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Peritonealdialyselösungen – differenzierte Therapie und klinische Konsequenzen

Peritoneal dialysis solutions – differential therapy and clinical consequences

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Der Nephrologe Aims and scope

Zusammenfassung

Peritonealdialyselösungen sind in ihrer herkömmlichen Zusammensetzung aufgrund ihres niedrigen pH-Wertes, der hohen Osmolalität und ihrem hohen Gehalt an Glukose und dessen Degradationsprodukten, die wiederum zur vermehrten AGE-Bildung führen, bioinkompatibel. Alternative osmotische Agenzien wie Icodextrin und aminosäurenhaltige PDL können für jeweils einen Wechsel pro Tag verwendet werden und können damit Glukose als Agens nicht vollständig ersetzen. In Mehrkammer-Beuteln sterilisierte glukosehaltige Peritonealdialyselösungen haben aufgrund ihres stark reduzierten Anteils an GDPs in vitro und in vivo Biokompatibilitätsvorteile gezeigt und können als neuer Goldstandard in der Peritonealdialyse bezeichnet werden. Des weiteren birgt die Reduktion des Natriumgehaltes in PD-Lösungen die Chance Blutdruckverhalten und Körpergewicht bei volumenexpandierten PD-Patienten zu reduzieren. Damit könnte es zur einer reduzierten kardiovaskulären Morbidität und Mortalität kommen.

Abstract

Conventional peritoneal dialysis (PD) solutions are bioincompatible due to their low pH, high osmolality and high glucose content, as well as their degradation products which can lead to advanced glycosylation end-product production. Alternative osmotic agents such as icodextrin and amino acid containing solutions can only be used for one exchange per day and are thus not able to fully replace glucose as the osmotic agent. Glucose solutions sterilized in multi-chambered bags are more biocompatible than standard solutions due to their very low content of glucose degradation products, and can be viewed as the new gold standard in PD treatment. Furthermore, low sodium containing PD fluids may help to reduce blood pressure and body weight in volume expanded patients and contribute to a reduction in cardiovascular morbidity and mortality.

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Interessenkonflikt

Der korrespondierende Autor weist auf eine Verbindung mit folgender Firma hin: Consultant für Fresenius Medical Care Deutschland GmbH. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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  1. Medizinische Klinik m. S. Nephrologie und internistische Intensivmedizin, Charitè-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13343, Berlin, Deutschland

    T.O. Bender, J. Witowski &  A. Jörres

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  1. T.O. Bender
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  2. J. Witowski
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  3. A. Jörres
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Correspondence to A. Jörres.

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Bender, T., Witowski, J. & Jörres, A. Peritonealdialyselösungen – differenzierte Therapie und klinische Konsequenzen. Nephrologe 2, 100–106 (2007). https://doi.org/10.1007/s11560-006-0065-8

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