Chung S H, Stenvinkel P, Bergström J, Lindholm B
Department of Clinical Science, Karolinska Institute, Stockholm, Sweden.
Perit Dial Int. 2000;20 Suppl 5:S57-67.
Despite the bioincompatibility of the "old", standard, high glucose, lactate-buffered peritoneal dialysis (PD) solutions, PD is itself a highly successful dialysis modality with patient survival equivalent to that of hemodialysis (HD) during the initial 3 - 5 years of dialysis therapy. Nevertheless, PD technique survival is often limited by infectious complications and alterations in the structure and function of the peritoneal membrane. These local changes also have a negative impact on patient survival owing to systemic effects such as those often seen in patients with high peritoneal transport rate and loss of ultrafiltration (UF) capacity. Patient mortality remains unacceptably high in both HD and PD patients, with most premature deaths being associated with signs of malnutrition, inflammation, and atherosclerotic cardiovascular disease (MIA syndrome). These systemic signs are likely to be influenced by PD solutions both directly and indirectly (via changes in the peritoneal membrane). New, biocompatible PD solutions may have favorable local effects (viability and function of the peritoneal membrane) and systemic effects (for example, on MIA syndrome). Amino acid-based solution [Nutrineal (N): Baxter Healthcare Corporation, Deerfield, IL, U.S.A.] may improve nutritional status as well as peritoneal membrane viability. Bicarbonate/lactate-buffered solution [Physioneal (P): Baxter Healthcare Corporation] may ameliorate local and systemic effects of low pH, high lactate, and high glucose degradation products. Icodextrin-based solution [Extraneal (E): Baxter Healthcare SA, Castlebar, Ireland] may improve hypertension and cardiovascular problems associated with fluid overload and may extend time on therapy in patients with loss of UF capacity. The positive effects of each of these new, biocompatible solutions have been demonstrated in several studies. It is likely that the combined use of N, P, and E solutions will produce favorable synergies in regard to both local effects (peritoneal viability) and systemic effects (less malnutrition, inflammation, and fluid overload). Solution combination is an exciting area for clinical study in the coming years. Furthermore, dialysis fluid additives such as hyaluronan, which protects and improves the function of the peritoneal membrane, may further improve PD solutions. The new, biocompatible PD solutions represent an entirely new era in the evolution of the PD therapy; they are likely to have markedly positive effects on both PD technique and PD patient survival in coming years.
尽管传统的、标准的、高糖、乳酸缓冲的腹膜透析（PD）液存在生物不相容性，但在透析治疗的最初3至5年里，PD本身仍是一种非常成功的透析方式，患者生存率与血液透析（HD）相当。然而，PD技术的生存率常常受到感染并发症以及腹膜结构和功能改变的限制。这些局部变化还会因全身效应（如在腹膜高转运率和超滤（UF）能力丧失的患者中常见的那些效应）而对患者生存率产生负面影响。HD和PD患者的死亡率仍然高得令人难以接受，大多数过早死亡都与营养不良、炎症和动脉粥样硬化性心血管疾病（MIA综合征）的体征有关。这些全身体征可能直接或间接（通过腹膜的变化）受到PD液的影响。新型生物相容性PD液可能具有良好的局部效应（腹膜的活力和功能）和全身效应（例如对MIA综合征的影响）。基于氨基酸的溶液[Nutrineal（N）：百特医疗保健公司，美国伊利诺伊州迪尔菲尔德]可能会改善营养状况以及腹膜活力。碳酸氢盐/乳酸缓冲溶液[Physioneal（P）：百特医疗保健公司]可能会改善低pH值、高乳酸和高葡萄糖降解产物的局部和全身效应。基于艾考糊精的溶液[Extraneal（E）：百特医疗保健公司，爱尔兰卡斯尔巴]可能会改善与液体超负荷相关的高血压和心血管问题，并可能延长超滤能力丧失患者的治疗时间。这些新型生物相容性溶液各自的积极效应已在多项研究中得到证实。N、P和E溶液联合使用可能会在局部效应（腹膜活力）和全身效应（减少营养不良、炎症和液体超负荷）方面产生良好的协同作用。溶液联合是未来几年临床研究中一个令人兴奋的领域。此外，透析液添加剂如透明质酸，可保护和改善腹膜功能，可能会进一步改善PD液。新型生物相容性PD液代表了PD治疗发展的一个全新时代；它们可能会在未来几年对PD技术和PD患者生存率产生显著的积极影响。
