Division of Nephrology, Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Perit Dial Int. 2010 Mar-Apr;30(2):192-200. doi: 10.3747/pdi.2008.00159. Epub 2010 Feb 1.
Long-term peritoneal dialysis (PD) with conventional glucose based, lactate-buffered PD fluids may lead to morphological and functional alterations of the peritoneal membrane. It was hypothesized that long-term exposure to a different buffer and a mixture of osmotic agents would cause less peritoneal abnormality.
To investigate the effects of long-term exposure to a bicarbonate/lactate-buffered dialysis solution with a mixture of osmotic agents: glycerol 1.4%, amino acids 0.5%, and dextrose 1.1% (= 1% glucose) (GLAD) in a rat model with chronic kidney failure.
All rats underwent a peritoneal catheter implantation and a 70% nephrectomy. Thereafter, the rats were randomly divided into 3 groups: GLAD, 3.86% Dianeal (Baxter, Nivelles, Belgium), and buffer (Physioneal without glucose, Baxter). All rats were infused daily for 16 weeks with the appropriate PD fluid. Afterwards, a peritoneal permeability analysis (SPARa) was performed using 3.86% Physioneal in all groups. After the SPARa, the rats were sacrificed to obtain tissue samples for morphometric determinations. Omental tissue was stained with picro Sirius red for assessment of fibrosis and with CD31 for vessel density.
GLAD and Dianeal showed faster small solute transport compared to the hypotonic buffer. No differences between the groups were present in ultrafiltration. Dianeal had the lowest value for free water transport and the highest protein clearances. Total triglyceride in plasma was not different between GLAD and the buffer. Vessel density after GLAD exposure (20 V/F) was very similar to the value found for the buffer solution (17 V/F); Dianeal caused a significantly higher value (35 V/F, p < 0.01). Also, the amount of fibrosis was higher in the Dianeal-exposed rats (p < 0.01).
Both hypertonic dialysis solutions increased peritoneal solute transport. GLAD exposure was associated with the best preservation of peritoneal morphology. The results of GLAD were very similar to those of the bicarbonate/lactate-buffered solution without osmotic agents. Studies in humans are needed for further assessment of GLAD.
长期使用基于葡萄糖的常规乳酸盐缓冲腹膜透析（PD）液可能会导致腹膜形态和功能发生改变。有人假设，长期接触不同的缓冲液和混合渗透剂会导致较少的腹膜异常。
研究在慢性肾衰竭大鼠模型中，长期暴露于碳酸氢盐/乳酸盐缓冲透析液与混合渗透剂（甘油 1.4%、氨基酸 0.5%和 1.1%葡萄糖[=1%葡萄糖]（GLAD））的影响。
所有大鼠均行腹膜导管植入和 70%肾切除术。此后，大鼠随机分为 3 组：GLAD、3.86% Dianeal（百特，Nivelles，比利时）和缓冲液（无葡萄糖的 Physioneal，百特）。所有大鼠均每日接受适当的 PD 液输注 16 周。之后，所有组均使用 3.86% Physioneal 进行腹膜通透性分析（SPARa）。SPARa 后，处死大鼠获取组织样本进行形态计量学测定。大网膜组织用苦味酸天狼猩红染色评估纤维化，用 CD31 评估血管密度。
GLAD 和 Dianeal 与低渗缓冲液相比，小分子溶质转运更快。超滤在各组之间无差异。Dianeal 的游离水转运率最低，蛋白清除率最高。GLAD 与缓冲液组的血浆总三酰甘油无差异。GLAD 暴露后的血管密度（20 V/F）与缓冲液溶液的测量值非常相似（17 V/F）；Dianeal 导致的血管密度显著更高（35 V/F，p < 0.01）。此外，Dianeal 暴露大鼠的纤维化程度更高（p < 0.01）。
两种高渗透析液均增加了腹膜溶质转运。GLAD 暴露与腹膜形态的最佳保留相关。GLAD 的结果与无渗透剂的碳酸氢盐/乳酸盐缓冲液非常相似。需要进行人体研究以进一步评估 GLAD。
