Mortier Siska, Faict Dirk, Schalkwijk Casper G, Lameire Norbert H, De Vriese An S
Renal Unit, University Hospital, Ghent, Belgium.
Kidney Int. 2004 Sep;66(3):1257-65. doi: 10.1111/j.1523-1755.2004.00879.x.
Chronic exposure to peritoneal dialysis fluid (PDF) affects the peritoneum, but precise causative factors are incompletely understood. We examined the effects of standard and new PDF on peritoneal function and structure.
Female Wistar rats received twice daily intraperitoneal infusions of a standard lactate-buffered 3.86% glucose PDF at pH 5.5 (Dianeal) (N= 12), a low glucose degradation product (GDP) containing bicarbonate/lactate-buffered 3.86% glucose PDF at pH 7.4 (Physioneal) (N= 12), a lactate-buffered amino acid-based PDF at pH 6.7 (Nutrineal) (N= 12) or Earle's Balanced Salt Solution at pH 7.4 (EBSS) (N= 12) during 12 weeks.
Net ultrafiltration was lower after treatment with standard PDF, but not with low-GDP bicarbonate/lactate-buffered and amino acid-based PDF, compared to EBSS. Peritonea exposed to standard PDF were characterized by an increased expression of vascular endothelial growth factor (VEGF), microvascular proliferation as well as submesothelial fibrosis, which were not observed in other groups. Staining for methylglyoxal adducts was prominent in the standard PDF-exposed group, mild in the low GDP bicarbonate/lactate-buffered group and absent in the other groups. Standard PDF induced accumulation of advanced glycation end products (AGEs) and up-regulation of the receptor for AGE (RAGE). AGEs accumulation was absent and RAGE expression was only modestly increased in low-GDP bicarbonate/lactate-buffered and amino acid-based PDF.
Long-term in vivo exposure to standard PDF adversely affects peritoneal function and structure. A low-GDP bicarbonate/lactate-buffered and amino acid-based PDF better preserved peritoneal integrity and may thus improve the longevity of the peritoneal membrane. GDPs and associated accelerated AGE formation are the main causative factors in PDF-induced peritoneal damage.
长期接触腹膜透析液（PDF）会影响腹膜，但确切的致病因素尚不完全清楚。我们研究了标准和新型PDF对腹膜功能和结构的影响。
雌性Wistar大鼠在12周内每天接受两次腹膜内输注，分别为pH 5.5的标准乳酸缓冲3.86%葡萄糖PDF（百特腹膜透析液）（N = 12）、pH 7.4的含低葡萄糖降解产物（GDP）的碳酸氢盐/乳酸缓冲3.86%葡萄糖PDF（费森尤斯腹膜透析液）（N = 12）、pH 6.7的乳酸缓冲氨基酸基PDF（百特氨基酸腹膜透析液）（N = 12）或pH 7.4的Earle平衡盐溶液（EBSS）（N = 12）。
与EBSS相比，用标准PDF治疗后净超滤率较低，但低GDP碳酸氢盐/乳酸缓冲和氨基酸基PDF治疗后净超滤率未降低。暴露于标准PDF的腹膜表现为血管内皮生长因子（VEGF）表达增加、微血管增殖以及间皮下纤维化，其他组未观察到这些情况。甲基乙二醛加合物染色在标准PDF暴露组中显著，在低GDP碳酸氢盐/乳酸缓冲组中轻度，在其他组中不存在。标准PDF诱导晚期糖基化终产物（AGEs）积累和AGE受体（RAGE）上调。低GDP碳酸氢盐/乳酸缓冲和氨基酸基PDF中未出现AGEs积累，RAGE表达仅适度增加。
长期体内暴露于标准PDF会对腹膜功能和结构产生不利影响。低GDP碳酸氢盐/乳酸缓冲和氨基酸基PDF能更好地保持腹膜完整性，从而可能提高腹膜的使用寿命。GDPs和相关的AGE形成加速是PDF诱导腹膜损伤的主要致病因素。
