Fusshoeller Andreas, Plail Marcus, Grabensee Bernd, Plum Joerg
Department of Nephrology and Rheumatology, Heinrich Heine-University of Düsseldorf, Moorenstrasse 5, 40225 Duesseldorf, Germany.
Nephrol Dial Transplant. 2004 Aug;19(8):2101-6. doi: 10.1093/ndt/gfh326. Epub 2004 Jun 22.
In chronic ambulatory peritoneal dialysis, bicarbonate-buffered fluids, with their neutral pH and less advanced glycosylation end-products (AGE) and glucose degradation products (GDP), have better biocompatibility than conventional peritoneal dialysis (PD) solutions. That difference may be more beneficial in automated peritoneal dialysis (APD), due to its more frequent exchanges and longer contact times with fresh dialysate. We performed a prospective, randomized study in APD patients to compare the biocompatibility of conventional and bicarbonate/lactate-buffered PD fluids.
We randomized 14 APD patients to have APD with either conventional or bicarbonate/lactate-based fluids. After 6 months, both groups changed to the other solution. The overall observation period was 12 months. After 1 and 5 months and again after 7 and 11 months, phagocytotic and respiratory burst capacities of effluent peritoneal macrophages were determined. Plasma interleukin (IL)-6 and C-reactive protein (CRP) as well as effluent IL-6, CRP, transforming growth factor (TGF)-beta 1, AGE and CA125 concentrations were measured. Inflow pain was quantified using a patient questionnaire.
Respiratory burst capacity remained unchanged and phagocytotic activity increased significantly during APD (P<0.001) with the bicarbonate/lactate fluid. Effluent IL-6 release was significantly lower than with the lactate fluid (P<0.05). While in the effluent TGF-beta 1 was unaffected, AGE concentration was lower after bicarbonate/lactate treatment (P<0.05). Effluent CA125 concentration, an indicator of mesothelial cell integrity, was higher (P<0.05) in neutral effluents. Finally, patients' inflow pain diminished (P = 0.05) when using the neutral fluid.
The use of a neutral PD fluid in APD improved patients' inflow pain as well as biocompatibility parameters reflecting enhanced phagocytotic activity of peritoneal macrophages, reduced constitutive inflammatory stimulation (IL-6), reduced AGE accumulation in the peritoneal cavity and better preservation of the mesothelial cell integrity. From the biocompatibility point of view, a neutral fluid with low GDP content can be recommended as the primary choice for APD.
在慢性非卧床腹膜透析中，碳酸氢盐缓冲液具有中性pH值、较少的晚期糖基化终产物（AGE）和葡萄糖降解产物（GDP），与传统腹膜透析（PD）溶液相比具有更好的生物相容性。由于自动腹膜透析（APD）交换更频繁且与新鲜透析液接触时间更长，这种差异在APD中可能更有益。我们对APD患者进行了一项前瞻性随机研究，以比较传统和碳酸氢盐/乳酸盐缓冲的PD液的生物相容性。
我们将14例APD患者随机分为使用传统或基于碳酸氢盐/乳酸盐的液体进行APD治疗。6个月后，两组互换使用另一种溶液。总观察期为12个月。在1个月和5个月后以及7个月和11个月后，分别测定流出液中腹膜巨噬细胞的吞噬和呼吸爆发能力。检测血浆白细胞介素（IL）-6、C反应蛋白（CRP）以及流出液中的IL-6、CRP、转化生长因子（TGF）-β1、AGE和CA125浓度。使用患者问卷对流入痛进行量化。
使用碳酸氢盐/乳酸盐溶液进行APD期间，呼吸爆发能力保持不变，吞噬活性显著增加（P<0.001）。流出液中IL-6释放显著低于使用乳酸盐溶液时（P<0.05）。虽然流出液中TGF-β1未受影响，但碳酸氢盐/乳酸盐治疗后AGE浓度较低（P<0.05）。作为间皮细胞完整性指标的流出液CA125浓度在中性流出液中较高（P<0.05）。最后，使用中性液体时患者的流入痛减轻（P = 0.05）。
在APD中使用中性PD液可改善患者的流入痛以及反映腹膜巨噬细胞吞噬活性增强、固有炎症刺激（IL-6）减少、腹膜腔中AGE积累减少和间皮细胞完整性得到更好保留的生物相容性参数。从生物相容性角度来看，可推荐低GDP含量的中性液体作为APD的首选。
