Garcia-Lopez E, Lindholm B, Tranaeus A
Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden.
Perit Dial Int. 2000;20 Suppl 5:S48-56.
The successful development of peritoneal dialysis (PD) during the last two decades has been made possible by using well-established glucose-based solutions with lactate as buffer. On the other hand, awareness has been increasing about the potentially negative effects of the high concentrations of glucose and lactate, and the low pH of conventional PD solutions. This awareness has prompted an intensive effort to search for and test alternative solutions. As a result, three new, more biocompatible solutions-containing either less glucose or less lactate--are available. Amino acid-based solution uses amino acids instead of glucose as the osmotic agent; it is indicated for treatment of malnutrition. The higher pH and absence of glucose in this solution may prevent alterations of the peritoneal membrane caused by acidity and high glucose concentrations. Bicarbonate/lactate-buffered solution contains a physiologic concentration of bicarbonate and a reduced concentration of lactate; it also has a physiologic pH and markedly reduced levels of glucose degradation products (GDPs). Icodextrin-based solution contains icodextrin as the osmotic agent; it is indicated for long dwells, delivering sustained ultrafiltration for more than 16 hours. This iso-osmolar glucose-free solution may reduce peritoneal membrane alterations caused by glucose or the hyperosmolality (or both) of conventional solutions. Clinical experience of the new solutions is now extensive, and their efficacy and safety are well documented. It therefore seems appropriate to state that we have entered a new era of PD therapy. Each of the new solutions may be less damaging to the peritoneal membrane than conventional solution. In addition, they permit better management of malnutrition and fluid status, and may thus help to improve PD patient survival. Although the effects of each of these new solutions have been well described, clinical documentation of the combined use of these new biocompatible PD solutions is still insufficient. However, the results of studies are expected, during the coming years, to support the combined use of the new solutions as the preferred standard practice for PD.
在过去二十年中，腹膜透析（PD）得以成功发展，这得益于使用了成熟的以葡萄糖为基础、乳酸作为缓冲剂的溶液。另一方面，人们越来越意识到高浓度葡萄糖和乳酸以及传统腹膜透析溶液低pH值可能产生的负面影响。这种认识促使人们大力寻找和测试替代溶液。结果，出现了三种新型的、生物相容性更好的溶液，它们要么含较少的葡萄糖，要么含较少的乳酸。氨基酸基溶液使用氨基酸而非葡萄糖作为渗透剂；适用于治疗营养不良。该溶液较高的pH值和不含葡萄糖的特性可能会防止因酸性和高葡萄糖浓度导致的腹膜改变。碳酸氢盐/乳酸缓冲溶液含有生理浓度的碳酸氢盐和降低浓度的乳酸；它也具有生理pH值，且葡萄糖降解产物（GDPs）水平显著降低。以艾考糊精为基础的溶液含有艾考糊精作为渗透剂；适用于长时间留腹，可提供超过16小时的持续超滤。这种等渗无糖溶液可能会减少因葡萄糖或传统溶液的高渗性（或两者兼有）导致的腹膜改变。目前关于这些新型溶液的临床经验已很丰富，其疗效和安全性也有充分记录。因此，似乎可以说我们已进入腹膜透析治疗的新时代。每种新型溶液对腹膜的损害可能都比传统溶液小。此外，它们能更好地管理营养不良和液体状态，从而可能有助于提高腹膜透析患者的生存率。尽管每种新型溶液的效果都已得到充分描述，但关于这些新型生物相容性腹膜透析溶液联合使用的临床记录仍不充分。然而，预计在未来几年，研究结果将支持联合使用这些新型溶液作为腹膜透析的首选标准做法。
