Devuyst Olivier, Topley Nicholas, Williams John D
Division of Nephrology, St Luc Academic Hospital, Université Catholique de Louvain Medical School, Brussels, Belgium.
Nephrol Dial Transplant. 2002;17 Suppl 3:12-5. doi: 10.1093/ndt/17.suppl_3.12.
Loss of peritoneal function is a major factor leading to treatment failure in peritoneal dialysis (PD). To date, however, the relationship between the observed functional changes (reduction in ultrafiltration and changes in solute transport) and the structural alterations in the membrane have not been fully defined. Here we present data from the Peritoneal Biopsy Registry identifying and characterizing both changes in parietal peritoneal membrane thickness (degree of fibrosis) and vascular alterations (blood vessel degenerative changes) and relate these to the duration of dialysis. The genesis of functional changes in the membrane may be related to these vascular alterations. This issue is discussed in relation to the importance of nitric oxide and its synthetic enzymes in this process and its potential interaction with endothelial cell aquaporin function. It is widely believed that conventional acidic, lactate-buffered glucose-containing dialysis solutions contribute to both the structural and functional changes in the dialysed peritoneal membrane. The introduction of new more biocompatible solutions potentially allows us to reverse or attenuate these negative changes. This will be discussed in the context of our current understanding of peritoneal pathology in PD.
腹膜功能丧失是导致腹膜透析（PD）治疗失败的主要因素。然而，迄今为止，所观察到的功能变化（超滤减少和溶质转运变化）与膜结构改变之间的关系尚未完全明确。在此，我们展示了腹膜活检登记处的数据，这些数据识别并描述了壁层腹膜厚度变化（纤维化程度）和血管改变（血管退行性变化），并将这些与透析时间相关联。膜功能变化的起源可能与这些血管改变有关。本文将结合一氧化氮及其合成酶在这一过程中的重要性以及它与内皮细胞水通道蛋白功能的潜在相互作用来讨论这一问题。人们普遍认为，传统的酸性、含乳酸缓冲葡萄糖的透析液会导致透析腹膜的结构和功能变化。新型生物相容性更好的透析液的引入可能使我们能够逆转或减轻这些负面变化。本文将在我们目前对PD腹膜病理学理解的背景下对此进行讨论。
