Stigant Caroline E, Bargman Joanne M
Department of Medicine, University of Toronto, Toronto General Hospital, Ontario, Canada.
Curr Opin Nephrol Hypertens. 2002 Nov;11(6):597-602. doi: 10.1097/00041552-200211000-00005.
This review examines recent developments in the understanding of the effect of conventional, bioincompatible peritoneal dialysis fluids on structural and functional changes in the peritoneal membrane. Emphasis is placed on the clinically relevant outcome of failure of long-term peritoneal dialysis. Therapeutic strategies to prevent technique failure, including the use of new peritoneal dialysis fluids and continuous flow peritoneal dialysis, are explored.
Long-term (greater than 6 months) exposure to new peritoneal dialysis fluids with physiologic pH, lower lactate concentrations, or lower concentrations of glucose degradation products results in improved leukocyte cytokine release, ultrafiltration, and mesothelial cell mass, respectively. Continuous flow peritoneal dialysis allows efficient small molecule removal using dialysate with lower glucose concentration and possibly less glucose degradation products. Recent technical advances include creation of a double-lumen peritoneal dialysis catheter, and methods of monitoring intra-abdominal pressure and ultrafiltration.
Though initial reports with biocompatible peritoneal dialysis fluids are promising, the efficacy of these new solutions in preventing long-term peritoneal dialysis failure is unproven. Conditions in which new peritoneal dialysis fluids may be beneficial are suggested. Continuous flow peritoneal dialysis requires substantial technical improvements before this technique can be widely accepted.
本综述探讨了对传统生物不相容性腹膜透析液对腹膜结构和功能变化影响的最新认识进展。重点关注长期腹膜透析失败这一临床相关结局。探索了预防技术失败的治疗策略，包括使用新型腹膜透析液和持续非卧床腹膜透析。
长期（超过6个月）暴露于生理pH值、较低乳酸浓度或较低葡萄糖降解产物浓度的新型腹膜透析液，分别可改善白细胞细胞因子释放、超滤和间皮细胞数量。持续非卧床腹膜透析使用较低葡萄糖浓度且可能葡萄糖降解产物较少的透析液可有效清除小分子物质。近期技术进展包括双腔腹膜透析导管的研发，以及监测腹腔内压力和超滤的方法。
尽管关于生物相容性腹膜透析液的初步报告很有前景，但这些新溶液在预防长期腹膜透析失败方面的疗效尚未得到证实。提出了新型腹膜透析液可能有益的情况。在持续非卧床腹膜透析技术被广泛接受之前，需要进行大量技术改进。
