Gao H, Lew S Q, Bosch J P
Division of Renal Diseases and Hypertension, Department of Medicine, The George Washington University Medical Center, Washington, D.C., USA.
Am J Nephrol. 1999;19(1):7-12. doi: 10.1159/000013418.
BACKGROUND/AIMS: Several studies indicate that small solute transport is influenced by peritoneal dialysate volume and dwell time. This study focuses on the clinical impact of peritoneal dialysis modality, continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD).
We studied 18 patients on CAPD and 11 on CCPD for 18 months and assessed biochemical parameters, nutritional status and efficiency of dialysis at 6-month intervals.
Four-hour D/P urea and creatinine ratios were similar in both CAPD and CCPD patients. However, 24-hour D/P urea and creatinine ratios were significantly higher in CAPD than in CCPD patients (0.9 +/- 0.1 vs. 0.8 +/- 0.2 and 0.8 +/- 0.1 vs. 0.6 +/- 0.2, p < 0.05 and p < 0.01, respectively). The dialysate urea nitrogen concentration was significantly different between the two groups (65 +/- 14 mg/dl in CAPD, 48 +/- 13 mg/dl in CCPD; p < 0.05). Total weekly Kt/V and total weekly creatinine clearance were not significantly different between CAPD and CCPD patients at 18 months (1.6 +/- 0.4 vs. 1.7 +/- 0.3 and 52 +/- 21 vs. 50 +/- 12 liters, respectively). Two-way ANOVA with a post-hoc Bonferroni-Dunn test showed serum potassium concentration was significantly lower in CCPD patients at 18 months (3.8 +/- 0.5 mEq/l, p < 0.05), and significant increases in triglyceride levels in the CAPD groups by 18 months (301 +/- 286 mg/dl, p < 0.05).
This study demonstrates that the mean serum triglyceride level increases in CAPD patients over time, and the mean serum potassium concentration decreases in CCPD patients at 18 months. Dialysis adequacy and nutritional status are not significantly different between the two peritoneal dialysis modalities, CAPD and CCPD. We suggest the peritoneal dialysis prescription for CAPD or CCPD with respect to volume and frequency of exchanges be individualized to achieve adequate of therapy.
背景/目的：多项研究表明，小分子溶质转运受腹膜透析液量和驻留时间的影响。本研究聚焦于腹膜透析方式，即持续性非卧床腹膜透析（CAPD）和持续性循环腹膜透析（CCPD）的临床影响。
我们对18例进行CAPD的患者和11例进行CCPD的患者进行了18个月的研究，并每隔6个月评估生化参数、营养状况和透析效率。
CAPD和CCPD患者的4小时D/P尿素和肌酐比率相似。然而，CAPD患者的24小时D/P尿素和肌酐比率显著高于CCPD患者（分别为0.9±0.1对0.8±0.2和0.8±0.1对0.6±0.2，p<0.05和p<0.01）。两组间透析液尿素氮浓度存在显著差异（CAPD组为65±14mg/dl，CCPD组为48±13mg/dl；p<0.05）。18个月时，CAPD和CCPD患者的每周总Kt/V和每周总肌酐清除率无显著差异（分别为1.6±0.4对1.7±0.3以及52±21对50±12升）。采用事后Bonferroni-Dunn检验的双向方差分析显示，18个月时CCPD患者的血清钾浓度显著较低（3.8±0.5mEq/l，p<0.05），而CAPD组的甘油三酯水平在18个月时显著升高（301±286mg/dl，p<0.05）。
本研究表明，随着时间推移，CAPD患者的平均血清甘油三酯水平升高，18个月时CCPD患者的平均血清钾浓度降低。CAPD和CCPD这两种腹膜透析方式在透析充分性和营养状况方面无显著差异。我们建议根据CAPD或CCPD的腹膜透析处方，在交换量和频率方面进行个体化调整，以实现充分治疗。
