Basso Anna, Cacciapuoti Martina, Stefanelli Lucia Federica, Nalesso Federico, Calò Lorenzo A
Nephrology, Dialysis and Transplantation Unit, Department of Medicine, University of Padova, 35128 Padova, Italy.
Life (Basel). 2024 Sep 18;14(9):1173. doi: 10.3390/life14091173.
Oxidative stress (OxSt) and inflammation are common in end-stage renal disease and dialysis patients; they are known risk factors for cardiovascular disease and mortality. In peritoneal dialysis (PD), OxSt and inflammation are even further increased compared to the already increased oxidative stress of their pre-dialysis phase. This is due to the high glucose-based solutions currently used, whose continuous contact with the peritoneal membrane can induce significant long-term morphological and functional changes (mesothelial to mesenchymal transition, thickening, neo-angiogenesis and fibrosis) of the peritoneal membrane. Oxidative stress plays a very important role in these processes, which may compromise the peritoneal dialysis procedure. There is, therefore, the need for more biocompatible dialysis fluids with polymers other than glucose to prevent and treat OxSt and inflammation. The most known and used of such glucose-free and more biocompatible peritoneal dialysis solutions is icodextrin, which has shown a protective effect from oxidative stress. This has supported the consideration of the use of glucose-free-based peritoneal dialysis fluids in order to reduce oxidative stress and improve peritoneal membrane survival. Studies investigating peritoneal dialysis with the use of osmo-metabolic agents (L-carnitine, xylitol and their combination) in peritoneal fluids replacing glucose-based fluids are, in fact, ongoing. They represent a promising strategy to reduce OxSt, preserve the peritoneal membrane's integrity and improve patients' outcome.
氧化应激（OxSt）和炎症在终末期肾病及透析患者中很常见；它们是心血管疾病和死亡的已知危险因素。在腹膜透析（PD）中，与透析前阶段已经升高的氧化应激相比，OxSt和炎症甚至进一步加剧。这是由于目前使用的高糖溶液，其与腹膜的持续接触可导致腹膜发生显著的长期形态和功能变化（间皮向间充质转化、增厚、新生血管形成和纤维化）。氧化应激在这些过程中起着非常重要的作用，这可能会损害腹膜透析程序。因此，需要使用除葡萄糖以外的聚合物制成的更具生物相容性的透析液来预防和治疗OxSt及炎症。最知名且常用的此类无葡萄糖且生物相容性更好的腹膜透析液是艾考糊精，它已显示出对氧化应激的保护作用。这支持了使用无葡萄糖腹膜透析液以降低氧化应激并提高腹膜存活时间的考虑。事实上，正在进行关于在腹膜液中使用渗透代谢剂（L-肉碱、木糖醇及其组合）替代基于葡萄糖的液体进行腹膜透析的研究。它们是降低OxSt、保持腹膜完整性并改善患者预后的一种有前景的策略。
