Prof. Dr. Ing. Jörg Vienken

Abstract:

Current opinion associates the success of extracorporeal blood purification therapies to the quality of applied hardware, such as filters, tubing and monitors. However, properties of blood proteins and adminstered infusion solutions can also be considered determinants of therapeutic success.

Blood proteins, and among them the most frequent protein albumin, are known for their bindung capacity for both endogenous and exogenous toxins, as well as for pharmaceutical drugs. The binding capacity of albumin determines albumin´s efficiency as a “molecular vacuum cleaner”. Under pathological clinical conditions however, such as kidney or liver failure, a massive reduction in albumin binding is observed. This phenomenon can be attributed to a modification in the 3D-conformation of this protein. Consequently, the dogma of nephrologists that the dialysis membrane should be impermeable for albumin has to be revised. It should be considered that under such pathological conditions a 3D-modifed albumin must be removed. Clincial trials have shown the superiority of protein peremable membranes in this respect.

Peritoneal dialysis (PD) technique patient survival remains challenging due to peritonitis and longterm alterations to peritoneal membrane function and integrity. Hence administering modified infusion solutions for PD may help to overcome this problem. A novel approach, supplementing such dialysis solutions with the dipeptide Alanyl-glutamine (AlaGlu), has proven to be a promising tool for improvement. Clinical trials with supplemented infusion solutions with AlaGlu have shown benefits to surrogate markers of cell function in randomized controlled studies when peritoneal cellular stress responses and leukocate function have been restored. 

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