Ishikura Kenji, Hataya Hiroshi, Ikeda Masahiro, Honda Masataka
Department of Pediatric Nephrology, Tokyo Metropolitan Children's Hospital, Tokyo, Japan.
Perit Dial Int. 2003 May-Jun;23(3):270-5.
Owing to the discord between body weight and body surface area (BSA), creatinine clearance (CCr) is predisposed to be small in pediatric patients on peritoneal dialysis (PD). Alternatively, Kt/V creatinine (Kt/V creat), which is normalized to total body water (TBW) rather than BSA, could be a better dialytic indicator. In this study, the efficiency of dialysis and the nutritional status of pediatric patients on chronic PD were examined, and the utility of dialytic indicators was evaluated.
49 patients under 20 years old, in stable condition, and on PD were analyzed. Weekly total Kt/V of urea (Kt/V urea), CCr, Kt/V creat, and normalized protein equivalent of nitrogen appearance (nPNA) were measured for all patients and for patients under 6 years old. The target value was 2.0/week for Kt/V urea and 60 L/ week/1.73 m2 for CCr, as recommended by the Kidney Disease Outcomes Quality Initiative guidelines. The target value for Kt/V creat was set as 1.52/week, using a male model with a height of 170 cm and a body weight of 65 kg.
The mean values of delivered Kt/V urea, CCr, Kt/V creat, and nPNA (and proportion of patients that achieved each target value) for all patients were 2.25 +/- 0.57/ week (67.4%), 53.8 +/- 19.3 L/week1/.73 m2 (26.5%), 1.83 +/- 0.73/ week (65.3%), and 1.11 +/- 0.42 g/day, respectively. The values for patients under 6 years old were 2.38 +/- 0.26/week (90.0%), 45.9 +/- 12.8 L/week/1.73 m2 (10.0%), 1.94 +/- 0.51/week (90.0%), and 1.52 +/- 0.67 g/day, respectively. Stepwise multiple regression analyses revealed that the relationship between CCr and Kt/V urea was affected by the patient's age.
Our pediatric patients achieved the recommended target value of Kt/V urea. At the same time, the nPNA results reflected the patient's status well. However, CCr appeared to be inappropriate as an indicator for patients under 6 years old. Kt/V creat is suggested to be a better dialytic indicator for these patients.
由于体重与体表面积（BSA）不匹配，接受腹膜透析（PD）的儿科患者的肌酐清除率（CCr）往往较低。相比之下，以总体水（TBW）而非BSA进行标准化的肌酐Kt/V（Kt/V creat）可能是更好的透析指标。在本研究中，我们检测了慢性PD儿科患者的透析效率和营养状况，并评估了透析指标的实用性。
分析了49例20岁以下、病情稳定且接受PD治疗的患者。测量了所有患者以及6岁以下患者的每周尿素总Kt/V（Kt/V urea）、CCr、Kt/V creat和标准化蛋白氮出现率（nPNA）。根据肾脏疾病改善全球预后（KDIGO）指南的建议，Kt/V urea的目标值为每周2.0，CCr的目标值为每周60 L/1.73 m²。使用身高170 cm、体重65 kg的男性模型，将Kt/V creat的目标值设定为每周1.52。
所有患者的透析Kt/V urea、CCr、Kt/V creat和nPNA的平均值（以及达到各目标值的患者比例）分别为2.25±0.57/周（67.4%）、53.8±19.3 L/周/1.73 m²（26.5%）、1.83±0.73/周（65.3%）和1.11±0.42 g/天。6岁以下患者的值分别为2.38±0.26/周（90.0%）、45.9±12.8 L/周/1.73 m²（10.0%）、1.94±0.51/周（90.0%）和1.52±0.67 g/天。逐步多元回归分析显示，CCr与Kt/V urea之间的关系受患者年龄影响。
我们的儿科患者达到了推荐的Kt/V urea目标值。同时，nPNA结果能很好地反映患者状况。然而，CCr似乎不适用于6岁以下患者作为指标。建议Kt/V creat对这些患者来说是更好的透析指标。
