Jörres A
Department of Nephrology and Medical Intensive Care, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität zu Berlin, Germany.
Adv Ren Replace Ther. 2001 Jul;8(3):164-72. doi: 10.1053/jarr.2001.26349.
The functional integrity of the peritoneal membrane is of critical importance for the long-term success of peritoneal dialysis therapy. In addition to water and solute transport properties, the function of the membrane encompasses complex interactions with immune cells, invading microorganisms, and dialysis fluid components. During chronic peritoneal dialysis, intraperitoneal homeostasis is threatened by the repeated exposure to an unphysiologic environment that is created by the instilled solutions. Whereas their acidic pH and hyperosmolality were shown to primarily induce alterations of acute cell function, long-term peritoneal function might be affected by the repeated exposure to high concentrations of glucose and glucose degradation products. In addition to their intrinsic toxicity, these might induce or accelerate glycation processes, such as formation and deposition of advanced glycation end products in the peritoneal membrane. Presently, a new generation of dual-chambered peritoneal dialysis solutions combining the advantages of neutral pH and reduced glucose degradation products content is being introduced into clinical practice. In addition to an improved in vitro biocompatibility profile, emerging clinical trials of these novel solutions indicate that they might also improve the host defense status, membrane transport characteristics, ultrafiltration capacity, and effluent markers of peritoneal membrane integrity, while being safe and effective in correcting uremic acidosis and providing relief of inflow pain. Overall, these findings suggest that these new dialysis solutions might constitute an important step toward better preservation of long-term peritoneal membrane function during peritoneal dialysis.
腹膜的功能完整性对于腹膜透析治疗的长期成功至关重要。除了水和溶质转运特性外，该膜的功能还包括与免疫细胞、入侵微生物和透析液成分的复杂相互作用。在慢性腹膜透析期间，腹腔内稳态受到反复暴露于由注入溶液所营造的非生理环境的威胁。虽然已表明其酸性pH值和高渗性主要诱导急性细胞功能改变，但长期腹膜功能可能会受到反复暴露于高浓度葡萄糖和葡萄糖降解产物的影响。除了其内在毒性外，这些物质可能诱导或加速糖基化过程，例如晚期糖基化终产物在腹膜中的形成和沉积。目前，结合了中性pH值和降低葡萄糖降解产物含量优势的新一代双腔腹膜透析溶液正在引入临床实践。除了改善体外生物相容性特征外，这些新型溶液的新兴临床试验表明，它们还可能改善宿主防御状态、膜转运特性、超滤能力以及腹膜完整性的流出标记物，同时在纠正尿毒症酸中毒和缓解流入疼痛方面安全有效。总体而言，这些发现表明，这些新型透析溶液可能是朝着在腹膜透析期间更好地保留长期腹膜功能迈出的重要一步。
