St. Elisabeth-Krankenhaus, Straubing, Germany.
Nephrol Dial Transplant. 2010 Jul;25(7):2288-96. doi: 10.1093/ndt/gfq087. Epub 2010 Mar 1.
Residual renal function (RRF) impacts outcome of peritoneal dialysis (PD) patients. Some PD fluids contain glucose degradation products (GDPs) which have been shown to affect cell systems and tissues. They may also act as precursors of advanced glycosylation endproducts (AGEs) both locally and systemically, potentially inflicting damage to the kidney as the major organ for AGE elimination. We conducted a clinical study in PD patients to see if the content of GDP in the PD fluid has any influence on the decline of the residual renal function.
In a multicentre approach, 80 patients (GFF > or = 3 mL/min/1.732 or creatinine clearance > or =3 mL/min/1.73 m(2)) were randomized to treatment with a PD fluid containing low levels of GDP or standard PD fluid for 18 months. RRF was assessed every 4-6 weeks. Fluid balance, mesothelial cell mass marker CA125, peritoneal membrane characteristics, C-reactive protein (CRP), total protein, albumin, electrolytes and phosphate were measured repeatedly.
Data from 69 patients revealed a significant difference in monthly RRF change: -1.5% (95% CI = -3.07% to +0.03%) with low GDP (43 patients) vs -4.3% (95% CI = -6.8% to -2.06%) with standard fluids (26 patients) (P = 0.0437), independent of angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker medication. Twenty-four-hour urine volume declined more slowly with low-GDP fluid compared to standard fluids (12 vs 38 mL/month, P = 0.0241), and monthly change of phosphate level was smaller (+0.013 vs +0.061 mg/dL, P = 0.0381).
Our prospective study demonstrates for the first time a significant benefit concerning preservation of RRF and urine volume of using a PD fluid with low GDP levels. These findings suggest that GDPs might affect patient outcome related to RRF.
残余肾功能（RRF）影响腹膜透析（PD）患者的预后。一些 PD 液含有葡萄糖降解产物（GDPs），这些产物已被证明会影响细胞系统和组织。它们还可能作为晚期糖基化终产物（AGEs）的前体，在局部和全身发挥作用，可能会对肾脏造成损害，因为肾脏是 AGE 消除的主要器官。我们在 PD 患者中进行了一项临床研究，以观察 PD 液中 GDP 的含量是否会影响残余肾功能的下降。
采用多中心方法，将 80 例（GFF≥3ml/min/1.732 或肌酐清除率≥3ml/min/1.73m2）患者随机分为低 GDP PD 液治疗组或标准 PD 液治疗组，治疗时间为 18 个月。每 4-6 周评估一次 RRF。反复测量液体平衡、间皮细胞质量标志物 CA125、腹膜膜特性、C 反应蛋白（CRP）、总蛋白、白蛋白、电解质和磷酸盐。
69 例患者的数据显示，RRF 每月变化的差异有统计学意义：低 GDP 组（43 例）为-1.5%（95%CI=-3.07%0.03%），标准液组（26 例）为-4.3%（95%CI=-6.8%-2.06%）（P=0.0437），与血管紧张素转换酶（ACE）抑制剂或血管紧张素受体阻滞剂的使用无关。与标准液相比，低 GDP 液组的 24 小时尿量下降更缓慢（12 比 38ml/月，P=0.0241），每月磷酸盐水平变化较小（+0.013 比+0.061mg/dL，P=0.0381）。
我们的前瞻性研究首次证明，使用 GDP 水平低的 PD 液可显著提高 RRF 和尿量的保留率。这些发现表明 GDPs 可能会影响与 RRF 相关的患者预后。
