Flanigan M J, Rocco M V, Prowant B, Frederick P R, Frankenfield D L
University of Iowa College of Medicine, Iowa City, Iowa 52242-4060, USA.
Kidney Int. 2001 Dec;60(6):2377-84. doi: 10.1046/j.1523-1755.2001.00060.x.
The Peritoneal Dialysis-Clinical Performance Measures Project (PD-CPM) characterizes peritoneal dialysis within the U.S. Current survey results are reported and compared to those of previous years.
Prevalence data from random national samples of adult peritoneal dialysis (PD) patients participating in the United States End-Stage Renal Disease (ESRD) program have been collected annually since 1995.
In 1995, 79% of the respondents used continuous ambulatory peritoneal dialysis (CAPD) rather than automated peritoneal dialysis (APD). The mean hematocrit (Hct) of PD patients was 32% and only 66% of individuals had a measurement of dialysis adequacy reported. The mean weekly Kt/Vurea (wKt/V) and weekly creatinine clearance (wCCr) reported for CAPD patients in 1995 were 1.9 and 67 L/1.73 m2/week, respectively. In 2000 the median age of PD patients was 55 years and 63% were white. The leading cause of ESRD was diabetes mellitus (34%) and 54% of adult PD patients performed some form of APD rather than CAPD. Age, sex, size, hematocrit, peritoneal permeability, dialysis adequacy, residual renal function and nutritional indices did not differ between APD and CAPD patients. The mean hemoglobin (Hb) for the 2000 PD-CPM population was 11.6 +/- 1.4 g/dL (mean +/- 1 SD) and 11% of patients had an average Hb below 10 g/dL. The average serum albumin was 3.5 +/- 0.5 g/dL by the bromcresol green method and 56% of subjects had an average serum albumin equal to or above 3.5 g/dL (or 3.2 g/dL by bromcresol purple). In 2000 85% of patients had a dialysis adequacy measurement reported and the mean calculated wKt/V and wCCr were 2.3 +/- 0.6 and 72.7 +/- 24.9 liters/1.73 m2/week for CAPD patients and 2.3 +/- 0.6 and 71.6 +/- 25.1 L/1.73 m2/week for APD patients. PD subjects had a mean body weight of 76 +/- 19 kg and body mass index (BMI) of 27.5 +/- 6.4 kg/m2. The protein equivalent of nitrogen appearance (nPNA) of these patients was 0.95 +/- 0.31 g/kg/day, their normalized creatinine appearance rate (nCAR) equaled 17 +/- 6.5 mg/kg/day, resulting in a percent lean body mass (%LBM) of 64 +/- 17% of actual body weight. Serum albumin correlated in a positive fashion with BMI, nPNA, nCAR and %LBM, but not with wCCr.
The majority of indicator variables monitored by the PD-CPM have improved since 1995. PD patients have higher hemoglobins and a greater proportion of patients meet the criteria for adequate dialysis. Serum albumin values, however, remain marginal and unchanged over the five-year project. Furthermore, serum albumin values fail to correlate with the intensity of renal replacement therapy and are not strongly correlated with alternative estimates of nutritional status.
腹膜透析临床性能指标项目（PD-CPM）对美国的腹膜透析情况进行了描述。现将当前的调查结果进行报告，并与往年的结果进行比较。
自1995年起，每年收集参与美国终末期肾病（ESRD）项目的成年腹膜透析（PD）患者全国随机样本的患病率数据。
1995年，79%的受访者使用持续性非卧床腹膜透析（CAPD）而非自动化腹膜透析（APD）。PD患者的平均血细胞比容（Hct）为32%，仅有66%的个体报告了透析充分性的测量结果。1995年报告的CAPD患者的平均每周尿素清除率（wKt/V）和每周肌酐清除率（wCCr）分别为1.9和67 L/1.73 m²/周。2000年，PD患者的中位年龄为55岁，63%为白人。ESRD的主要病因是糖尿病（34%），54%的成年PD患者采用某种形式的APD而非CAPD。APD和CAPD患者在年龄、性别、体型、血细胞比容、腹膜通透性、透析充分性、残余肾功能和营养指标方面无差异。2000年PD-CPM人群的平均血红蛋白（Hb）为11.6±1.4 g/dL（均值±1标准差），11%的患者平均Hb低于10 g/dL。采用溴甲酚绿法测得平均血清白蛋白为3.5±0.5 g/dL，56%的受试者平均血清白蛋白等于或高于3.5 g/dL（或采用溴甲酚紫法为3.2 g/dL）。2000年，85%的患者报告了透析充分性测量结果，CAPD患者的平均计算wKt/V和wCCr分别为2.3±0.6和72.7±24.9升/1.73 m²/周，APD患者分别为2.3±0.6和71.6±25.1 L/1.73 m²/周。PD受试者的平均体重为76±19 kg，体重指数（BMI）为27.5±6.4 kg/m²。这些患者的蛋白质氮出现率（nPNA）为0.95±0.31 g/kg/天，其标准化肌酐出现率（nCAR）等于17±6.5 mg/kg/天，导致瘦体重百分比（%LBM）为实际体重的64±17%。血清白蛋白与BMI、nPNA、nCAR和%LBM呈正相关，但与wCCr无关。
自1995年以来，PD-CPM监测的大多数指标变量有所改善。PD患者的血红蛋白更高，且有更大比例的患者符合充分透析的标准。然而，在为期五年的项目中，血清白蛋白值仍处于临界水平且未发生变化。此外，血清白蛋白值与肾脏替代治疗的强度无关，与营养状况的其他评估指标也没有强相关性。
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