保护腹膜功能新认识
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摘要
腹膜透析(peritoneal dialysis, PD)是一种广泛应用的肾脏替代疗法。随着腹膜透析龄的不断延长,患者腹膜功能随之出现改变,特征为对溶质转运加快,对水分超滤逐渐减少,直至发生超滤衰竭(ultra-filtration failure,UFF),最终导致腹膜透析失败。反复发作的腹膜炎、长期暴露于生物不相容透析液、较长的透析龄是腹膜功能减退的主要影响因素。腹膜相应的解剖学变化包括腹膜纤维化、血管透明变性和血管形成。为了更有效的评估和预测腹膜功能变化,越来越多的生物标记物用于临床实践。对于保护腹膜功能实施切实有效的措施可以延长PD的时间,提高患者的生存率。近年来,针对保护腹膜功能的措施成为了新的研究热点。本文就近年来国内、国际上有关保护腹膜功能相关措施的最新研究进展进行简述。
Peritoneal dialysis(PD) is a widely used renal replacement therapy. As the increase of PD age in the patients, changes of peritoneal function occur, which is characterized by the increase of solute transport and decrease of ultrafiltration. Ultrafiltration failure(UFF) will eventually lead to PD failure. Recurrent peritonitis, prolonged exposure to bioincompatible dialysate and long dialysis age are the major contributors to peritoneal dysfunction. Corresponding anatomical changes in the peritoneum include peritoneal fibrosis, hyalinizing vasculopathy and angiogenesis. Many biomarkers are clinically used to effectively assess and predict changes of peritoneal function. Implementing effective measures to protect peritoneal function can prolong PD age and improve survival rate of PD patients. Recently, strategies to preserve peritoneal membrane function in PD patients have become a new research hotspot. This review briefly describes the latest research progress in strategies to preserve peritoneal membrane function.
Peritoneal dialysis(PD) is a widely used renal replacement therapy. As the increase of PD age in the patients, changes of peritoneal function occur, which is characterized by the increase of solute transport and decrease of ultrafiltration. Ultrafiltration failure(UFF) will eventually lead to PD failure. Recurrent peritonitis, prolonged exposure to bioincompatible dialysate and long dialysis age are the major contributors to peritoneal dysfunction. Corresponding anatomical changes in the peritoneum include peritoneal fibrosis, hyalinizing vasculopathy and angiogenesis. Many biomarkers are clinically used to effectively assess and predict changes of peritoneal function. Implementing effective measures to protect peritoneal function can prolong PD age and improve survival rate of PD patients. Recently, strategies to preserve peritoneal membrane function in PD patients have become a new research hotspot. This review briefly describes the latest research progress in strategies to preserve peritoneal membrane function.
引文
[1] Reyes MJ, Bajo MA, Hevia C, et al.Inherent high peritoneal transport and ultrafiltration deficiency[R].Proc Eur Dial Transplant Assoc Eur Ren Assoc,2007,22(1):218-223.
[2] Kim CD, Kwon HM, Park SH, et al. Effects of low glucose degradation products peritoneal dialysis fluid on the peritoneal fibrosis and vascularization in a chronic rat model. Therapeutic apheresis and dialysis[R].Ther Apher Dial,2007,11(1):56-64.
[3] Barreto DL, Coester AM, Struijk DG. Can effluent matrix metalloproteinase 2 and plasminogen activator inhibitor 1 be used as biomarkers of peritoneal membrane alterations in peritoneal dialysis patients[J].Perit Dial Int,2013,33(5):529-537.
[4] Ahmad S, North BV, Qureshi A,et al. CCL18 in peritoneal dialysis patients and encapsulating peritoneal sclerosis[J]. Eur J Clin Invest,2010,40(12):1067-1073.
[5] Mizutani M, Ito Y, Mizuno M,et al. Connective tissue growth factor(CTGF/CCN2)is increased in peritoneal dialysis patients with high peritoneal solute transport rate[J]. Am J Physiol Renal Physiol,2010,298(3):F721-733.
[6] Whitty R, Bargman JM, Kiss A,et al. Residual Kidney Function and Peritoneal Dialysis-Associated Peritonitis Treatment Outcomes[J].Clin J Am Soc Nephrol,2017,12(12):2016-2022.
[7] Liu Y, Ma X, Zheng J, et al. Effects of angiotensinconverting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients:a meta-analysis of randomised controlled trials[J].BMC nephrology, 2017,18(1):206.
[8] Shen JI, Saxena AB, Vangala S, et al. Renin-angiotensin system blockers and residual kidney function loss in patients initiating peritoneal dialysis:an observational cohort study[J].BMC nephrology, 2017,18(1):196.
[9] Flessner MF. Peritoneal ultrafiltration:physiology and failure[J]. Contrib Nephrol,2009,163:7-14.
[10] Han SH, Ahn SV, Yun JY, et al. Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysis[R]. Proc Eur Dial Transplant Assoc Eur Ren Assoc,2012,27(5):2044-2050.
[11] Nessim SJ, Perl J Bargman JM. The renin-angiotensin-aldosterone system in peritoneal dialysis[J]. Kidney Int,2010,78(1):23-28.
[12] Jing S, Kezhou Y, Hong Z,et al. Effect of renin-angiotensin system inhibitors on prevention of peritoneal fibrosis in peritoneal dialysis patients[J]. Nephrol,2010,15(1):27-32.
[13] Herzog R, Bender TO, Vychytil A, et al. Dynamic Olinked N-acetylglucosamine modification of proteins affects stress responses and survival of mesothelial cells exposed to peritoneal dialysis fluids[J]. J Am Soc Nephrol,2014,25(12):2778-2788.
[14] Zhang Z, Jiang N and Ni Z. Strategies for preventing peritoneal fibrosis in peritoneal dialysis patients:new insights based on peritoneal inflammation and angiogenesis[J]. Front Med,2017,11(3):349-358.
[15] Loureiro J, Sandoval P, del Peso G, et al. Tamoxifen ameliorates peritoneal membrane damage by blocking mesothelial to mesenchymal transition in peritoneal dialysis[J]. PloS one,2013,8(4):e61165.
[16] Margetts P. Heparin and the peritoneal membrane[J].Perit Dial Int, 2009,29(1):16-19.
[17] Schilte MN, Loureiro J, Keuning ED, et al. Long-term intervention with heparins in a rat model of peritoneal dialysis[J]. Perit Dial Int,2009,29(1):26-35.
[18] Fabbrini P,Schilte MN,Zareie M, et al. Celecoxib treatment reduces peritoneal fibrosis and angiogenesis and prevents ultrafiltration failure in experimental peritoneal dialysis[R].Proc Eur Dial Transplant Assoc Eur Ren Assoc,2009,24(12):3669-3676.
[2] Kim CD, Kwon HM, Park SH, et al. Effects of low glucose degradation products peritoneal dialysis fluid on the peritoneal fibrosis and vascularization in a chronic rat model. Therapeutic apheresis and dialysis[R].Ther Apher Dial,2007,11(1):56-64.
[3] Barreto DL, Coester AM, Struijk DG. Can effluent matrix metalloproteinase 2 and plasminogen activator inhibitor 1 be used as biomarkers of peritoneal membrane alterations in peritoneal dialysis patients[J].Perit Dial Int,2013,33(5):529-537.
[4] Ahmad S, North BV, Qureshi A,et al. CCL18 in peritoneal dialysis patients and encapsulating peritoneal sclerosis[J]. Eur J Clin Invest,2010,40(12):1067-1073.
[5] Mizutani M, Ito Y, Mizuno M,et al. Connective tissue growth factor(CTGF/CCN2)is increased in peritoneal dialysis patients with high peritoneal solute transport rate[J]. Am J Physiol Renal Physiol,2010,298(3):F721-733.
[6] Whitty R, Bargman JM, Kiss A,et al. Residual Kidney Function and Peritoneal Dialysis-Associated Peritonitis Treatment Outcomes[J].Clin J Am Soc Nephrol,2017,12(12):2016-2022.
[7] Liu Y, Ma X, Zheng J, et al. Effects of angiotensinconverting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients:a meta-analysis of randomised controlled trials[J].BMC nephrology, 2017,18(1):206.
[8] Shen JI, Saxena AB, Vangala S, et al. Renin-angiotensin system blockers and residual kidney function loss in patients initiating peritoneal dialysis:an observational cohort study[J].BMC nephrology, 2017,18(1):196.
[9] Flessner MF. Peritoneal ultrafiltration:physiology and failure[J]. Contrib Nephrol,2009,163:7-14.
[10] Han SH, Ahn SV, Yun JY, et al. Effects of icodextrin on patient survival and technique success in patients undergoing peritoneal dialysis[R]. Proc Eur Dial Transplant Assoc Eur Ren Assoc,2012,27(5):2044-2050.
[11] Nessim SJ, Perl J Bargman JM. The renin-angiotensin-aldosterone system in peritoneal dialysis[J]. Kidney Int,2010,78(1):23-28.
[12] Jing S, Kezhou Y, Hong Z,et al. Effect of renin-angiotensin system inhibitors on prevention of peritoneal fibrosis in peritoneal dialysis patients[J]. Nephrol,2010,15(1):27-32.
[13] Herzog R, Bender TO, Vychytil A, et al. Dynamic Olinked N-acetylglucosamine modification of proteins affects stress responses and survival of mesothelial cells exposed to peritoneal dialysis fluids[J]. J Am Soc Nephrol,2014,25(12):2778-2788.
[14] Zhang Z, Jiang N and Ni Z. Strategies for preventing peritoneal fibrosis in peritoneal dialysis patients:new insights based on peritoneal inflammation and angiogenesis[J]. Front Med,2017,11(3):349-358.
[15] Loureiro J, Sandoval P, del Peso G, et al. Tamoxifen ameliorates peritoneal membrane damage by blocking mesothelial to mesenchymal transition in peritoneal dialysis[J]. PloS one,2013,8(4):e61165.
[16] Margetts P. Heparin and the peritoneal membrane[J].Perit Dial Int, 2009,29(1):16-19.
[17] Schilte MN, Loureiro J, Keuning ED, et al. Long-term intervention with heparins in a rat model of peritoneal dialysis[J]. Perit Dial Int,2009,29(1):26-35.
[18] Fabbrini P,Schilte MN,Zareie M, et al. Celecoxib treatment reduces peritoneal fibrosis and angiogenesis and prevents ultrafiltration failure in experimental peritoneal dialysis[R].Proc Eur Dial Transplant Assoc Eur Ren Assoc,2009,24(12):3669-3676.