Szeto Cheuk-Chun, Wong Teresa Yuk-Hwa, Chow Kai-Ming, Leung Chi-Bon, Wang Angela Yee-Moon, Lui Siu-Fai, Li Philip Kam-Tao
Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin.
Perit Dial Int. 2002 Mar-Apr;22(2):197-203.
To study the effect of increasing the daytime dialysis exchange frequency on dialysis adequacy and nutritional status of Chinese anuric patients.
University teaching hospital.
100 anuric patients on continuous ambulatory peritoneal dialysis (CAPD).
50 patients had one additional daytime 2-L exchange (intervention group); the dialysis regimen remained unchanged in the other 50 patients (control group).
Dialysis adequacy [Kt/V, weekly creatinine clearance (wCCr), and net ultrafiltration (UF)] and nutritional status [serum albumin, dietary protein intake, represented by normalized protein nitrogen appearance (nPNA), and percent lean body mass (%LBM)] were measured at 0 and 6 months.
Baseline dialysis adequacy and nutritional indices were comparable between the two groups. In the control group, all parameters remained stable at month 6. In the intervention group, there were significant increases in UF, Kt/V, wCCr, nPNA, and %LBM from months 0 to 6. The improvement in nPNA was affected by daily exchange volume. In 30 patients, the number of exchanges was increased from 3 to 4 per day; their Kt/V and nPNA rose significantly from month 0 to month 6. In the other 20 patients, the number of exchanges was increased from 4 to 5 per day; there was a significant increase in Kt/V but nPNA remained static. The change in nPNA correlated inversely with Kt/V at month 0 (Pearson's r = -0.352, p = 0.012). Multivariate analysis with a general linear model showed that age, Kt/V at month 0, and 3 dialysis exchanges per day at month 0 (versus 4 exchanges) were independent predictors of the change in nPNA.
Increasing the number of peritoneal dialysis exchanges effectively increased Kt/V in Chinese anuric CAPD patients. However, the improvement in nPNA correlated inversely with baseline Kt/V. Although increasing the number of exchanges from 3 to 4 per day improved nPNA, increasing the number of daily exchanges beyond 4 may not improve nPNA further.
研究增加日间透析交换频率对中国无尿患者透析充分性及营养状况的影响。
大学教学医院。
100例接受持续性非卧床腹膜透析（CAPD）的无尿患者。
50例患者增加一次日间2L交换（干预组）；另外50例患者透析方案不变（对照组）。
在0个月和6个月时测量透析充分性指标[Kt/V、每周肌酐清除率（wCCr）和净超滤量（UF）]及营养状况指标[血清白蛋白、以标准化蛋白氮呈现率（nPNA）表示的饮食蛋白摄入量和瘦体重百分比（%LBM）]。
两组间基线透析充分性和营养指标具有可比性。对照组中，所有参数在第6个月时保持稳定。干预组中，从0个月到6个月，UF、Kt/V、wCCr、nPNA和%LBM均显著增加。nPNA的改善受每日交换量影响。30例患者每日交换次数从3次增加到4次；其Kt/V和nPNA从0个月到6个月显著升高。另外20例患者每日交换次数从4次增加到5次；Kt/V显著增加，但nPNA保持不变。在0个月时，nPNA的变化与Kt/V呈负相关（Pearson相关系数r = -0.352，p = 0.012）。采用一般线性模型的多变量分析显示，年龄、0个月时的Kt/V以及0个月时每日3次透析交换（与4次交换相比）是nPNA变化的独立预测因素。
增加腹膜透析交换次数可有效提高中国无尿CAPD患者的Kt/V。然而，nPNA的改善与基线Kt/V呈负相关。虽然将每日交换次数从3次增加到4次可改善nPNA，但每日交换次数超过4次可能不会进一步改善nPNA。
