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腹膜透析与炎症。

Peritoneal dialysis and inflammation.

机构信息

Campus Centro Oeste Dona Lindu, Federal University of São João del-Rei, Brazil.

Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Brazil.

出版信息

Clin Chim Acta. 2014 Mar 20;430:109-14. doi: 10.1016/j.cca.2013.12.003. Epub 2013 Dec 11.

Abstract

Peritoneal dialysis (PD) is a kidney replacement therapy for end stage renal disease (ESRD) patients. Despite being a lifesaving treatment, the rate of mortality in patients under PD is elevated, mainly due to the chronic peritoneal dysfunction which is characterized by inflammation, peritoneal fibrosis and neoangiogenesis. The inflammatory process is trigged and modulated by the type of the peritoneal dialysis solutions (PDSs) used during PD. Currently, different PDSs are commercially available: (i) the conventional solutions; (ii) solutions of neutral pH containing low concentration of glucose degradation products (GDPs); (iii) solutions with icodextrin; and (iv) solutions containing taurine. Therefore, the aim of this review is to describe the different types of peritoneal dialysis solutions used during PD and their relationship with systemic and intraperitoneal inflammation. Some studies suggested that solutions of neutral pH containing low concentration of GDPs, icodextrin and taurine have better biocompatibility and lower influence on the inflammatory process compared to the conventional one. On the other hand, the studies, in general, were performed with a small population and for a short period of time. Therefore, further well-designed and -controlled clinical trials with larger number of individuals are required in order to better understand the role of different peritoneal dialysis solution types in the development of inflammation in patients with chronic peritoneal dialysis. Accordingly, studies that are more well-designed, well-controlled and with a larger number of patients are needed to explain and define the role of different types of PDS in the inflammation development in patients with chronic peritoneal dialysis.

摘要

腹膜透析 (PD) 是治疗终末期肾病 (ESRD) 患者的肾脏替代疗法。尽管 PD 是一种救生治疗方法,但 PD 患者的死亡率仍然很高,主要原因是慢性腹膜功能障碍,其特征是炎症、腹膜纤维化和新生血管形成。炎症过程是由 PD 期间使用的腹膜透析溶液 (PDS) 的类型触发和调节的。目前,有不同类型的 PDS 可用于商业用途:(i) 常规溶液;(ii) pH 值中性且 GDPs 浓度较低的溶液;(iii) 含有艾考糊精的溶液;和 (iv) 含有牛磺酸的溶液。因此,本综述的目的是描述 PD 期间使用的不同类型的腹膜透析溶液及其与全身和腹腔内炎症的关系。一些研究表明,与常规溶液相比,pH 值中性且 GDPs 浓度较低、含有艾考糊精和牛磺酸的溶液具有更好的生物相容性和对炎症过程的影响较小。另一方面,这些研究通常是在小群体中进行的,且持续时间较短。因此,需要进行更多设计良好、控制良好且纳入更多个体的临床试验,以更好地了解不同类型的腹膜透析溶液在慢性腹膜透析患者炎症发展中的作用。因此,需要进行更多设计良好、控制良好且纳入更多患者的研究,以解释和确定不同类型的 PDS 在慢性腹膜透析患者炎症发展中的作用。

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