Phu Nguyen Hoan, Hien Tran Tinh, Mai Nguyen Thi Hoang, Chau Tran Thi Hong, Chuong Ly Van, Loc Pham Phu, Winearls Christopher, Farrar Jeremy, White Nicholas, Day Nicholas
Center for Tropical Diseases, Center for Tropical Diseases, Cho Quan Hospital, Ho Chi Minh City, Vietnam.
N Engl J Med. 2002 Sep 19;347(12):895-902. doi: 10.1056/NEJMoa020074.
In some parts of the world, peritoneal dialysis is widely used for renal replacement in acute renal failure. In resource-rich countries, it has been supplanted in recent years by hemodialysis and, most recently, by hemofiltration and associated techniques. The relative efficacy of peritoneal dialysis and hemofiltration is not known.
We conducted an open, randomized comparison of pumped venovenous hemofiltration and peritoneal dialysis in patients with infection-associated acute renal failure in an infectious-disease referral hospital in Vietnam.
Seventy adult patients with severe falciparum malaria (48 patients) or sepsis (22 patients) were enrolled; 34 were assigned to hemofiltration and 36 to peritoneal dialysis. The mortality rate was 47 percent (17 patients) in the group assigned to peritoneal dialysis, as compared with 15 percent (5 patients) in the group assigned to hemofiltration (P=0.005). The rates of resolution of acidosis and of decline in the serum creatinine concentration in the group assigned to hemofiltration were more than twice those in the group assigned to peritoneal dialysis (P<0.005), and renal-replacement therapy was required for a significantly shorter period. In a multivariate analysis, the odds ratio for death was 5.1 (95 percent confidence interval, 1.6 to 16) and that for a need for future dialysis was 4.7 (95 percent confidence interval, 1.3 to 17) in the group assigned to peritoneal dialysis. The cost of hemofiltration per survivor was less than half that of peritoneal dialysis, and the cost per life saved was less than one third.
Hemofiltration is superior to peritoneal dialysis in the treatment of infection-associated acute renal failure.
在世界上的一些地区，腹膜透析被广泛用于急性肾衰竭的肾脏替代治疗。在资源丰富的国家，近年来它已被血液透析所取代，最近又被血液滤过及相关技术所取代。腹膜透析和血液滤过的相对疗效尚不清楚。
在越南一家传染病转诊医院，我们对感染相关性急性肾衰竭患者进行了一项关于泵驱动静脉-静脉血液滤过和腹膜透析的开放性随机对照研究。
纳入了70例成年患者，其中48例患有严重恶性疟原虫疟疾，22例患有脓毒症；34例被分配接受血液滤过，36例接受腹膜透析。腹膜透析组的死亡率为47%（17例患者），而血液滤过组为15%（5例患者）（P=0.005）。血液滤过组的酸中毒缓解率和血清肌酐浓度下降率是腹膜透析组的两倍多（P<0.005），且需要肾脏替代治疗的时间明显更短。在多变量分析中，腹膜透析组的死亡比值比为5.1（95%置信区间为1.6至16），未来需要透析的比值比为4.7（95%置信区间为1.3至17）。每位存活者的血液滤过成本不到腹膜透析成本的一半，而每挽救一条生命的成本不到腹膜透析的三分之一。
在治疗感染相关性急性肾衰竭方面，血液滤过优于腹膜透析。
