Bonomini Mario, Di Liberato Lorenzo, Zammit Victor, Arduini Arduino
Department of Medicine, Section of Nephrology and Dialysis, G. d'Annunzio University, SS. Annunziata Hospital, 66100 Chieti, Italy.
Clinical Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
Molecules. 2019 Sep 23;24(19):3449. doi: 10.3390/molecules24193449.
The advantages of peritoneal dialysis (PD) over hemodialysis (HD) are well-documented. Notwithstanding, only a small proportion of patients with end-stage renal disease (ESRD) are managed with PD. This may be related to the high glucose load that PD solutions in current use have on the patient. The effects of such excess glucose include the relatively early limitation of the ultrafiltration capacity of the peritoneal membrane, and the metabolic effects associated with hyperglycemia, e.g., decreased insulin sensitivity. This article describes the advantages that may be realized by the glucose-sparing effects of substituting part of the glucose load with other osmotically active metabolites, particularly L-carnitine. The latter is anticipated to have metabolic advantages of its own, especially as in PD patients, high plasma concentrations can be achieved in the absence of renal clearance. Besides its better biocompatibility, L-carnitine demonstrates anti-anemia action due to its effects on erythropoiesis, and positive effects on the longevity and deformability of erythrocytes. Observations from our trials on the use of carnitine-enriched PD solutions have demonstrated the effectiveness of L-carnitine as an efficient osmolyte in PD, and its favorable effect on the insulin sensitivity of the patients. The significance of these findings for future developments in the use of PD in the management of patients with ESRD is discussed.
腹膜透析（PD）相对于血液透析（HD）的优势已有充分记录。尽管如此，终末期肾病（ESRD）患者中只有一小部分接受腹膜透析治疗。这可能与目前使用的腹膜透析液对患者的高葡萄糖负荷有关。这种过量葡萄糖的影响包括腹膜超滤能力相对较早受限，以及与高血糖相关的代谢影响，例如胰岛素敏感性降低。本文描述了用其他具有渗透活性的代谢物（特别是L-肉碱）替代部分葡萄糖负荷所带来的节省葡萄糖效应可能实现的优势。预计L-肉碱自身具有代谢优势，尤其是在腹膜透析患者中，在没有肾脏清除功能的情况下也能达到较高的血浆浓度。除了具有更好的生物相容性外，L-肉碱因其对红细胞生成的影响而具有抗贫血作用，并且对红细胞的寿命和可变形性有积极影响。我们关于使用富含肉碱的腹膜透析液的试验观察结果表明，L-肉碱作为腹膜透析中一种有效的渗透剂是有效的，并且对患者的胰岛素敏感性有有利影响。本文讨论了这些发现对未来在终末期肾病患者管理中使用腹膜透析的发展的意义。
