Dejardin Agnès, Robert Annie, Goffin Eric
Department of Nephrology, Université catholique de Louvain, Brussels, Belgium.
Nephrol Dial Transplant. 2007 May;22(5):1437-44. doi: 10.1093/ndt/gfl745. Epub 2007 Feb 17.
The clinical determinants of intraperitoneal pressure (IPP) are ill defined, and the potential impact of elevated IPP on peritoneal dialysis (PD)-related complications is still a matter of debate. We measured IPP in newly started PD patients, assessed its clinical determinants and analysed the incidence of PD-related complications.
IPP was measured in 61 consecutive patients [46 males and 15 females, 47 automated peritoneal dialysis (APD) and 14 continuous ambulatory peritoneal dialysis (CAPD), aged: 52+/-17 years], an average of 2 months after PD onset, using increasing (from 0 to 3000 ml) dialysate volumes. The prescription of day and night dialysate infusion volumes was made to avoid IPP>16 cm H2O. We assessed the relationship between baseline clinical characteristics and IPP and the putative influence of IPP on subsequent PD-related complications, such as hernias, late leakage, gastro-oesophageal reflux (GOR) and enteric peritonitis (EP). IPP at the time of the complication was computed by linear interpolation across available couples of data (volume and IPP). Correlations were assessed using Pearson's r; Kaplan-Meier survival curves with log-rank test were used for complication occurrence analysis.
At baseline, mean IPP was 13.5+/-3.3 (5-22.5) cm H2O for 2000 ml inflow; IPP rose linearly as intraperitoneal volume (IPV) increased [R2=0.96, 95% CI (0.88; 1.00)]. IPP was significantly higher in patients with a higher body mass index (BMI) (P=0.03) but age, gender, weight, height, body surface area (BSA), diabetes mellitus or a past history of abdominal surgery did not correlate with IPP. Incidence of abdominal wall complications or GOR was not correlated with IPP. Patients with a night IPP>14 cm H2O had a higher incidence of EP (P=0.039) and a worse survival free of EP (P=0.03).
This study shows a strong linear correlation between IPP and IPV, a significant impact of BMI on IPP and a higher incidence of EP in patients with higher IPP. We recommend to measure IPP in PD patients to guide the prescription of intraperitoneal volumes.
腹腔内压（IPP）的临床决定因素尚不明确，IPP升高对腹膜透析（PD）相关并发症的潜在影响仍存在争议。我们测量了新开始接受PD治疗患者的IPP，评估其临床决定因素，并分析了PD相关并发症的发生率。
连续对61例患者[46例男性和15例女性，47例接受自动化腹膜透析（APD），14例接受持续性非卧床腹膜透析（CAPD），年龄：52±17岁]进行IPP测量，测量时间为PD开始后平均2个月，使用逐渐增加（从0至3000 ml）的透析液量。制定日间和夜间透析液输注量的处方以避免IPP>16 cm H₂O。我们评估了基线临床特征与IPP之间的关系，以及IPP对随后PD相关并发症（如疝气、晚期渗漏、胃食管反流（GOR）和肠道腹膜炎（EP））的假定影响。并发症发生时的IPP通过对可用的数据对（容量和IPP）进行线性插值计算得出。使用Pearson相关系数r评估相关性；采用Kaplan-Meier生存曲线和对数秩检验进行并发症发生情况分析。
基线时，2000 ml入液量时的平均IPP为13.5±3.3（5 - 22.5）cm H₂O；IPP随着腹腔内容量（IPV）增加呈线性上升[R² = 0.96，95%置信区间（0.88；1.00）]。体重指数（BMI）较高的患者IPP显著更高（P = 0.03），但年龄、性别、体重、身高、体表面积（BSA）、糖尿病或腹部手术史与IPP均无相关性。腹壁并发症或GOR的发生率与IPP无关。夜间IPP>14 cm H₂O的患者EP发生率更高（P = 0.039），且无EP的生存情况更差（P = 0.03）。
本研究显示IPP与IPV之间存在强线性相关性，BMI对IPP有显著影响，IPP较高的患者EP发生率更高。我们建议测量PD患者的IPP以指导腹腔容量的处方。
