Gan Hong-bing, Chen Meng-hua, Lindholm Bengt, Wang Tao
Institute of Nephrology, First Hospital, Peking University, 8 Xishiku Street, Beijing, 100034, P.R.China.
Int Urol Nephrol. 2005;37(3):575-9. doi: 10.1007/s11255-005-1202-4.
Diabetic patients especially the elderly have higher mortality on peritoneal dialysis treatment as compared to nondiabetic patients. As fluid overload is an important contributor for the high dropout rate in peritoneal dialysis therapy, the present study tried to compare the fluid status in diabetic and non-diabetic peritoneal dialysis patients and to investigate the effect of salt and water restriction on fluid status in diabetic peritoneal dialysis patients.
A cross sectional study was performed in 58 peritoneal dialysis patients who had been treated for at least 3 months. Among them, 20 patients were diabetics and the others were nondiabetics. We reviewed their dialysis prescription, peritoneal ultrafiltration, urine volume and fluid status. Then the 20 diabetic patients were advised to restrict their salt and water intake and were followed for 3 months.
During the cross sectional study there were no significant differences in age, gender, height and urine volume between the diabetic and nondiabetic patients. However, body weight, normalized extracellular water (nECW), dialysis dose, dialysate glucose load, peritoneal ultrafiltration, total fluid removal and the prevalence and extent of edema were all significantly higher in diabetics as compared to nondiabetics. After restricting salt and water intake, body weight, nECW, edema, fasting blood glucose, dialysate dose, dialysate glucose load, peritoneal ultrafiltration and total fluid removal were all significantly decreased, whereas the urine volume did not change significantly.
The present study suggests that diabetic patients were more fluid overloaded as compared to nondiabetics despite use of more hypertonic glucose solutions and, as a consequence, higher peritoneal ultrafiltration and higher total fluid removal; this indicates that our diabetic patients must have had significantly higher salt and fluid intakes. It also suggests that restricting salt and water intake can effectively treat fluid overload in diabetic peritoneal dialysis patients. Dietary salt and fluid restriction may help reduce the use of hypertonic glucose solution and thus facilitate the blood glucose control in diabetic patients undergoing peritoneal dialysis.
与非糖尿病患者相比，糖尿病患者尤其是老年患者在腹膜透析治疗中的死亡率更高。由于液体超负荷是腹膜透析治疗中高退出率的一个重要因素，本研究试图比较糖尿病和非糖尿病腹膜透析患者的液体状态，并研究限盐和限水对糖尿病腹膜透析患者液体状态的影响。
对58例接受腹膜透析治疗至少3个月的患者进行了横断面研究。其中，20例为糖尿病患者，其余为非糖尿病患者。我们回顾了他们的透析处方、腹膜超滤、尿量和液体状态。然后建议20例糖尿病患者限制盐和水的摄入量，并随访3个月。
在横断面研究中，糖尿病患者和非糖尿病患者在年龄、性别、身高和尿量方面无显著差异。然而，与非糖尿病患者相比，糖尿病患者的体重、标准化细胞外液（nECW）、透析剂量、透析液葡萄糖负荷、腹膜超滤、总液体清除量以及水肿的发生率和程度均显著更高。限制盐和水的摄入量后，体重、nECW、水肿、空腹血糖、透析液剂量、透析液葡萄糖负荷、腹膜超滤和总液体清除量均显著降低，而尿量无显著变化。
本研究表明，尽管使用了更多高渗葡萄糖溶液，因此腹膜超滤和总液体清除量更高，但糖尿病患者比非糖尿病患者更容易出现液体超负荷；这表明我们的糖尿病患者盐和液体摄入量一定显著更高。研究还表明，限制盐和水的摄入量可以有效治疗糖尿病腹膜透析患者的液体超负荷。饮食限盐和限水可能有助于减少高渗葡萄糖溶液的使用，从而有助于接受腹膜透析的糖尿病患者控制血糖。
