Kim Sejoong, Oh Jieun, Kim Suhnggwon, Chung Wookyung, Ahn Curie, Kim Sung Gyun, Oh Kook-Hwan
Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea.
Nephrol Dial Transplant. 2009 Sep;24(9):2899-908. doi: 10.1093/ndt/gfp054. Epub 2009 Mar 3.
In vitro studies of peritoneal dialysis (PD) solutions demonstrated that a biocompatible fluid with neutral-pH and low glucose degradation products (LF) has better biocompatibility than a conventional acidic lactate-buffered fluid (CF). However, few clinical trials have investigated the effects of the biocompatible solution on residual renal function (RRF). We performed a prospective, randomized trial with patients starting continuous ambulatory peritoneal dialysis (CAPD).
Ninety-one incident patients started CAPD for 12-month treatment with either LF (Balance, Fresenius, n = 48) or CF (CAPD/DPCA, Fresenius, n = 43). RRF, peritoneal solute transport rate and solute clearance were measured every 6 months.
LF had a significant effect on the change of glomerular filtration rate (GFR) (P = 0.048 by the mixed model). In per-protocol analysis, GFR in the LF group did not decrease over a 12-month period, while GFR in the control group significantly decreased (0.13 +/- 33.4 L/ week/1.73 m(2) for LF versus -13.6 +/- 19.4 L/week/1.73 m(2) for CF, P = 0.049). Subgroup analysis for patients with initial GFR of 2 mL/min/1.73 m(2) or above showed a significantly higher GFR for the LF group over the 12-month period. At Month 13, serum total CO(2) levels were higher and serum albumin levels were lower in the LF group. No differences between the two groups were observed for the C-reactive protein. Over the 12-month period, effluent cancer antigen-125 levels significantly increased in the LF group, compared with those of the CF group, while effluent interleukin-6 levels were not different between the two groups.
Our study suggests that LF may better preserve RRF over the 12-month treatment period in incident CAPD patients.
腹膜透析（PD）液的体外研究表明，具有中性pH值和低糖降解产物的生物相容性液体（LF）比传统的酸性乳酸盐缓冲液（CF）具有更好的生物相容性。然而，很少有临床试验研究生物相容性溶液对残余肾功能（RRF）的影响。我们对开始持续性非卧床腹膜透析（CAPD）的患者进行了一项前瞻性随机试验。
91例初治患者开始接受CAPD治疗12个月，分别使用LF（百特平衡液，费森尤斯公司，n = 48）或CF（CAPD/DPCA，费森尤斯公司，n = 43）。每6个月测量一次RRF、腹膜溶质转运率和溶质清除率。
LF对肾小球滤过率（GFR）的变化有显著影响（混合模型分析，P = 0.048）。在符合方案分析中，LF组的GFR在12个月内没有下降，而对照组的GFR显著下降（LF组为0.13±33.4 L/周/1.73 m²，CF组为-13.6±19.4 L/周/1.73 m²，P = 0.049）。对初始GFR为2 mL/分钟/1.73 m²或更高的患者进行亚组分析显示，LF组在12个月内的GFR显著更高。在第13个月时，LF组的血清总CO₂水平较高，血清白蛋白水平较低。两组的C反应蛋白没有差异。在12个月期间，与CF组相比，LF组的腹透液癌抗原-125水平显著升高，而两组的腹透液白细胞介素-6水平没有差异。
我们的研究表明，在初治CAPD患者的12个月治疗期内，LF可能能更好地保护RRF。
