Yang Xiao, Fang Wei, Bargman Joanne M, Oreopoulos Dimitrios G
Peritoneal Dialysis Program, Toronto General Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada.
Perit Dial Int. 2008 Jan-Feb;28(1):82-92.
Patients on continuous ambulatory peritoneal dialysis (CAPD) who have high small-molecule peritoneal transport have increased mortality.
To investigate the impact of baseline peritoneal transport characteristics on patient and technique survival in incident peritoneal dialysis (PD) patients, most of whom are on automated PD (APD), with the use of icodextrin.
Retrospective observational cohort study.
A single PD unit.
193 new patients that began PD between January 2000 and September 2004, and had an initial peritoneal equilibration test within 6 months of commencement of PD. Patients were divided into low (L), low average (LA), high average (HA), and high (H) peritoneal transport groups. Death-censored technique failure and patient survival were examined.
Of the 193 patients, 151 (78.1%) were on APD or on APD with icodextrin or on CAPD with icodextrin. At the end of 1, 3, and 5 years, patient survival was 91%, 82%, and 67% in LA group; 95%, 77%, and 69% in HA group; and 96%, 71%, and 71% in H group. Technique survival was 100%, 90%, and 77% in LA group; 96%, 84%, and 72% in HA group; and 92%, 87%, and 77% in H group. High peritoneal permeability did not predict worse patient survival or technique failure, while age, diabetes, a lower glomerular filtration rate, and high body mass index (> or =30 kg/m(2)) were independent predictors of death.
This study suggests that higher peritoneal transport is not a significant independent risk factor for either mortality or death-censored technique failure. The favorable outcome for high transporters in this study may be due to improved management of volume status by the increased use of APD and the use of icodextrin-based dialysis fluid.
持续性非卧床腹膜透析（CAPD）患者中，小分子腹膜转运率高者死亡率增加。
研究基线腹膜转运特征对新进入腹膜透析（PD）患者（大多数接受自动化腹膜透析[APD]）使用艾考糊精时患者及技术生存的影响。
回顾性观察队列研究。
单个腹膜透析单元。
193例2000年1月至2004年9月开始腹膜透析且在开始腹膜透析6个月内进行首次腹膜平衡试验的新患者。患者被分为低（L）、低平均（LA）、高平均（HA）和高（H）腹膜转运组。检查死亡删失技术失败率和患者生存率。
193例患者中，151例（78.1%）接受APD或使用艾考糊精的APD或使用艾考糊精的CAPD。在1年、3年和5年末，LA组患者生存率分别为91%、82%和67%；HA组分别为95%、77%和69%；H组分别为96%、71%和71%。LA组技术生存率分别为100%、90%和77%；HA组分别为96%、84%和72%；H组分别为92%、87%和77%。高腹膜通透性并未预示患者生存率降低或技术失败，而年龄、糖尿病、较低的肾小球滤过率和高体重指数（≥30kg/m²）是死亡的独立预测因素。
本研究提示，较高的腹膜转运不是死亡率或死亡删失技术失败的重要独立危险因素。本研究中高转运者的良好结局可能归因于通过增加APD使用量及使用基于艾考糊精的透析液改善了容量状态管理。
