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Peritoneal dialysis: from bench to bedside
#MMPMID26120456
Krediet RT
Clin Kidney J
2013[Dec]; 6
(6
): 568-77
PMID26120456
show ga
Peritoneal dialysis was first employed in patients with acute renal failure in
the 1940s and since the 1960s for those with end-stage renal disease. Its
popularity increased enormously after the introduction of continuous ambulatory
peritoneal dialysis in the end of 1970s. This stimulated both clinical and basic
research. In an ideal situation, this should lead to cross-fertilization between
the two. The present review describes two examples of interactions: one where it
worked out very well and another where basic science missed the link with
clinical findings. Those on fluid transport are examples of how old physiological
findings on absorption of saline and glucose solutions were adopted in peritoneal
dialysis by the use of glucose as an osmotic agent. The mechanism behind this in
patients was first solved mathematically by the assumption of ultrasmall
intracellular pores allowing water transport only. At the same time, basic
science discovered the water channel aquaporin-1 (AQP-1), and a few years later,
studies in transgenic mice confirmed that AQP-1 was the ultrasmall pore. In
clinical medicine, this led to its assessment in patients and the notion of its
impairment. Drugs for treatment have been developed. Research on biocompatibility
is not a success story. Basic science has focussed on dialysis solutions with a
low pH and lactate, and effects of glucose degradation products, although the
first is irrelevant in patients and effects of continuous exposure to high
glucose concentrations were largely neglected. Industry believed the bench more
than the bedside, resulting in 'biocompatible' dialysis solutions. These
solutions have some beneficial effects, but are evidently not the final answer.
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