Nishina Makoto, Endoh Masayuki, Suzuki Daisuke, Tanabe Ryoji, Endoh Haruko, Hirahara Ichiro, Sakai Hideto
Division of Nephrology and Metabolism, Department of Internal Medicine, Tokai University, School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan.
Clin Exp Nephrol. 2004 Dec;8(4):339-43. doi: 10.1007/s10157-004-0310-2.
Conventional lactate-buffered peritoneal dialysis (PD) solutions have several bioincompatible characteristics, including acidic pH, lactate buffer, and the presence of glucose degradation products (GDPs), and these characteristics contribute to membrane dysfunction in PD patients. The formation of GDPs can be reduced by separating the glucose component of the solution from the lactate component during sterilization. This study was carried out to evaluate the clinical effect of dual-chambered neutral-pH PD solution in patients on continuous ambulatory peritoneal dialysis (CAPD).
Thirteen CAPD patients using conventional PD solution were enrolled in this study. The fast peritoneal equilibration test (fast PET) was performed periodically before and after treatment with neutral PD solution. The concentration of matrix metalloproteinase-2 (MMP-2) in dialysate effluent was measured using 4-h dwelling 2.5% glucose dialysis solution. The patients were categorized into two groups, according to the value of the initial dialysate/plasma (D/P) creatinine ratio: i.e., lower transporters (group L, D/PCr < 0.65) and higher transporters (group H, D/PCr >/= 0.65).
The mean D/P creatinine ratio measured by fast PET, was significantly decreased (0.72 +/- 0.09 to 0.60 +/- 0.06; P < 0.03) after treatment with neutral PD solution in group H. The mean glucose level in 4-h dwelling dialysate effluent was elevated (824.6 +/- 195.9 mg/dl to 942.6 +/- 147.8 mg/dl; P < 0.022) in all subjects. In group H, a significant decrease of MMP-2 in the dialysate effluent was recognized from 15 months after the beginning of treatment with the neutral PD solution (141.4 +/- 52.5 ng/ml to 91.3 +/- 15.1 ng/ml; P < 0.05), with the lowest value being shown at 21 months (80.0 +/- 31.8 ng/ml; P < 0.03).
Neutral-pH peritoneal dialysis solution decreased the MMP-2 level in dialysate and improved peritoneal function in high-transporter patients with CAPD treatment.
传统的乳酸缓冲腹膜透析（PD）液具有多种生物不相容特性，包括酸性pH值、乳酸缓冲剂以及葡萄糖降解产物（GDPs）的存在，这些特性会导致PD患者出现膜功能障碍。在灭菌过程中将溶液中的葡萄糖成分与乳酸成分分离，可以减少GDPs的形成。本研究旨在评估双腔中性pH值PD液对持续非卧床腹膜透析（CAPD）患者的临床效果。
13例使用传统PD液的CAPD患者纳入本研究。在使用中性PD液治疗前后定期进行快速腹膜平衡试验（fast PET）。使用4小时留存的2.5%葡萄糖透析液测量透析液流出液中基质金属蛋白酶-2（MMP-2）的浓度。根据初始透析液/血浆（D/P）肌酐比值将患者分为两组：即低转运者（L组，D/PCr < 0.65）和高转运者（H组，D/PCr ≥ 0.65）。
H组使用中性PD液治疗后，fast PET测量的平均D/P肌酐比值显著降低（从0.72 ± 0.09降至0.60 ± 0.06；P < 0.03）。所有受试者4小时留存的透析液流出液中的平均葡萄糖水平升高（从824.6 ± 195.9 mg/dl升至942.6 ± 147.8 mg/dl；P < 0.022）。在H组中，从开始使用中性PD液治疗15个月后，透析液流出液中的MMP-2显著降低（从141.4 ± 52.5 ng/ml降至91.3 ± 15.1 ng/ml；P < 0.05），在21个月时达到最低值（80.0 ± 31.8 ng/ml；P < 0.03）。
中性pH值腹膜透析液可降低透析液中MMP-2水平，并改善CAPD治疗的高转运患者的腹膜功能。
