Cooper S, Iliescu E A, Morton A R
Division of Nephrology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
Adv Perit Dial. 2001;17:244-7.
Peritoneal dialysis (PD) patients lose significant quantities of protein and albumin during the dialysis procedure. The losses are greater in high transporters. The aim of the present study was to investigate the relationship between peritoneal membrane transport characteristics and protein losses. We studied 33 PD patients [14 men, 19 women; mean age: 53.5 years (range: 21-80 years)]. Fourteen patients had diabetes, and 22 were on automated PD. Dialysis adequacy was good, with a mean Kt/V of 2.63 (range: 1.51-4.89). Patients underwent a standard peritoneal equilibration test (PET). In addition, dialysate albumin (Alb) and protein (Pro) were measured at 0, 1, 2, and 4 hours, after lack of interference from unspent dialysate was ensured. Of the 33 patients, 23 were high or high-average transporters [based on 4-hour dialysate-to-plasma ratio of creatinine (D/PCr > or = 0.65)]. Protein losses owing to PD ranged from 3.5 g/day to 13.2 g/day (median: 5.9 g/day), of which 1.9-7.14 g/day (median: 3.21 g/day) was albumin. The 4-hour D/PCr correlated with the 4-hour D/PAlb (r = 0.62, p < 0.01), and 4-hour D/PPro (r = 0.63, p < 0.01). This finding persisted after correction for volume, indicating that it was not simply a concentration effect. The 4-hour D/PAlb and 4-hour D/PPro also correlated with the 24-hour PD albumin and protein losses. These results suggest a strong association between D/PCr and D/P for proteins. This observation is consistent with the increased protein losses through PD in high transporters and may be related to the inferior outcomes in this group.
腹膜透析（PD）患者在透析过程中会大量丢失蛋白质和白蛋白。高转运者的丢失量更大。本研究的目的是探讨腹膜转运特性与蛋白质丢失之间的关系。我们研究了33例PD患者[14例男性，19例女性；平均年龄：53.5岁（范围：21 - 80岁）]。14例患者患有糖尿病，22例采用自动化腹膜透析。透析充分性良好，平均Kt/V为2.63（范围：1.51 - 4.89）。患者接受了标准的腹膜平衡试验（PET）。此外，在确保无残留透析液干扰后，于0、1、2和4小时测量透析液中的白蛋白（Alb）和蛋白质（Pro）。在33例患者中，23例为高或高平均转运者[基于4小时透析液与血浆肌酐比值（D/PCr≥0.65）]。PD导致的蛋白质丢失范围为3.5克/天至13.2克/天（中位数：5.9克/天），其中白蛋白为1.9 - 7.14克/天（中位数：3.21克/天）。4小时D/PCr与4小时D/PAlb（r = 0.62，p < 0.01）以及4小时D/PPro（r = 0.63，p < 0.01）相关。校正体积后该发现依然存在，表明这并非单纯的浓度效应。4小时D/PAlb和4小时D/PPro也与24小时PD白蛋白和蛋白质丢失相关。这些结果表明D/PCr与蛋白质的D/P之间存在密切关联。这一观察结果与高转运者通过PD导致的蛋白质丢失增加相一致，并且可能与该组患者较差的预后有关。
