Palabras clave
Diálisis peritoneal
soluciones dialíticas
biocompatibilidad
membrana peritoneal
función renal residual
soluciones dialíticas
biocompatibilidad
membrana peritoneal
función renal residual
Cómo citar
1.
Montenegro Martínez J. Beneficios clínicos de las soluciones biocompatibles de diálisis peritoneal. Rev. Colomb. Nefrol. [Internet]. 18 de noviembre de 2016 [citado 3 de julio de 2024];3(2):117-9. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/243
Resumen
El fallo de la membrana peritoneal se ha atribuido a la inflamación y principalmente a la exposición crónica de las soluciones convencionales de diálisis peritoneal; por tal razón, ante la limitación en el uso a largo plazo de esta técnica dialítica se investigaron nuevas soluciones, más biocompatibles, tanto del continente (plásticos) como del contenido. Respecto al contenido se retiraron los plásticos que llevaban cloruro de polivinilo y ftalatos, por sus efectos nocivos y la profunda huella ecológica de sus residuos. Las características críticas del contenido de las soluciones convencionales de DP vienen determinadas por su pH bajo, por la concentración de lactato, por la concentración alta de glucosa, por los productos de degradación de la glucosa y, por ende, por sus productos finales de la glicación, así como por la osmolaridad. Los cambios introducidos en las soluciones biocompatibles sin PVC son: pH neutro, reemplazo del tampón de lactato por bicarbonato o mezcla de ambos y mínimo contenido de PDG. Dada su mayor biocompatibilidad, las nuevas soluciones afectan menos a la membrana peritoneal, ocasionan una menor inflamación peritoneal, mejoran las defensas peritoneales locales y preservan más tiempo la función renal residual. En la mayoría de los estudios observacionales se registran todos estos beneficios clínicos a través de las soluciones biocompatibles; sin embargo, en los estudios aleatorizados no se demuestran estas enormes ventajas, aunque estos últimos contienen errores. En conclusión, como experto en usar los dos tipos de soluciones durante más de 25 años, desde nuestro punto de vista debemos aconsejar la opción biocompatible porque incorporan algunos beneficios clínicos.Citas
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2. Jorres A, Topley N, Gahl GM. Biocompatibility of peritoneal dialysis fluids. Int J Artif Organs. 1992; 15: 79-83.
3. Montenegro J. Does a ‘biocompatible’ peritoneal dialysis fluid improve survival compared with a standard fluid? Nat Clin Pract Nephrol. 2006 Jan; 2(1): 14-5.
4. Garcia-Lopez E, Lindholm B, Davies S. An update on peritoneal dialysis solutions. Nat Rev Nephrol. 2012 Feb; 8(4): 224-33.
5. Nässberger L, Arbin A, Östelius J. Exposure of patients to phthalates from polyvinyl chloride tubes and bags during dialysis. Nephron. 1987; 45: 286-90.
6. Mettang T, Thomas S, Kiefer T, Fischer FP, Kuhlmann U, Wodarz R, et al. The fate of leached di (2-ethylhexyl) phthalate (DEHP) in patients undergoing CAPD treatment. Perit Dial Int. 1996; 16: 58-62.
7. Fischer F-P, Machleidt C, Rettenmeier AW, Kuhlmann U, Mettang T. Plasticizers and inhibition of leukocyte function in vitro. Perit Dial Int. 1998; 18: 620-5.
8. Mettang T, Pauli-Magnus C, Alscher DM, et al. Influence of plasticizer-free CAPD bags and tubings on serum, urine, and dialysate levels of phthalic acid esters in CAPD patients. Perit Dial Int. 2000 Jan-Feb; 20(1): 80-84.
9. Duwe AK, Vas SI, Weatherhead JW. Effects of the composition of peritoneal dialysis fluid on chemiluminescence, phagocytosis, and bactericidal activity in vitro. Infect Immun. 1981 Jul; 33(1): 130-5.
10. Alobaidi HM, Coles GA, Davies M, Lloyd D. Host defence in continuous ambulatory peritoneal dialysis: the effect of the dialysate on phagocyte function. Nephrol Dial Transplant. 1986; 1(1): 16-2.
11. Dobos GJ, André M, Böhler J, Norgauer J, et al. Inhibition of C5a-induced actin polymerization, chemotaxis, and phagocytosis of human polymorphonuclear neutrophils incubated in a glucose-based dialysis solution. Adv Perit Dial. 1993; 9: 307-11.
12. Van Bronswijk H, Verbrugh HA, Heezius HC, van der Meulen J, Oe PL, Verhoef J. Dialysis fluids and local host resistance in patients on continuous ambulatory peritoneal dialysis. Eur J Clin Microbiol Infect Dis. 1988 Jun;7(3): 368-73.
13. Mortier S, Lameire NH, De Vriese AS. The effects of peritoneal dialysis solutions on peritoneal host defense. Perit Dial Int. 2004 Mar-Apr; 24(2): 123-38.
14. Kaupke CJ, Zhang J, Rajpoot D, Wang J, Zhou XJ, Vaziri ND. Effects of conventional peritoneal dialysates on leukocyte adhesion and CD11b, CD18 and CD14 expression. Kidney Int. 1996 Nov; 50(5): 1676-8.
15. Steinhauer HB, Brugger U, Atmanspacher R, Lubrich-Birkner I, Schollmeyer P. Effect of CAPD dialysate on the release of eicosanoids and cytokines from human peritoneal macrophages. AdvPerit Dial. 1992; 8: 47-52.
16. Jörres A, Topley N, Witowski J, Liberek T, Gahl GM Impact of peritoneal dialysis solutions on peritoneal immune defense. Perit Dial Int. 1993; 13 Suppl 2: S291-4.
17. Topley N, Jörres A, Luttmann W, et al. Human peritoneal mesothelial cells synthesize interleukin-6: induction by IL-1 beta and TNF alpha. Kidney Int. 1993 Jan; 43(1): 226-33.
18. Witowski J, Topley N, Jörres A, Liberek T, Coles GA, Williams JD. Effect of lactate-buffered peritoneal dialysis fluilds on human peritoneal mesothelial cell interleukin-6 and prostaglandin synthesis. Kidney Int. 1995 Ja; 47(1):283-93.
19. Douvdevani A, Rapoport J, Konforty A, Yulzari R, Moran A, Chaimovitz C. Intracellular acidification mediates the inhibitory effect of eritoneal dialysate on peritoneal macrophages. J Am Soc Nephrol. 1995 Aug; 6(2): 207-13.
20. Kocyigit I, Unal A, Gungor O, et al. Effects of dialysis solution on the cardiovascular function in peritoneal dialysis patients. Intern Med. 2015; 54(1): 3-10.
21. Topley N, Kaur D, Petersen MM, Jörres A, Passlick-Deetjen J, Coles GA, Williams JD. Biocompatibility of bicarbonate buffered peritoneal dialysis fluids: influence on mesothelial cell and neutrophil function. Kidney Int. 1996 May; 49(5): 1447-56.
22. Ogata S, Naito T, Yorioka N, Kiribayashi K, Kuratsune M, Kohno N. Effect of lactate and bicarbonate on human peritoneal mesothelial cells, fibroblasts and vascular endothelial cells, and the role of basic fibroblast growth factor. Nephrol Dial Transplant. 2004 Nov; 19(11): 2831-7.
23. De Fijter CW, Verbrugh HA, Peters ED, et al. In vivo exposure to the currently available peritoneal dialysis fluids decreases the function of peritoneal macrophages in CAPD. Clin Nephrol. 1993 Feb; 39(2): 75-80.
24. Himmele R, Jensen L, Fenn D, Ho CH, Sawin DA, Díaz-Buxo JA. A new neutral-pH low-GDP peritoneal dialysis fluid. Perit Dial Int. 2012 Jul-Aug; 32(4): 444-52.
25. Erixon M, Wieslander A, Lindén T, et al. How to avoid glucose degradation products in peritoneal dialysis fluids. Perit Dial Int. 2006 Jul-Aug; 26(4): 490-7.
26. Perl J, Nessim SJ, Bargman JM. The biocompatibility of neutral pH, low-GDP peritoneal dialysis solutions: benefit at bench, bedside, or both? Kidney Int. 2011 Apr; 79(8): 814-24.
27. Carozzi S, Nasini MG, Schelotto C, Caviglia PM, Santoni O, Pietrucci A. A biocompatibility study on peritoneal dialysis solution bags for CAPD. Adv Perit Dial. 1993; 9: 138-42.
28. Kristensen SR, Pedersen FB Cytotoxicity testing of two CAPD dialysis fluids in a model system of quiescent fibroblasts. Nephrol Dial Transplant. 1993; 8(2): 163-7.
29. Jörres A, Gahl GM, Topley N, et al. In-vitro biocompatibility of alternative CAPD fluids; comparison of bicarbonate-buffered and glucose-polymer-based solutions. Nephrol Dial Transplant. 1994; 9(7): 785-90.
30. Sundaram S, Cendoroglo M, Cooker LA, Jaber BL, Faict D, Holmes CJ, Pereira BJ. Effect of two-chambered bicarbonate lactate-buffered peritoneal dialysis fluids on peripheral blood mononuclear cell and polymorphonuclear cell function in vitro. Am J Kidney Dis. 1997 Nov; 30(5): 680-9.
31. Plum J, Lordnejad MR, Grabensee B. Effect of alternative peritoneal dialysis solutions on cell viability, B apoptosis/necrosis and cytokine expression in human monocytes. Kidney Int. 1998 Jul; 54(1): 224-35. Erratum in:Kidney Int 1998 Aug; 54(2): 677.
32. Topley N, Mackenzie R, Petersen MM, et al. In vitro testing of a potentially biocompatible continuous ambulatory peritoneal dialysis fluid. Nephrol Dial Transplant. 1991; 6(8): 574-8.
33. Dobos GJ, Böhler J, Kuhlmann J, et al. Bicarbonate-based dialysis solution preserves granulocyte functions. Perit Dial Int. 1994; 14(4): 366-70.
34. Fischer FP, Schenk U, Kiefer T, et al. In vitro effects of bicarbonate-versus lactate-buffered continuous ambulatory peritoneal dialysis fluids on peritoneal macrophage function. Am J Kidney Dis. 1995 Dec; 26(6):924-33.
35. Di Paolo N, Garosi G, Petrini G, Traversari L, Rossi P. Peritoneal dialysis solution biocompatibility testing in animals. Perit Dial Int. 1995; 15(7Suppl): S61-9; discussion S69-70.
36. Jörres A, Bender TO, Finn A, et al. Biocompatibility and buffers: effect of bicarbonate-buffered peritoneal dialysis fluids on peritoneal cell function. Kidney Int. 1998 Dec; 54(6): 2184-93.
37. Lage C, Pischetsrieder M, Aufricht C, Jörres A, Schilling H, Passlick-Deetjen J. First in vitro and in vivo experiences with Stay-Safe Balance, a pH-neutral solution in a dual-chambered bag. Perit Dial Int. 2000; 20Suppl 5:S28-32.
38. Witowski J, Wisniewska J, Korybalska K, et al. Prolonged exposure to glucose degradation products impairs viability and function of human peritoneal mesothelial cells. J Am Soc Nephrol. 2001 Nov; 12(11):2434-41.
39. Catalán MP, Reyero A, Egido J, Ortiz A. Acceleration of neutrophil apoptosis by glucose-containing peritoneal dialysis solutions: role of caspases. J Am Soc Nephrol. 2001 Nov; 12(11): 2442-9.
40. Fusshoeller A, Baehr J, Grabensee B, Plum J Biocompatibility of a bicarbonate/lactate-buffered PD fluid tested with a double-chamber cell culture system. Perit Dial Int. 2005 Jul-Aug; 25(4): 387-9.
41. Musi B, Braide M, Carlsson O, et al. Biocompatibilityof peritoneal dialysis fluids: long-term exposure of nonuremicrats. Perit Dial Int. 2004 Jan-Feb; 24(1): 37-47.
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2. Jorres A, Topley N, Gahl GM. Biocompatibility of peritoneal dialysis fluids. Int J Artif Organs. 1992; 15: 79-83.
3. Montenegro J. Does a ‘biocompatible’ peritoneal dialysis fluid improve survival compared with a standard fluid? Nat Clin Pract Nephrol. 2006 Jan; 2(1): 14-5.
4. Garcia-Lopez E, Lindholm B, Davies S. An update on peritoneal dialysis solutions. Nat Rev Nephrol. 2012 Feb; 8(4): 224-33.
5. Nässberger L, Arbin A, Östelius J. Exposure of patients to phthalates from polyvinyl chloride tubes and bags during dialysis. Nephron. 1987; 45: 286-90.
6. Mettang T, Thomas S, Kiefer T, Fischer FP, Kuhlmann U, Wodarz R, et al. The fate of leached di (2-ethylhexyl) phthalate (DEHP) in patients undergoing CAPD treatment. Perit Dial Int. 1996; 16: 58-62.
7. Fischer F-P, Machleidt C, Rettenmeier AW, Kuhlmann U, Mettang T. Plasticizers and inhibition of leukocyte function in vitro. Perit Dial Int. 1998; 18: 620-5.
8. Mettang T, Pauli-Magnus C, Alscher DM, et al. Influence of plasticizer-free CAPD bags and tubings on serum, urine, and dialysate levels of phthalic acid esters in CAPD patients. Perit Dial Int. 2000 Jan-Feb; 20(1): 80-84.
9. Duwe AK, Vas SI, Weatherhead JW. Effects of the composition of peritoneal dialysis fluid on chemiluminescence, phagocytosis, and bactericidal activity in vitro. Infect Immun. 1981 Jul; 33(1): 130-5.
10. Alobaidi HM, Coles GA, Davies M, Lloyd D. Host defence in continuous ambulatory peritoneal dialysis: the effect of the dialysate on phagocyte function. Nephrol Dial Transplant. 1986; 1(1): 16-2.
11. Dobos GJ, André M, Böhler J, Norgauer J, et al. Inhibition of C5a-induced actin polymerization, chemotaxis, and phagocytosis of human polymorphonuclear neutrophils incubated in a glucose-based dialysis solution. Adv Perit Dial. 1993; 9: 307-11.
12. Van Bronswijk H, Verbrugh HA, Heezius HC, van der Meulen J, Oe PL, Verhoef J. Dialysis fluids and local host resistance in patients on continuous ambulatory peritoneal dialysis. Eur J Clin Microbiol Infect Dis. 1988 Jun;7(3): 368-73.
13. Mortier S, Lameire NH, De Vriese AS. The effects of peritoneal dialysis solutions on peritoneal host defense. Perit Dial Int. 2004 Mar-Apr; 24(2): 123-38.
14. Kaupke CJ, Zhang J, Rajpoot D, Wang J, Zhou XJ, Vaziri ND. Effects of conventional peritoneal dialysates on leukocyte adhesion and CD11b, CD18 and CD14 expression. Kidney Int. 1996 Nov; 50(5): 1676-8.
15. Steinhauer HB, Brugger U, Atmanspacher R, Lubrich-Birkner I, Schollmeyer P. Effect of CAPD dialysate on the release of eicosanoids and cytokines from human peritoneal macrophages. AdvPerit Dial. 1992; 8: 47-52.
16. Jörres A, Topley N, Witowski J, Liberek T, Gahl GM Impact of peritoneal dialysis solutions on peritoneal immune defense. Perit Dial Int. 1993; 13 Suppl 2: S291-4.
17. Topley N, Jörres A, Luttmann W, et al. Human peritoneal mesothelial cells synthesize interleukin-6: induction by IL-1 beta and TNF alpha. Kidney Int. 1993 Jan; 43(1): 226-33.
18. Witowski J, Topley N, Jörres A, Liberek T, Coles GA, Williams JD. Effect of lactate-buffered peritoneal dialysis fluilds on human peritoneal mesothelial cell interleukin-6 and prostaglandin synthesis. Kidney Int. 1995 Ja; 47(1):283-93.
19. Douvdevani A, Rapoport J, Konforty A, Yulzari R, Moran A, Chaimovitz C. Intracellular acidification mediates the inhibitory effect of eritoneal dialysate on peritoneal macrophages. J Am Soc Nephrol. 1995 Aug; 6(2): 207-13.
20. Kocyigit I, Unal A, Gungor O, et al. Effects of dialysis solution on the cardiovascular function in peritoneal dialysis patients. Intern Med. 2015; 54(1): 3-10.
21. Topley N, Kaur D, Petersen MM, Jörres A, Passlick-Deetjen J, Coles GA, Williams JD. Biocompatibility of bicarbonate buffered peritoneal dialysis fluids: influence on mesothelial cell and neutrophil function. Kidney Int. 1996 May; 49(5): 1447-56.
22. Ogata S, Naito T, Yorioka N, Kiribayashi K, Kuratsune M, Kohno N. Effect of lactate and bicarbonate on human peritoneal mesothelial cells, fibroblasts and vascular endothelial cells, and the role of basic fibroblast growth factor. Nephrol Dial Transplant. 2004 Nov; 19(11): 2831-7.
23. De Fijter CW, Verbrugh HA, Peters ED, et al. In vivo exposure to the currently available peritoneal dialysis fluids decreases the function of peritoneal macrophages in CAPD. Clin Nephrol. 1993 Feb; 39(2): 75-80.
24. Himmele R, Jensen L, Fenn D, Ho CH, Sawin DA, Díaz-Buxo JA. A new neutral-pH low-GDP peritoneal dialysis fluid. Perit Dial Int. 2012 Jul-Aug; 32(4): 444-52.
25. Erixon M, Wieslander A, Lindén T, et al. How to avoid glucose degradation products in peritoneal dialysis fluids. Perit Dial Int. 2006 Jul-Aug; 26(4): 490-7.
26. Perl J, Nessim SJ, Bargman JM. The biocompatibility of neutral pH, low-GDP peritoneal dialysis solutions: benefit at bench, bedside, or both? Kidney Int. 2011 Apr; 79(8): 814-24.
27. Carozzi S, Nasini MG, Schelotto C, Caviglia PM, Santoni O, Pietrucci A. A biocompatibility study on peritoneal dialysis solution bags for CAPD. Adv Perit Dial. 1993; 9: 138-42.
28. Kristensen SR, Pedersen FB Cytotoxicity testing of two CAPD dialysis fluids in a model system of quiescent fibroblasts. Nephrol Dial Transplant. 1993; 8(2): 163-7.
29. Jörres A, Gahl GM, Topley N, et al. In-vitro biocompatibility of alternative CAPD fluids; comparison of bicarbonate-buffered and glucose-polymer-based solutions. Nephrol Dial Transplant. 1994; 9(7): 785-90.
30. Sundaram S, Cendoroglo M, Cooker LA, Jaber BL, Faict D, Holmes CJ, Pereira BJ. Effect of two-chambered bicarbonate lactate-buffered peritoneal dialysis fluids on peripheral blood mononuclear cell and polymorphonuclear cell function in vitro. Am J Kidney Dis. 1997 Nov; 30(5): 680-9.
31. Plum J, Lordnejad MR, Grabensee B. Effect of alternative peritoneal dialysis solutions on cell viability, B apoptosis/necrosis and cytokine expression in human monocytes. Kidney Int. 1998 Jul; 54(1): 224-35. Erratum in:Kidney Int 1998 Aug; 54(2): 677.
32. Topley N, Mackenzie R, Petersen MM, et al. In vitro testing of a potentially biocompatible continuous ambulatory peritoneal dialysis fluid. Nephrol Dial Transplant. 1991; 6(8): 574-8.
33. Dobos GJ, Böhler J, Kuhlmann J, et al. Bicarbonate-based dialysis solution preserves granulocyte functions. Perit Dial Int. 1994; 14(4): 366-70.
34. Fischer FP, Schenk U, Kiefer T, et al. In vitro effects of bicarbonate-versus lactate-buffered continuous ambulatory peritoneal dialysis fluids on peritoneal macrophage function. Am J Kidney Dis. 1995 Dec; 26(6):924-33.
35. Di Paolo N, Garosi G, Petrini G, Traversari L, Rossi P. Peritoneal dialysis solution biocompatibility testing in animals. Perit Dial Int. 1995; 15(7Suppl): S61-9; discussion S69-70.
36. Jörres A, Bender TO, Finn A, et al. Biocompatibility and buffers: effect of bicarbonate-buffered peritoneal dialysis fluids on peritoneal cell function. Kidney Int. 1998 Dec; 54(6): 2184-93.
37. Lage C, Pischetsrieder M, Aufricht C, Jörres A, Schilling H, Passlick-Deetjen J. First in vitro and in vivo experiences with Stay-Safe Balance, a pH-neutral solution in a dual-chambered bag. Perit Dial Int. 2000; 20Suppl 5:S28-32.
38. Witowski J, Wisniewska J, Korybalska K, et al. Prolonged exposure to glucose degradation products impairs viability and function of human peritoneal mesothelial cells. J Am Soc Nephrol. 2001 Nov; 12(11):2434-41.
39. Catalán MP, Reyero A, Egido J, Ortiz A. Acceleration of neutrophil apoptosis by glucose-containing peritoneal dialysis solutions: role of caspases. J Am Soc Nephrol. 2001 Nov; 12(11): 2442-9.
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