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Dialyse aktuell 2018; 22(09): 404-409
DOI: 10.1055/a-0765-9503
Schwerpunkt | Dialyse
© Georg Thieme Verlag KG Stuttgart · New York

Biokompatible Peritonealdialyselösungen

Alte und neue Konzepte
Andreas Vychytil
Abteilung für Nephrologie und Dialyse, Klinik für Innere Medizin III, Medizinische Universität Wien, Österreich
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Publication History

Publication Date:
23 November 2018 (online)

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Zusammenfassung

Durch langzeitige intraperitoneale Anwendung von Glukoselösungen treten bei PD-Patienten (PD: Peritonealdialyse) morphologische und funktionelle Schäden an der Peritonealmembran auf. Es gibt keine eindeutige Evidenz, dass PD-Lösungen mit alternativen osmotischen Substanzen (Icodextrin, Aminosäuren) langfristig einen günstigen Einfluss auf peritonealeSchäden bei chronischen PD-Patienten haben. Dennoch ist die klinische Bedeutung von icodextrinhaltigen PD-Lösungen zur Optimierung des Salz- und Wasserhaushaltes uneingeschränkt. In rezenten Metaanalysen haben Low-GDP-Lösungen (GDP: Glukosedegradationsprodukte) harte Endpunkte wie Peritonitis und technisches Versagen nicht signifikant beeinflusst. Dennoch weisen einzelne kleinere Studien und Kohortenstudien darauf hin, dass diese Lösungen morphologische Schäden der Peritonealmembran reduzieren. Alanyl-Glutamin als Zusatz zur PD-Lösung hat in ersten klinischen Studien zu membranprotektiven, immunmodulatorischen und antiinflammatorischen Effekten geführt. Klinische Studien mit längerer Beobachtungszeit müssen zeigen, ob dies auch mit einer verbesserten Peritonitisrate, einem verbesserten technischen Überleben und/oder Überleben von PD-Patienten assoziiert ist.

 

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