Taylor G S, Patel V, Spencer S, Fluck R J, McIntyre C W
Department of Renal Medicine, Derby City General Hospital, Derby, UK.
Clin Nephrol. 2002 Dec;58(6):445-50. doi: 10.5414/cnp58445.
Malnutrition is a common problem in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Hypoalbuminemia in CAPD patients is an independent risk factor for death and is associated with malnutrition. Previous short-term studies have examined the use of amino acid based PD solutions in terms of albumin levels and anthropometric changes, but not clinical outcome. We report on the extended use of 1.1% amino acid based peritoneal dialysis solution (Nutrineal) and have assessed clinical utility in terms of nutrition, biochemical indices, dialysis adequacy and clinical outcomes.
The effect of Nutrineal was studied retrospectively in 22 patients during the past 30 months. All patients had an albumin level of < 35 g/l prior to commencing Nutrineal, and had either a protein intake < 1.2 g/kg or weight loss of > 5% in the previous 3 months. 19 of the 22 patients underwent an 8-week trial of oral nutritional supplements with no improvement in serum albumin level. Albumin level, normalized protein catabolic rate, weight, Kt/V and creatinine clearance were assessed for all patients prior to Nutrineal and at the end of the study period.
The mean time on Nutrineal therapy was 13.6 months (range 6-26 months). There were no reported side effects of the treatment. There was an average of 1 episode of peritonitis per 23 treatment months, and only 1 patient died (4% annually adjusted mortality cf 8.9% on the peritoneal dialysis program as a whole). There was a significant increase in albumin level from 22.45 +/- 0.97 range 14-33 g/l to 25.68 +/- 1.159 range 16-35 g/l (p = 0.0036). Normalized protein catabolic rate increased significantly, from 0.898 +/- 0.053 to 1.085 +/- 0.056 g/kg/day (p = 0.0057). Weight decreased slightly although this did not reach statistical significance. Kt/V and creatinine clearance both decreased significantly, but remained within the adequate range in > 80% of the patients. There was no significant change in residual renal function (mean residual creatinine clearance 3.8 +/- 0.59 ml/min at the start of the study period, cf 3.4 +/- 0.61 ml/min at the end).
These data suggest that Nutrineal can be used safely and effectively for an extended period of time. Such use is associated with a low mortality rate and a low peritonitis rate, although dialysis adequacy is compromised to a degree.
营养不良是持续性非卧床腹膜透析（CAPD）患者的常见问题。CAPD患者的低白蛋白血症是死亡的独立危险因素，且与营养不良相关。以往的短期研究已就基于氨基酸的腹膜透析液在白蛋白水平和人体测量学变化方面的应用进行了考察，但未涉及临床结局。我们报告了1.1%基于氨基酸的腹膜透析液（Nutrineal）的长期应用情况，并从营养、生化指标、透析充分性和临床结局方面评估了其临床效用。
回顾性研究了过去30个月中22例患者使用Nutrineal的效果。所有患者在开始使用Nutrineal之前白蛋白水平均<35 g/l，且在前3个月中蛋白质摄入量<1.2 g/kg或体重减轻>5%。22例患者中有19例接受了为期8周的口服营养补充剂试验，但血清白蛋白水平未改善。在使用Nutrineal之前及研究期末对所有患者的白蛋白水平、标准化蛋白分解代谢率、体重、Kt/V和肌酐清除率进行了评估。
Nutrineal治疗的平均时间为13.6个月（范围6 - 26个月）。未报告该治疗的副作用。每23个治疗月平均发生1次腹膜炎，仅1例患者死亡（年调整死亡率4%，而整个腹膜透析项目的死亡率为8.9%）。白蛋白水平从22.45±0.97（范围14 - 33 g/l）显著升高至25.68±1.159（范围16 - 35 g/l）（p = 0.0036）。标准化蛋白分解代谢率显著增加，从0.898±0.053增至1.085±0.056 g/kg/天（p = 0.0057）。体重略有下降，尽管未达到统计学显著性。Kt/V和肌酐清除率均显著下降，但超过80%的患者仍保持在充分范围内。残余肾功能无显著变化（研究期初平均残余肌酐清除率为3.8±0.59 ml/min，期末为3.4±0.61 ml/min）。
这些数据表明，Nutrineal可安全有效地长期使用。尽管透析充分性在一定程度上受到影响，但这种使用方式与低死亡率和低腹膜炎发生率相关。
