Frankenfield D L, Prowant B F, Flanigan M J, Frederick P R, Bailie G R, Helgerson S D, Rocco M V
Health Care Financing Administration, Baltimore, Maryland, USA.
Kidney Int. 1999 May;55(5):1998-2010. doi: 10.1046/j.1523-1755.1999.00448.x.
This article describes the changes in four core indicator variables: dialysis adequacy, hematocrit, serum albumin, and blood pressure in peritoneal dialysis CAPD and cycler patients over a three-year period.
A national random sample of adult peritoneal dialysis patients in the United States was drawn each study period. Clinical data abstraction forms were completed by facility staff for patients selected for the sample, returned to the respective network, then forwarded to the Health Care Financing Administration for analysis.
The mean weekly Kt/V urea for CAPD patients increased from 1.91 in 1995 to 2.12 in 1997 (P < 0.001) and for cycler patients, from 2.12 in 1996 to 2.24 in 1997 (P < 0.05). The mean weekly creatinine clearance for CAPD patients increased from 61.48 liter/week/1.73 m2 in 1995 to 65.84 liter/week/1.73 m2 in 1997 (P < 0.05). For cycler patients, it increased from 63.37 liter/week/1.73 m2 in 1996 to 67.45 liter/week/1.73 m2 in 1997 (P < 0.05). Despite this increase in adequacy values, less than 40% of peritoneal dialysis patients in 1997 had weekly Kt/V urea or creatinine clearance values that met subsequently published National Kidney Foundation's Dialysis Outcomes Quality Initiative (DOQI) guidelines. These data suggest that the dialysis prescription may not be adequately modified to compensate for increased body weight and for decreased residual renal function as years on dialysis increase. The average hematocrit value increased modestly in both CAPD and cycler patients from 1995 to 1997, and the number of patients with a hematocrit of less than 25% decreased from 6% in 1995 to 1.4% in 1997 (P < 0.001). Both serum albumin values and systolic and diastolic blood pressure values were essentially unchanged during the three-year period of observation.
Despite improvements in dialysis adequacy and hematocrit values, there remains much room for improvement in these core indicator values.
本文描述了三年期间持续性非卧床腹膜透析（CAPD）和循环式腹膜透析患者的四个核心指标变量的变化情况，这四个指标变量分别为透析充分性、血细胞比容、血清白蛋白和血压。
在每个研究期间，从美国成年腹膜透析患者中抽取全国随机样本。设施工作人员为入选样本的患者填写临床数据提取表，将表格返回各自的网络，然后转发给医疗保健财务管理局进行分析。
CAPD患者的平均每周尿素Kt/V值从1995年的1.91增至1997年的2.12（P<0.001），循环式腹膜透析患者的该值则从1996年的2.12增至1997年的2.24（P<0.05）。CAPD患者的平均每周肌酐清除率从1995年的61.48升/周/1.73平方米增至1997年的65.84升/周/1.73平方米（P<0.05）。循环式腹膜透析患者的该值从1996年的63.37升/周/1.73平方米增至1997年的67.45升/周/1.73平方米（P<0.05）。尽管充分性数值有所增加，但1997年仍有不到40%的腹膜透析患者的每周尿素Kt/V值或肌酐清除率值符合随后公布的美国国家肾脏基金会透析预后质量倡议（DOQI）指南。这些数据表明，随着透析年限的增加，透析处方可能未得到充分调整以补偿体重增加和残余肾功能下降的情况。1995年至1997年，CAPD和循环式腹膜透析患者的平均血细胞比容值均略有增加，血细胞比容低于25%的患者数量从1995年的6%降至1997年的1.4%（P<0.001）。在三年观察期内，血清白蛋白值以及收缩压和舒张压值基本未变。
尽管透析充分性和血细胞比容值有所改善，但这些核心指标值仍有很大的提升空间。
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