Hernández-Jaras J, García H, Agramunt I
Servicio de Nefrología Hospital General de Castellón Avda. de Benicassim, s/n. 12004 Castellón de la Plana.
Nefrologia. 2002;22(1):42-8.
This study was designed to assess lactate and TCO2 transfers during PET and in 24-hour drained dialysate, relating them with the membrane transport type and acid-base status. Forty PETs were studied, performed in 23 clinically stable patients maintained on CAPD for 6.5 +/- 3 months using 35 mEq/l of lactated-based dialysate. No significant changes in plasma concentration of lactate and TCO2 were observed. Lactate gain (LG) was 51.91 +/- 4.86 and 220.82 +/- 22.61 mEq and TCO2 loss was 46.49 +/- 6.9 and 183.51 +/- 32.9 mEq during PET and 24 h respectively. When analyzed these transfers according to membrane transport characteristics (High/High-average group: HHAG and low/low-average group: LLAG), LG was significantly higher (53.94 +/- 3.7 vs 48.86 +/- 4.8 mEq during TEP p < 0.01, and 228.06 +/- 15.6 vs 209.96 +/- 27.2 mEq during 24 h p < 0.05). TCO2 loss was greater (48.66 +/- 7.15 vs 43.25 +/- 5.5 mEq p < 0.05 and 187.22 +/- 27.3 vs 177.93 +/- 35.3 during PET and 24 h respectively) in HHAG vs LLAG. When evaluating transfers according to patients' acid-base status (normal and acidotic group), no significant differences were found in LG, but there was a significant difference in TCO2 loss (47.7 +/- 5.9 vs 39.76 +/- 6.1 mEq p < 0.01). We did not observe significant differences in acid-base balance during PET according to membrane transport characteristics (HHAG vs LLAG). However, acid-base balance was more positive in acidotic patients' PET than in normal patients (9.87 +/- 6.6 vs 3.92 +/- 6.8 mEq p < 0.05). TCO2 loss during PET directly correlated with plasma TCO2 concentration pre-PET (r: 0.43, p < 0.01). However no significant correlation was found between plasma lactate levels and lactate gain during PET. In conclusion, the lactate gain and bicarbonate loss account for the net dialytic base balance during PET and 24 h. However, the peritoneal membrane transport characteristics as well as the acid-base status can determine a higher or lower aionic transfer (lactate and bicarbonate).
本研究旨在评估腹膜透析（PET）期间及24小时引流透析液中乳酸和总二氧化碳（TCO2）的转运情况，并将其与膜转运类型和酸碱状态相关联。对40例PET进行了研究，这些PET由23例临床稳定的患者完成，他们使用35 mEq/l的乳酸盐透析液进行持续性非卧床腹膜透析（CAPD）6.5±3个月。未观察到血浆乳酸和TCO2浓度有显著变化。PET期间和24小时内，乳酸增加量（LG）分别为51.91±4.86 mEq和220.82±22.61 mEq，TCO2损失量分别为46.49±6.9 mEq和183.51±32.9 mEq。根据膜转运特征（高/高平均组：HHAG和低/低平均组：LLAG）分析这些转运时，LG显著更高（PET期间为53.94±3.7 mEq vs 48.86±4.8 mEq，p<0.01；24小时时为228.06±15.6 mEq vs 209.96±27.2 mEq，p<0.05）。HHAG组的TCO2损失大于LLAG组（PET期间分别为48.66±7.15 mEq vs 43.25±5.5 mEq，p<0.05；24小时时分别为187.22±27.3 mEq vs 177.93±35.3 mEq）。根据患者的酸碱状态（正常组和酸中毒组）评估转运时，LG无显著差异，但TCO2损失有显著差异（47.7±5.9 mEq vs 39.76±6.1 mEq，p<0.01）。根据膜转运特征（HHAG vs LLAG），我们未观察到PET期间酸碱平衡有显著差异。然而，酸中毒患者PET期间的酸碱平衡比正常患者更呈正值（9.87±6.6 mEq vs 3.92±6.8 mEq，p<0.05）。PET期间TCO2损失与PET前血浆TCO2浓度直接相关（r：0.43，p<0.01）。然而，PET期间血浆乳酸水平与乳酸增加量之间未发现显著相关性。总之，乳酸增加量和碳酸氢盐损失量构成了PET期间和24小时内的净透析碱平衡。然而，腹膜膜转运特征以及酸碱状态可决定更高或更低的离子转运（乳酸和碳酸氢盐）。
