Baxter Healthcare Corporation, Renal Division, McGaw Park, Illinois 60085, USA.
Perit Dial Int. 2011 Sep-Oct;31(5):537-44. doi: 10.3747/pdi.2010.00169. Epub 2011 May 31.
Recently, bimodal peritoneal dialysis (PD) solutions containing low concentrations of Na have been shown to increase 24-hour ultrafiltration (UF) or UF efficiency (UF volume per gram of carbohydrate or CHO absorbed) and Na removal in high ("fast") transport patients during automated PD therapy. We used computer simulations to compare UF efficiency and Na removal at equivalent 24-hour UF volumes using either a generic bimodal solution (2.27% glucose + 7.5% icodextrin) during the long dwell or an increase in the glucose concentration during the short dwells, with all solutions containing Na at the conventional concentration (132 mEq/L).
The 3-pore model has been shown to accurately predict peritoneal transport for PD solutions containing glucose or icodextrin, or both. Here, we used that model to calculate 24-hour UF volume, CHO absorption, and Na removal for high (H), high-average (HA), and low-average (LA) transport patients on automated PD. Nighttime therapy consisted of 1.36% or 2.27% glucose solution (or both), and daytime therapy consisted of either Extraneal (Baxter Healthcare Corporation, Deerfield, IL, USA) or a bimodal solution.
As expected, addition of glucose to either the long dwell or the short dwells resulted in increased UF volume and glucose absorption. The increase in UF was a function of patient transport type (bimodal range: 288 - 490 mL; short-dwell range: 323 - 350 mL), and the increase in CHO absorption was smaller with glucose added to short dwells than with bimodal solution (range: 18 - 30 g vs. 34 - 39 g). The 24-hour UF efficiency was higher when high glucose concentrations were used during short-dwell exchanges than when a bimodal PD solution was used for the long dwell (0.6 to 1.2 mL/g vs. -0.1 to 0.5 mL/g). By contrast, Na removal was lower with the short-dwell exchanges (28.3 - 30.7 mmol vs. 36.2 - 53.3 mmol), likely because of more pronounced Na sieving.
Our modeling studies predict that generic bimodal PD solutions will provide higher Na removal but not higher 24-hour UF efficiency compared with current automated PD prescriptions using Extraneal for the long dwell and glucose-containing solutions for the short dwells. The modeling predictions from this study require clinical validation.
最近，含有低浓度钠的双模态腹膜透析（PD）溶液已被证明可以增加高（“快”）转运患者在自动化 PD 治疗期间的 24 小时超滤（UF）或 UF 效率（每克吸收的碳水化合物或 CHO 的超滤量）和钠的清除率。我们使用计算机模拟比较了使用常规浓度（132 mEq/L）的钠的通用双模态溶液（2.27%葡萄糖+7.5%艾考糊精）在长停留期间或短停留期间增加葡萄糖浓度时，在等效 24 小时 UF 量下的 UF 效率和钠清除率。
三孔模型已被证明可以准确预测含有葡萄糖或伊可定或两者的 PD 溶液的腹膜转运。在这里，我们使用该模型计算了自动化 PD 治疗的高（H）、高平均（HA）和低平均（LA）转运患者的 24 小时 UF 量、CHO 吸收和钠清除率。夜间治疗包括 1.36%或 2.27%葡萄糖溶液（或两者），白天治疗包括 Extraneal（百特医疗保健公司，美国伊利诺伊州迪尔菲尔德）或双模态溶液。
正如预期的那样，在长停留或短停留期间添加葡萄糖会导致 UF 量和葡萄糖吸收增加。UF 的增加是患者转运类型的函数（双模态范围：288-490 mL；短停留范围：323-350 mL），并且与双模态溶液相比，短停留期间添加葡萄糖导致 CHO 吸收增加较小（范围：18-30 g 与 34-39 g）。与使用双模态 PD 溶液进行长停留相比，在短停留期间使用高葡萄糖浓度时，24 小时 UF 效率更高（0.6 至 1.2 mL/g 与-0.1 至 0.5 mL/g）。相比之下，短停留交换时 Na 清除率较低（28.3-30.7 mmol 与 36.2-53.3 mmol），这可能是由于 Na 筛出更为明显。
我们的建模研究预测，与目前使用 Extraneal 进行长停留和含葡萄糖溶液进行短停留的自动化 PD 处方相比，通用双模态 PD 溶液将提供更高的 Na 清除率，但不会提高 24 小时 UF 效率。本研究的建模预测需要临床验证。
