Experiencia clínica con las nuevas soluciones de diálisis peritoneal

Résumé

Conventional peritoneal dialysis solutions lead to high and prolonged exposure to glucose-lactate and acid pH, which can cause peritoneal damage, mediated mainly by glucose degradation products (GDP) and high glucose concentrations. Ultrafiltration failure can follow, due to loss of mesothelial cells, fibrosis, and especially the increase in vascular area due to neoangiogenesis. The new solutions have clearly shown better biocompatibility, which translates clinically into better results of the technique by reducing membrane alterations and infections. Patient prognosis may also be improved through a better fluid balance due to maintenance of ultrafiltration and reduction of systemic inflammatory effects. However, long-term studies are required to definitively establish this benefit. These findings allow us to recommend the use of the new bicameral solutions with low GDP and with a neutral pH, buffered with lactate, a combination of bicarbonate/lactate, or bicarbonate only, as well as solutions with new osmotic agents that allow a lesser use of high glucose concentrations.