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IN-DEPTH REVIEW |
1 Home Therapies Development, Fresenius Medical Care North America, Lexington Massachusetts, USA;2 Department of Nephrology & Hypertension and Research Center for Experimental Nephrology, Ha'Emek Medical Center, Afula, Israel
Correspondence to: J.A. Diaz-Buxo, Home Therapies Development, Fresenius
Medical Care, 1001 Morehead Square Drive, Suite 470, Charlotte, North Carolina
28203
USA.
jose.diaz-buxo{at}fmc-na.com
Extensive experience with chronic peritoneal dialysis has identified a
series of functional and anatomical pathologic changes in the peritoneal
membrane thought to be the result of repeated insults from bioincompatible
solutions. Laboratory and clinical findings from recent investigations often
conflict and are difficult to interpret due to variations in methodologies,
animal models, study designs, and data analyses. The principal
pathophysiologic mechanisms identified thus far are oxidative stress,
inflammation, and their consequences. Many substances used to neutralize the
action of these insults, prevent formation of toxic compounds, or directly
alter solute and water transport to improve peritoneal membrane performance
have been studied. We herein review the most promising of these substances or
those that deserve attention because their use has contributed to better
understanding of peritoneal pathophysiology. Most peritoneal solution
additives have proved useless due to their toxicity and undesirable effects,
ineffectiveness, or manufacturing limitations. A few substances deserve more
attention, particularly those capable of restoring negatively charged membrane
sites, those that somehow improve permselectivity, scavengers of oxidants, and
advanced glycation end-product inhibitors and breakers. Recent publications on
clinical experience with neutral pH, low glucose degradation product (GDP)
peritoneal solutions, although few and preliminary, are most encouraging. The
virtual elimination of GDPs in these novel solutions will probably preclude
the need for GDP scavengers and inhibitors. Nonetheless, there is room for
further significant improvement in solution biocompatibility and for compounds
that may restore peritoneal function.
KEY WORDS: Peritoneal membrane protection; peritoneal solution additives; peritoneal membrane transport; peritoneal dialysis solutions.
Received 14 February 2006; accepted 1 May 2006.
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