Han Seung Hyeok, Ahn Song Vogue, Yun Jee Young, Tranaeus Anders, Han Dae-Suk
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Am J Kidney Dis. 2009 Oct;54(4):711-20. doi: 10.1053/j.ajkd.2009.05.014. Epub 2009 Jul 19.
Despite the theoretical benefits of biocompatible physiological-pH bicarbonate/lactate-buffered (B/L) peritoneal dialysis solution, there is only limited evidence supporting a superior clinical outcome associated with its use.
Observational study.
SETTINGS & PARTICIPANTS: 2,163 patients starting peritoneal dialysis therapy between July 2003 and December 2006 from 54 centers in Korea were enrolled.
B/L solution and icodextrin use.
All-cause mortality and technique failure.
Patient outcomes were compared between patients prescribed B/L and conventional solutions by using propensity score and intention-to-treat analyses.
542 patients initiated peritoneal dialysis therapy with B/L solution, and 1,621, with conventional solution. Fifteen patients prescribed B/L solution switched to conventional solution, and 386 of those initially using conventional solution switched to B/L solution during follow-up. Propensity score matching yielded 542 matched pairs of patients. In the matched cohort, there were no significant differences in age, diabetes, cardiovascular comorbidity, socioeconomic status, icodextrin use, or center experience between the 2 groups. All-cause deaths occurred in 52 (9.6%) patients in the B/L-solution group compared with 102 (18.9%) in the conventional-solution group (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.50 to 0.98; P = 0.04). In addition, icodextrin use was significantly associated with a reduced risk of death (HR, 0.40; 95% CI, 0.28 to 0.58; P < 0.001). Thirty-three (6.1%) and 48 (8.9%) technique failures occurred in the B/L- and conventional-solution groups, respectively (HR, 0.91; 95% CI, 0.58 to 1.43; P = 0.7). The survival benefit of B/L solution persisted in the unmatched cohort (HR, 0.69; 95% CI, 0.52 to 0.93; P = 0.02).
Retrospective analysis, lack of laboratory data, and unknown indications for use of B/L solution.
Use of a biocompatible B/L peritoneal dialysis solution with physiological pH is associated with improved survival compared with conventional solution. Large randomized clinical trials are warranted to confirm this finding.
尽管生物相容性生理pH值碳酸氢盐/乳酸缓冲（B/L）腹膜透析液具有理论上的益处，但仅有有限的证据支持其使用能带来更好的临床结果。
观察性研究。
纳入了2003年7月至2006年12月期间韩国54个中心开始腹膜透析治疗的2163例患者。
B/L液的使用和艾考糊精的使用。
全因死亡率和技术失败。
通过倾向评分和意向性分析比较了使用B/L液和传统透析液的患者的预后。
542例患者开始使用B/L液进行腹膜透析治疗，1621例使用传统透析液。15例使用B/L液的患者改为使用传统透析液，在随访期间，最初使用传统透析液的患者中有386例改为使用B/L液。倾向评分匹配产生了542对匹配的患者。在匹配队列中，两组患者在年龄、糖尿病、心血管合并症、社会经济状况、艾考糊精使用或中心经验方面无显著差异。B/L液组有52例（9.6%）患者发生全因死亡，而传统透析液组为102例（18.9%）（风险比[HR]，0.70；95%置信区间[CI]，0.50至0.98；P = 0.04）。此外，使用艾考糊精与死亡风险降低显著相关（HR，0.40；95%CI，0.28至0.58；P < 0.001）。B/L液组和传统透析液组分别有33例（6.1%）和48例（8.9%）发生技术失败（HR，0.91；95%CI，0.58至1.43；P = 0.7）。B/L液的生存益处在即未匹配队列中仍然存在（HR，0.69；95%CI，0.52至0.93；P = 0.02）。
回顾性分析、缺乏实验室数据以及B/L液使用指征不明。
与传统透析液相比，使用具有生理pH值的生物相容性B/L腹膜透析液与生存率提高相关。需要进行大型随机临床试验来证实这一发现。
