Bonomini Mario, Di Liberato Lorenzo, Rago Carmela, Lombardi Teresa, Sirolli Vittorio, Arduini Arduino
Dipartimento di Medicina e Scienze dell'Invecchiamento, Scuola di Specializzazione in Nefrologia, Università degli Studi "G. d'Annunzio", Chieti - Pescara, Italy; UOC Clinica Nefrologica, Ospedale SS. Annunziata, Chieti, Italy.
UOSD Dialisi, Ospedale SS. Annunziata, Chieti, Italy.
G Ital Nefrol. 2021 Oct 26;38(5):2021-vol5.
Peritoneal dialysis is an efficient renal replacement therapy for uremic patients but is currently under-prescribed. This is partly due to the unfavorable effects on peritoneal morphology and function (bioincompatibility) of current glucose-based solutions. Use of standard solutions can cause several peritoneal alterations including inflammation, mesothelial to mesenchymal transition, and neo-angiogenesis. The final step is fibrosis, which reduces the peritoneal filtration capacity and can lead to ultrafiltration failure and transfer of the patient to hemodialysis. Bioincompatibility can be local (peritoneum) but also systemic, due to the excessive absorption of glucose from the dialysate. Several strategies have been adopted to improve the biocompatibility of peritoneal dialysis solutions, based on the alleged causal factors. Some new solutions available on the market contain low glucose degradation products and neutral pH, others contain icodextrin or aminoacids. Clinical benefits have been associated with the use of these solutions, which however have some limitations and a debated biocompatibility profile. More recent strategies include the use of cytoprotective agents or osmo-metabolic agents in the dialysate. In this article, we review the different approaches currently under development to improve the biocompatibility of peritoneal dialysis solution and hence the clinical outcome and the viability of the technique.
腹膜透析是一种针对尿毒症患者的有效肾脏替代疗法，但目前应用不足。部分原因在于当前基于葡萄糖的溶液对腹膜形态和功能存在不良影响（生物不相容性）。使用标准溶液会导致多种腹膜改变，包括炎症、间皮向间充质转化以及新生血管形成。最后一步是纤维化，这会降低腹膜滤过能力，并可能导致超滤失败以及患者转而接受血液透析。生物不相容性可能是局部的（腹膜），也可能是全身性的，这是由于透析液中葡萄糖的过度吸收所致。基于所谓的致病因素，已采用多种策略来提高腹膜透析溶液的生物相容性。市场上一些新的溶液含有低葡萄糖降解产物和中性pH值，其他一些含有艾考糊精或氨基酸。使用这些溶液已显示出临床益处，然而它们存在一些局限性且生物相容性存在争议。更新的策略包括在透析液中使用细胞保护剂或渗透代谢剂。在本文中，我们综述了目前正在开发的不同方法，以改善腹膜透析溶液的生物相容性，从而改善临床结局和该技术的可行性。
