Fischbach Michel, Terzic Joëlle, Chauvé Sylvie, Laugel Vincent, Muller Audrey, Haraldsson Börje
Nephrology Dialysis Transplantation Children's Unit, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France.
Nephrol Dial Transplant. 2004 Apr;19(4):925-32. doi: 10.1093/ndt/gfg518.
Although conventional peritoneal dialysis fluids (PDFs), such as Dianeal, are non-physiological in composition, new PDFs including Physioneal have a more neutral pH, are at least partially buffered with bicarbonate and, most importantly, contain low concentrations of glucose degradation products (GDPs).
To evaluate the impact of new PDFs in childcare, we performed a comparative crossover study with Dianeal and Physioneal. We examined both intraperitoneal pressure (IPP), which partly reflects pain induction, and the total pore area available for exchange, which indicates the number of capillaries perfused in the peritoneal membrane at any given moment and therefore partly reflects peritoneal dialysis capacity. The IPP was determined after inflow of 1000 ml/m(2) body surface area (BSA) of dialysate (intraperitoneal volume; IPV). The steady-state unrestricted area over diffusion distance (A(0)/ triangle up x, in cm(2)/cm per 1.73 m(2) BSA) was calculated from the three-pore theory. Six children were enrolled in the study. On the first day, two consecutive peritoneal equilibration tests of 90 min each were performed using first Dianeal and then Physioneal. On the second study day, the procedure was repeated with the fluids given in the opposite order.
The mean IPP normalized to IPV (ml/m(2)) was significantly higher for Dianeal (9.5 +/- 0.9 cm/1000 ml/m(2)) than for Physioneal (7.9 +/- 1.2 cm/1000 ml/m(2), P < 0.01). The mean A(0)/ triangle up x was 17 +/- 4% larger with Dianeal (36 095 +/- 2009 cm(2)/cm per 1.73 m(2)) than with Physioneal (31 780 +/- 2185 cm(2)/cm per 1.73 m(2), P < 0.001; based on 24 data pairs).
These pilot study results suggest a higher biocompatibility for Physioneal than for Dianeal. Less inflow pain associated with Physioneal induced a lower IPP reflecting enhanced fill volume tolerance, and the lower A(0)/ triangle up x reflected less capillary recruitment. Taken together, these results suggest that the new more biocompatible PDFs will improve peritoneal dialysis therapy, although this conclusion will require verification in extended clinical trials.
尽管传统的腹膜透析液（PDFs），如百特腹膜透析液，其成分是非生理性的，但包括百特生理性腹膜透析液在内的新型PDFs具有更中性的pH值，至少部分用碳酸氢盐缓冲，并且最重要的是，含有低浓度的葡萄糖降解产物（GDPs）。
为了评估新型PDFs在儿童护理中的影响，我们对百特腹膜透析液和百特生理性腹膜透析液进行了一项对比交叉研究。我们检查了部分反映疼痛诱导的腹腔内压力（IPP）以及可用于交换的总孔面积，后者表明在任何给定时刻腹膜中灌注的毛细血管数量，因此部分反映了腹膜透析能力。在注入1000 ml/m²体表面积（BSA）的透析液（腹腔内体积；IPV）后测定IPP。根据三孔理论计算扩散距离上的稳态无限制面积（A₀/Δx，单位为cm²/cm每1.73 m² BSA）。六名儿童参与了该研究。第一天，先使用百特腹膜透析液，然后使用百特生理性腹膜透析液，各进行两次连续90分钟的腹膜平衡试验。在研究的第二天，以相反的顺序给予液体重复该过程。
以IPV（ml/m²）标准化后的平均IPP，百特腹膜透析液（9.5±0.9 cm/1000 ml/m²）显著高于百特生理性腹膜透析液（7.9±1.2 cm/1000 ml/m²，P<0.01）。百特腹膜透析液的平均A₀/Δx（每1.73 m²为36095±2009 cm²/cm）比百特生理性腹膜透析液（每1.73 m²为31780±2185 cm²/cm）大17±4%（基于24对数据，P<0.001）。
这些初步研究结果表明，百特生理性腹膜透析液比百特腹膜透析液具有更高的生物相容性。与百特生理性腹膜透析液相关的流入疼痛较少，导致IPP较低，反映出填充量耐受性增强，而较低的A₀/Δx反映出较少的毛细血管募集。综上所述，这些结果表明新型生物相容性更高的PDFs将改善腹膜透析治疗，尽管这一结论需要在扩展的临床试验中得到验证。
