Peritonealdialyselösungen
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- 作者：Univ. Prof. Dr. A. Vychytil
- 关键词：SchlüsselwörterGlukosedegradationsprodukte ; Icodextrin ; Aminosäuren ; Nierenrestfunktion ; Peritoneale Ultrafiltration
- 刊名：Der Nephrologe
- 出版年：2017
- 出版时间：January 2017
- 年：2017
- 卷：12
- 期：1
- 页码：20-26
- 全文大小：241KB
- 刊物主题：Nephrology; Angiology; Metabolic Diseases; Oncology; Transplant Surgery; Urology;
- 出版者：Springer Medizin
- ISSN：1862-0418
- 卷排序：12
文摘
Peritoneal dialysis (PD) solutions containing glucose are an important component for successful performance of PD; however, due to a low pH and high concentrations of glucose degradation products (GDP) the biocompatibility of conventional glucose solutions is not optimal. Although there is not enough evidence that newer PD fluids with lower GDP concentrations lead to better preservation of the peritoneal membrane or even to improvement of technical or patient survival, better biocompatibility of these solutions has been shown both by in vitro and ex vivo studies as well as by peritoneal biopsy studies. Some trials have reported a positive effect of low GDP solutions on residual renal function; however, it remains unclear whether this phenomenon is caused by the lower GDP concentration or by slight overhydration of patients. Treatment with PD fluids containing icodextrin is associated with better peritoneal ultrafiltration, higher sodium elimination and reduced glucose load as compared to regimens which exclusively use glucose solutions. Furthermore, some data suggest positive metabolic effects of icodextrin in PD patients due to the reduced administration of glucose. Based on data from some studies reporting anabolic effects, attempts should be made to use amino acid solutions in patients with malnutrition. It remains unclear whether solutions containing amino acids as part of a PD regimen can be associated with positive long-term metabolic effects or contribute to preservation of the peritoneal membrane. Solutions for PD with low sodium concentrations could be used in the future for optimization of blood pressure. Initial results have shown that addition of alanylglutamine to PD solutions can improve peritoneal host defence mechanisms and it is hoped that this could contribute to longer survival of the peritoneal membrane.