Department of Nephrology, Soroka Medical Center, Faculty of Health Science, Ben Gurion University of the Negev, Beer-Sheva, Israel.
J Neurosurg Anesthesiol. 2013 Jul;25(3):262-6. doi: 10.1097/ANA.0b013e318283f86a.
Previous study has demonstrated the efficacy of hemodialysis in reducing blood glutamate levels. The purpose of the present study is to investigate whether peritoneal dialysis (PD) may be effective in lowering blood glutamate levels, which may serve as a potential tool for improving neurological function after brain injury.
Two liters of dialysis solution were infused over 10 minutes into 18 patients with stage V chronic kidney disease. Blood samples were collected immediately before initiation of PD, and hourly for a total of 5 blood samples. Blood samples were sent for determination of glutamate, creatinine, urea, glucose, glutamate oxaloacetate transaminase, and glutamate pyruvate transaminase. PD samples were collected and analyzed for glutamate, creatinine, urea, and glucose at the same time points as the blood samples.
Blood glutamate concentrations were significantly reduced by 60 minutes after the infusion of dialysis solution (P<0.0001), whereas levels of glutamate in the dialysis solution were increased significantly by 60 minutes (P<0.0001).
We demonstrated that PD is an effective modality in reducing blood glutamate concentrations. This method may be potentially utilized for the treatment of acute and chronic brain disorders that are accompanied by elevated glutamate in the brain's extracellular fluid. Considering the rapid saturation of the PD solution with glutamate, we recommend frequent dwelling of the PD solution in order to maintain low concentrations of blood glutamate.
先前的研究已经证明血液透析在降低血液谷氨酸水平方面的疗效。本研究的目的是探讨腹膜透析（PD）是否可能有效降低血液谷氨酸水平，这可能成为改善脑损伤后神经功能的一种潜在手段。
18 例 V 期慢性肾脏病患者在 10 分钟内输注 2 升透析液。在开始 PD 之前立即采集血样，并在接下来的 5 小时内每小时采集一次血样。血样用于测定谷氨酸、肌酐、尿素、葡萄糖、谷氨酸草酰乙酸转氨酶和谷氨酸丙酮酸转氨酶。同时在相同时间点采集 PD 样本，用于分析谷氨酸、肌酐、尿素和葡萄糖。
输注透析液 60 分钟后，血液谷氨酸浓度显著降低（P<0.0001），而透析液中的谷氨酸水平在 60 分钟时显著升高（P<0.0001）。
我们证明 PD 是一种有效降低血液谷氨酸浓度的方法。这种方法可能可用于治疗伴有脑外液谷氨酸升高的急性和慢性脑疾病。考虑到 PD 溶液与谷氨酸的快速饱和，我们建议频繁更换 PD 溶液以维持血液中低浓度的谷氨酸。
