Misra Paraish S, Nessim Sharon J, Perl Jeffrey
Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Semin Dial. 2017 Mar;30(2):164-173. doi: 10.1111/sdi.12579.
Adverse outcomes in peritoneal dialysis (PD), including PD related infections, the loss of residual kidney function (RKF), and longitudinal, deleterious changes in peritoneal membrane function continue to limit the long-term success of PD therapy. The observation that these deleterious changes occur upon exposure to conventional glucose-based PD solutions fuels the search for a more biocompatible PD solution. The development of a novel PD solution with a neutral pH, and lower in glucose degradation products (GDPs) compared to its conventional predecessors has been labeled a "biocompatible" solution. While considerable evidence in support of these novel solutions' biocompatibility has emerged from cell culture and animal studies, the clinical benefits as compared to conventional PD solutions are less clear. Neutral pH low GDP (NpHLGDP) PD solutions appear to be effective in reducing infusion pain, but their effects on other clinical endpoints including peritoneal membrane function, preservation of RKF, PD-related infections, and technique and patient survival are less clear. The literature is limited by studies characterized by relatively few patients, short follow-up time, heterogeneity with regards to the novel PD solution type under study, and the different patient populations under study. Nonetheless, the search for a more biocompatible PD solution continues with emerging data on promising non glucose-based solutions.
腹膜透析（PD）的不良后果，包括与PD相关的感染、残余肾功能（RKF）丧失以及腹膜功能的长期有害变化，仍然限制着PD治疗的长期成功。观察发现，暴露于传统的基于葡萄糖的PD溶液时会出现这些有害变化，这促使人们寻找一种生物相容性更好的PD溶液。一种新型PD溶液已被标记为“生物相容性”溶液，其pH值呈中性，与传统前辈相比，葡萄糖降解产物（GDPs）含量更低。虽然细胞培养和动物研究已经出现了大量支持这些新型溶液生物相容性的证据，但与传统PD溶液相比，其临床益处尚不清楚。中性pH低GDP（NpHLGDP）PD溶液似乎在减轻输注疼痛方面有效，但其对包括腹膜功能、RKF的保留、PD相关感染以及技术和患者生存率等其他临床终点的影响尚不清楚。该文献受到以下研究的限制：患者相对较少、随访时间短、所研究的新型PD溶液类型存在异质性以及所研究的患者群体不同。尽管如此，随着关于有前景的非葡萄糖基溶液的新数据不断涌现，寻找生物相容性更好的PD溶液的工作仍在继续。
