Gabriel Daniela Ponce, Nascimento Ginivaldo Victor Ribeiro do, Caramori Jacqueline Teixeira, Martim Luís Cuadrado, Barretti Pasqual, Balbi André Luís
Department of Internal Medicine, University Hospital, Botucatu School of Medicine, São Paulo State University, Rubião Júnior, CEP 18618-970 São Paulo, SP, Brazil.
Perit Dial Int. 2007 May-Jun;27(3):277-82.
Peritoneal dialysis (PD) is still widely used for acute renal failure (ARF) in developing countries despite concerns about its inadequacy. Continuous PD has been evaluated in ARF by analyzing the resolution of metabolic abnormality and normalization of plasma pH, bicarbonate, and potassium.
A prospective study was performed on 30 ARF patients who were assigned to high-dose continuous PD (Kt/V = 0.65 per session) via a flexible catheter (Tenckhoff) and automated PD with a cycler. Fluid removal, pH and metabolic control, protein loss, and patient outcome were evaluated.
Patients received 236 continuous PD sessions; 76% were admitted to ICUs. APACHE II score was 32.2+/-8.65. BUN concentrations stabilized after 3 sessions, creatinine after 4, and bicarbonate and pH after 2. Fluid removal was 2.1+/-0.62 L/day. Creatinine and urea clearances were 15.8+/-4.16 and 17.3+/-5.01 mL/minute respectively. Normalized creatinine clearance and urea Kt/V values were 110.6+/-22.5 L/week/1.73 m(2) body surface area and 3.8+/-0.6 respectively. Solute reduction index was 41%+/-6.5% per session. Serum albumin values remained stable in spite of considerable protein losses (median 21.7 g/day, interquartile range 9.1-29.8 g/day). Regarding ARF outcome, 23% of patients presented renal function recovery, 13% remained on dialysis after 30 days of follow-up, and 57% died.
High-dose continuous PD by flexible catheter and cycler was an effective treatment for ARF. It provided high solute removal, allowing appropriate metabolic and pH control, and adequate dialysis dose and fluid removal. Continuous PD can therefore be considered an alternative to other forms of renal replacement therapy in ARF.
尽管存在腹膜透析（PD）不充分的担忧，但在发展中国家，它仍被广泛用于治疗急性肾衰竭（ARF）。通过分析代谢异常的缓解情况以及血浆pH值、碳酸氢盐和钾的正常化情况，对急性肾衰竭患者进行持续腹膜透析评估。
对30例急性肾衰竭患者进行前瞻性研究，这些患者通过一根软性导管（Tenckhoff导管）和自动腹膜透析机接受高剂量持续腹膜透析（每次Kt/V = 0.65）。评估液体清除情况、pH值和代谢控制情况、蛋白质丢失情况以及患者的预后。
患者共接受了236次持续腹膜透析治疗；76%的患者入住重症监护病房。急性生理与慢性健康状况评分系统（APACHE II）评分为32.2±8.65。尿素氮（BUN）浓度在3次治疗后稳定，肌酐在4次治疗后稳定，碳酸氢盐和pH值在2次治疗后稳定。液体清除量为2.1±0.62升/天。肌酐清除率和尿素清除率分别为15.8±4.16和17.3±5.01毫升/分钟。标准化肌酐清除率和尿素Kt/V值分别为110.6±22.5升/周/1.73平方米体表面积和3.8±0.6。每次治疗的溶质清除指数为41%±6.5%。尽管蛋白质丢失量较大（中位数为21.7克/天，四分位间距为9.1 - 29.8克/天），但血清白蛋白值保持稳定。关于急性肾衰竭的预后，23%的患者肾功能恢复，13%的患者在随访30天后仍需透析，57%的患者死亡。
通过软性导管和腹膜透析机进行高剂量持续腹膜透析是治疗急性肾衰竭的有效方法。它能有效清除溶质，实现适当的代谢和pH值控制，并提供足够的透析剂量和液体清除量。因此，持续腹膜透析可被视为急性肾衰竭其他肾脏替代治疗形式的一种替代方法。
