Erhalt der peritonealen Dialysemembran – Welche Dialyselösung ist richtig?

Peritonealdialyselösungen mit Glukose als osmotisch wirksamem Agens beeinflussen die Integrität der Peritonealmembran, wobei die enthaltenen Glukose-Degradations-Produkte (GDPs) und die daraus resultierenden „advanced glycation products“ eine große Rolle spielen. pH-Wert, verwendeter Puffer und Osmolalität der Lösung haben jedoch ebenfalls einen großen Einfluss. Sogenannte biokompatible Lösungen versuchen, die GDP-Bildung durch ein 2-Kammer-System niedrig zu halten. Darüber hinaus haben sie einen möglichst physiologischen pH-Wert. Damit scheinen sie das klinische Outcome tatsächlich verbessern zu können. Wesentlich weniger GDPs als in herkömmlichen Lösungen ist in Icodextrin-Peritonealdialyse-Lösungen enthalten. Durch die Verwendung dieser Polyglukose kann der osmotisch wirksame Gradient deutlich länger aufrechterhalten werden, was eine bessere Ultrafiltration bei längeren Verweilzeiten und schnellerem Transporterstatus ermöglicht. Aminosäurelösungen zeigen in morphologischen Studien eine geringere Alteration des Mesothels sowie eine Reduktion profibrotischer Faktoren. Den Einfluss verschiedener Peritonealdialyselösungen auf die Integrität der Peritonealmembran müssen zukünftige histomorphologische Studien noch untersuchen. Verschiedene Funktionstests deuten darauf hin, dass sich die Dialysemembran bei der Verwendung biokompatibler Lösungen besser erhalten lässt.

Glucose-based peritoneal solutions influence the integrity of the peritoneal membrane. Glucose degradation products and advanced glycation end products play an important role in this process. Additionally, there is a negative impact of pH, different buffers and osmolality on membrane integrity. Dual-chamber bags with a more physiological pH minimize GDP formation. There is increasing evidence for a better clinical outcome for patients using biocompatible solutions. GDP content in Icodextrin is much lower compared to glucose-based solutions. The usage of polyglucose as the osmotic agent results in a sustained ultrafiltration, even during longer dwell times. In vitro and animal studies with amino acid solutions demonstrated a less intense alteration of the mesothelial cell layer and a reduction of profibrotic factors. In the future, histomorphological studies have to investigate the influence of different solutions on the peritoneal membrane. Functional tests point to a better preservation of the peritoneal membrane with biocompatible solutions.

Key words

peritoneal membrane - biocompatible solution - glucose - fibrosis - icodextrin - amino acids

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