Davenport Andrew, Willicombe Michelle Kay
University College London Center for Nephrology, University College London Medical School, London, UK.
Clin J Am Soc Nephrol. 2009 Jul;4(7):1207-12. doi: 10.2215/CJN.01060209. Epub 2009 Jun 25.
The peritoneal equilibration test (PET) was developed some 25 yr ago and has been used to help prescribe peritoneal dialysis. However, PET is affected by several factors, including diabetes and inflammation. It was speculated that extracellular fluid overload would increase PET ultrafiltration volumes, and therefore the usefulness of the PET in routine clinical practice was audited.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data from 211 consecutive patients attending a university teaching hospital for a standard PET who had multifrequency bioimpedance performance were analyzed to determine which factors affected net PET ultrafiltration volumes.
Net PET ultrafiltration volume was independent of gender, age, diabetes, residual renal function, peritoneal dialysis prescriptions (modes and dialysates), extracellular fluid volume, or C-reactive protein (CRP). There was an inverse regression with serum albumin and sodium on multiple logistical regression analysis (F = 13.4, P < 0.001 and F = 10.1, P = 0.001, respectively) and a positive regression with 24-h net peritoneal ultrafiltration volumes (F = 15.5, P < 0.001). As expected, there was a strong correlation with net sodium losses (r = 0.99, P < 0001).
It was found that PET test ultrafiltration volume in routine clinical practice was not affected by CRP, hyperglycemia, or extracellular fluid volume overload. Ultrafiltration volumes were increased in those patients with reduced serum sodium and albumin, most likely because of inflammation and protein malnutrition.
腹膜平衡试验(PET)大约在25年前被开发出来,一直用于辅助制定腹膜透析方案。然而,PET受多种因素影响,包括糖尿病和炎症。据推测,细胞外液超负荷会增加PET超滤量,因此对PET在常规临床实践中的实用性进行了评估。
设计、地点、参与者及测量方法:分析了211例连续在大学教学医院接受标准PET检查且有多频生物阻抗检测结果的患者数据,以确定哪些因素会影响PET净超滤量。
PET净超滤量与性别、年龄、糖尿病、残余肾功能、腹膜透析方案(模式和透析液)、细胞外液量或C反应蛋白(CRP)无关。在多元逻辑回归分析中,血清白蛋白和钠呈负相关(F分别为13.4,P<0.001和F为10.1,P=0.001),与24小时腹膜净超滤量呈正相关(F=15.5,P<0.001)。正如预期的那样,与钠净丢失量有很强的相关性(r=0.99,P<0.001)。
发现在常规临床实践中,PET试验超滤量不受CRP、高血糖或细胞外液量超负荷的影响。血清钠和白蛋白降低的患者超滤量增加,最可能是由于炎症和蛋白质营养不良。