Mineshima M, Suzuki S, Sato Y, Ishimori I, Ishida K, Kaneko I, Agishi T
Kidney Center, Tokyo Women's Medical University, Japan.
ASAIO J. 2000 Jan-Feb;46(1):95-8. doi: 10.1097/00002480-200001000-00022.
Continuous recirculating peritoneal dialysis (CRPD) was introduced to enhance solute removal efficiency in conventional peritoneal dialysis (PD) therapies such as continuous ambulatory peritoneal dialysis (CAPD). In CRPD, a portion of the dwell dialysate in the patient's peritoneal cavity is drained through a double-lumen catheter and purified by an extracorporeal dialyzer. In this study, solute removal characteristics and safety of CRPD are examined in ex vivo and clinical studies. Recirculation dialysis experiments using nine dogs (13.6 +/- 2.5 kg of body weight) were carried out for 240 min in the ex vivo study, whereas another seven dogs (12.1 +/- 2.8 kg) received conventional peritoneal dialysis (CPD) (120 min dwelling x 2) and six additional dogs (11.9 +/- 2.7 kg) received a Tidal PD (20 min dwelling x 12; 50% of tidal volume ratio) as controls. The ex vivo study revealed that CRPD has a higher efficiency for solute removal than CPD and is equivalent to Tidal PD. In the BUN reduction rate, the 19.4 +/- 5.5% in 240 min CRPD (n = 9) was significantly higher (p < 0.05) than the 3.5 +/- 3.6% in 240 min CPD (n = 7) and equivalent to the 17.3 +/- 4.7% in 240 min Tidal PD (n = 6). Continuous recirculating peritoneal dialysis maintained a low UN level in the peritoneal cavity due to dialysis with an extracorporeal dialyzer. This tendency was also seen in creatinine removal. In the clinical study, CRPD (n = 10) and CPD (n = 5) treatments were used in three renal failure patients. Higher solute removal efficiency was shown in CRPD than in CPD treatments, and the urea peritoneal clearance was 14.1 +/- 4.4 ml/min in CRPD (n = 10), significantly higher (p < 0.05) than the 7.3 +/- 2.1 ml/min in CPD (n = 5). No fibrin formation occurred during CRPD treatments.
持续循环腹膜透析（CRPD）被引入以提高传统腹膜透析（PD）疗法如持续非卧床腹膜透析（CAPD）中的溶质清除效率。在CRPD中，患者腹腔内的一部分留存透析液通过双腔导管引流，并由体外透析器进行净化。在本研究中，通过体外和临床研究来检验CRPD的溶质清除特性和安全性。在体外研究中，对9只狗（体重13.6±2.5千克）进行了240分钟的再循环透析实验，而另外7只狗（体重12.1±2.8千克）接受传统腹膜透析（CPD）（120分钟留存×2），另有6只狗（体重11.9±2.7千克）接受潮式腹膜透析（20分钟留存×12；潮气量比为50%）作为对照。体外研究表明，CRPD的溶质清除效率高于CPD，且与潮式腹膜透析相当。在尿素氮清除率方面，240分钟CRPD（n = 9）时的19.4±5.5%显著高于（p < 0.05）240分钟CPD（n = 7）时的3.5±3.6%，且与240分钟潮式腹膜透析（n = 6）时的17.3±4.7%相当。由于使用体外透析器进行透析，持续循环腹膜透析使腹腔内尿素氮水平保持较低。肌酐清除方面也呈现出这种趋势。在临床研究中，3例肾衰竭患者接受了CRPD（n = 10）和CPD（n = 5）治疗。CRPD治疗显示出比CPD更高的溶质清除效率，CRPD（n = 10）时的尿素腹膜清除率为14.1±4.4毫升/分钟，显著高于（p < 0.05）CPD（n = 5）时的7.3±2.1毫升/分钟。CRPD治疗期间未发生纤维蛋白形成。
