up to 1 in 100 people)

• Diarrhea
• Constipation

Very rare (may affect up to 1 in 10,000 people)

• Blood infection

Not known (frequency cannot be estimated from available data)

• Breathing difficulties
• Malaise
• Encapsulating peritoneal sclerosis, whose symptoms may include abdominal pain, abdominal distension, or vomiting

You may experience the following adverse effects when using balance e:

Very common (may affect more than 1 in 10 people)

• Potassium deficiency

Common (may affect up to 1 in 10 people)

• High blood sugar levels
• High blood fat levels
• Weight gain

Uncommon (may affect up to 1 in 100 people)

• Calcium deficiency
• Too low body fluid level, which may be recognized by rapid weight loss, decreased blood pressure, or rapid pulse.
• Too high body fluid level, which may be recognized by fluid accumulation in tissues and lungs, high blood pressure, or breathing difficulties.
• Dizziness

Not known (frequency cannot be estimated from available data)

• Increased parathyroid gland activity with potential disturbances in bone metabolism

Reporting of adverse effects

If you experience any adverse effect, consult your doctor, pharmacist, or nurse, even if it is a possible adverse effect not listed in this leaflet. You may also report them directly via the Spanish Pharmacovigilance System for Human Medicines: https://www.notificaram.es. By reporting adverse effects, you can help provide more information on the safety of this medicine.

5. Storage

Keep this medicine out of sight and reach of children.

Do not use this medicine after the expiry date stated on the bag and the box after EXP. The expiry date refers to the last day of the month indicated.

Do not store below 4ºC.

The ready-to-use solution should be used immediately and within 24 hours of mixing.

Medicines must not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines and packaging you no longer need. This will help protect the environment.

6. Contents of the package and other information

Composition of balance

• The active substances in 1 liter of ready-to-use solution are:

Calcium chloride dihydrate 0.1838 g
Sodium chloride 5.640 g
Sodium (S)-lactate solution 7.85 g
(3.925 g sodium (S)-lactate)
Magnesium chloride hexahydrate 0.1017 g
Glucose monohydrate 46.75 g
(42.5 g glucose)

These quantities of active substances are equivalent to:
1.25 mmol/l calcium, 134 mmol/l sodium, 0.5 mmol/l magnesium, 100.5 mmol/l chloride, 35 mmol/l lactate, and 235.8 mmol/l glucose.

The other components are water for injections, hydrochloric acid, sodium hydroxide, and sodium bicarbonate.

Appearance of the product and contents of the pack

The solution is clear and colourless.

The theoretical osmolarity of the ready-to-use solution is 509 mOsm/l; the pH is approximately 7.0.

balance is available in dual-chamber bags. One chamber contains the alkaline sodium lactate solution and the other chamber contains the acidic glucose solution with electrolytes.

balance is available in the following administration systems and pack sizes:

stay•safe : 4 bags of 2000 ml 4 bags of 2500 ml 4 bags of 3000 ml

sleep•safe : 4 bags of 3000 ml 2 bags of 5000 ml 2 bags of 6000 ml

Safe•Lock : 2 bags of 5000 ml 2 bags of 6000 ml

Some pack sizes may not be marketed.

Marketing Authorization Holder:

Fresenius Medical Care Deutschland GmbH, Else-Kröner-Straße 1, 61352 Bad Homburg v.d.H., Germany

Manufacturer:

Fresenius Medical Care Deutschland GmbH, Frankfurter Straße 6-8, 66606 St. Wendel, Germany

Local Representative:

Fresenius Medical Care España S.A.

C/ Ronda de Poniente, 8, ground floor, Parque Empresarial Euronova,

28760 Tres Cantos (Madrid)

Spain

This medicinal product is authorized in the European Economic Area (EEA) Member States and in the United Kingdom (Northern Ireland) under the following names:

See end of this multilingual leaflet.

Date of the most recent review of this leaflet: 02/2024

Detailed information on this medicinal product is available on the website of the Spanish Agency of Medicines and Medical Devices (AEMPS): http://www.aemps.gob.es/.

This medicinal product is authorized in the European Economic Area (EEA) Member States and in the United Kingdom (Northern Ireland) under the following names:

CZ	balance 4.25% glucose, 1.25 mmol/l calcium solution for peritoneal dialysis
DE, AT, LU	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis solution
DK	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis fluid
EE	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis solution
EL, CY	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis (clearance)
ES	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
FI	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis fluid
FR	Neutravera glucose 4.25%, calcium 1.25 mmol/l, solution for peritoneal dialysis
HR	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
HU	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis solution
IS	balance 4.25% glucose, 1.25 mmol/l calcium, dialysis fluid
IT	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
LT	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis solution
LV	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
NL, BE	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
NO	balance 4.25% glucose, 1.25 mmol calcium/l, peritoneal dialysis fluid
PL	balance 4.25% glucose and 1.25 mmol/l calcium, solution for peritoneal dialysis
PT	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
SE	balance 4.25% glucose, 1.25 mmol/l calcium, peritoneal dialysis fluid
SI	balance 42.5 mg/ml glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
SK	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis
UK(XI)	balance 4.25% glucose, 1.25 mmol/l calcium, solution for peritoneal dialysis