Fang Wei, Mullan Robert, Shah Hemal, Mujais Salim, Bargman Joanne M, Oreopoulos Dimitrios G
Peritoneal Dialysis Program, University Health Network, and University of Toronto, Toronto, Ontario, Canada.
Perit Dial Int. 2008 Jan-Feb;28(1):35-43.
It has been proposed that biocompatible bicarbonate/lactate based (Bic/Lac), physiologic-pH peritoneal dialysis (PD) solutions will be beneficial in long-term PD. However, we do not yet have detailed knowledge concerning the comparative physiology of buffer transport for these new solutions and their impact on underlying peritoneal transport of solutes and ultrafiltration (UF). The purpose of this study was to investigate the profile of buffer handling and peritoneal membrane transport characteristics during a single dwell of the new Bic/Lac-based versus standard lactate-based (Lac) PD solution.
In this prospective crossover study, we compared a 25 mmol/L bicarbonate/15 mmol/L lactate buffered, physiologic pH, low glucose degradation product (GDP) solution (Physioneal; Baxter Healthcare, McGaw Park, Illinois, USA) with a standard lactate buffered, acidic pH, conventional solution (Dianeal; Baxter). 18 patients underwent two peritoneal equilibration tests (PETs) with 2.5% Dianeal and 2.5% Physioneal separated by 1 week. Buffer transport, mass transfer area coefficients (MTACs), solute transport, and UF were determined for the two PETs. All bags were weighed by a nurse before instillation and after drainage to assess the net UF in each dwell.
18 patients that met the inclusion criteria were enrolled in this study. Whereas intraperitoneal pH remained constant at 7.52 +/- 0.11 throughout the dwell with the Bic/Lac solution, pH was still in the acidic range with the Lac solution after 1 hour (7.29 +/- 0.13, p < 0.001); this difference disappeared after the second hour of dwell. The MTACs for creatinine (10.68 +/- 3.66 vs 10.73 +/- 2.96 mL/minute/1.73 m(2), p > 0.05) and urea (27.94 +/- 10.50 vs 27.62 +/- 6.95 mL/min/1.73 m(2), p > 0.05), for Bic/Lac versus Lac respectively, did not differ between these two solutions; transport of glucose and other solutes was also similar. However, after a 4-hour dwell with Bic/Lac solution, net UF was significantly lower than that observed with Lac solution (274.2 +/- 223.3 mL vs 366.1 +/- 217.3 mL, p = 0.026).
Compared to standard Lac-based solution, Bic/Lac based, pH neutral, low-GDP solution avoids intraperitoneal acidity. Peritoneal mass transport kinetics are similar for small solutes. Net UF is significantly lower with Bic/Lac solution; the mechanism for this is unclear.
有人提出，基于生物相容性碳酸氢盐/乳酸盐（Bic/Lac）的生理pH值腹膜透析（PD）溶液对长期腹膜透析有益。然而，我们对这些新溶液的缓冲液转运比较生理学及其对溶质的基础腹膜转运和超滤（UF）的影响尚无详细了解。本研究的目的是研究新型基于Bic/Lac的溶液与标准基于乳酸盐（Lac）的PD溶液单次驻留期间的缓冲液处理情况和腹膜转运特性。
在这项前瞻性交叉研究中，我们将一种25 mmol/L碳酸氢盐/15 mmol/L乳酸盐缓冲、生理pH值、低葡萄糖降解产物（GDP）的溶液（百特医疗保健公司生产的百特生理性腹膜透析液，美国伊利诺伊州麦加公园）与一种标准乳酸盐缓冲、酸性pH值的传统溶液（百特医疗保健公司生产的百特乳酸盐腹膜透析液）进行了比较。18例患者接受了两次腹膜平衡试验（PET），分别使用2.5%的百特乳酸盐腹膜透析液和2.5%的百特生理性腹膜透析液，间隔1周。测定了两次PET的缓冲液转运、传质面积系数（MTAC）、溶质转运和超滤情况。所有袋子在灌注前和引流后由护士称重，以评估每次驻留的净超滤量。
18例符合纳入标准的患者纳入本研究。使用Bic/Lac溶液驻留期间，腹腔内pH值在整个驻留过程中保持恒定，为7.52±0.11，而使用Lac溶液1小时后pH值仍处于酸性范围（7.29±0.13，p<0.001）；驻留第二小时后这种差异消失。Bic/Lac溶液与Lac溶液相比，肌酐的MTAC（分别为10.68±3.66 vs 10.73±2.96 mL/分钟/1.73 m²，p>0.05）和尿素的MTAC（27.94±10.50 vs 27.62±6.95 mL/分钟/1.73 m²，p>0.05）在这两种溶液之间没有差异；葡萄糖和其他溶质的转运也相似。然而，使用Bic/Lac溶液驻留4小时后，净超滤量显著低于使用Lac溶液时（274.2±223.3 mL vs 366.1±217.3 mL，p=0.026）。
与标准的基于Lac的溶液相比，基于Bic/Lac的pH中性、低GDP溶液可避免腹腔内酸性。小溶质的腹膜质量转移动力学相似。Bic/Lac溶液的净超滤量显著较低；其机制尚不清楚。
