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Inflammation and Fibrosis |
Department of Medicine, University of Hong Kong, Hong Kong SAR, PR China
Correspondence to: T.M. Chan, Department of Medicine, Room 303, New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong SAR, PR China. dtmchan{at}hkucc.hku.hk
Background: Compelling data underscore the
bioincompatible nature of glucose-based peritoneal dialysis (PD) solutions and
their detrimental effects on peritoneal physiology and morphology. New PD
solutions have been formulated to tackle common clinical problems such as
inadequate ultrafiltration or malnutrition, and to improve
biocompatibility—the latter aimed at preserving the structural and
functional integrity of the peritoneum and reducing adverse systemic effects
on the patient.
Methods: This article reviews the factors in PD fluids
that alter normal peritoneal anatomy and physiology, and the data that
illustrate approaches to investigating the local and systemic biocompatibility
of new PD solutions.
Results: Chronic exposure of the peritoneal membrane to
glucose-based PD solutions results in denudation of the mesothelium, thickened
submesothelium, and hyalinization of the vasculature, often resulting in
reduced or lost solute and water clearance. Data from in vitro or
animal experiments and clinical studies have shown improved biocompatibility
profiles with new PD solutions that are glucose-free (that is, dialysates with
amino acids or icodextrin), bicarbonate-buffered, or compartmentalized during
heat sterilization to reduce levels of glucose degradation products. Improved
biocompatibility is denoted by reduced induction of proinflammatory,
profibrotic, or angiogenic growth factors in mesothelial cells and
macrophages, or by less perturbation of leukocyte phagocytic function.
Conclusions: Data from in vitro and animal
experiments show more favorable biocompatibility profiles with new PD fluids
than with glucose-based dialysates. Clinical studies are ongoing to assess the
impact of the new PD fluids on peritoneal function, morbidity, and
mortality.
KEY WORDS: Peritoneum; glucose; amino acid; icodextrin; bicarbonate.
This article has been cited by other articles:
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M. N. Schilte, J. W.A.M Celie, P. M. t. Wee, R. H.J. Beelen, and J. van den Born FACTORS CONTRIBUTING TO PERITONEAL TISSUE REMODELING IN PERITONEAL DIALYSIS Perit. Dial. Int., November 1, 2009; 29(6): 605 - 617. [Abstract] [Full Text] [PDF] |
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