Oliveira Luís, Rodrigues Anabela
Nephrology Department, CHP-Hospital Santo António, 4000 Porto, Portugal.
Int J Nephrol. 2011;2011:685457. doi: 10.4061/2011/685457. Epub 2011 Sep 29.
Background. Peritoneal membrane changes are induced by uraemia per se. We hypothesise that previous renal replacement therapy (RRT) time and residual renal function (RRF) at start of peritoneal dialysis impact on ultrafiltration failure (UFF). Methods. The time course of PET parameters from 123 incident patients, followed for median 26 (4-105) months, was evaluated by mixed linear model. Glucose 3.86% solutions were not used in their standard therapy. Sex, age, diabetes, previous RRT time, RRF, comorbidity score, PD modality and peritonitis episodes were investigated as possible determinants of UFF-free survival. Results. PET parameters remained stable during follow up. CA125 decreased significantly. Inherent UFF was diagnosed in 8 patients, 5 spontaneously recovering. Acquired UFF group presented type I UFF profile with compromised sodium sieving. At baseline they had lower RRF and longer previous time of RRT which remained significantly associated with UFF-free survival by Cox multivariate analysis (HR 0.648 (0.428-0.980), P = 0.04) and (HR 1.016 (1.004-1.028), P = 0.009, resp.). UFF free survival was 97%, 87% and 83% at 1, 3 and 5 years, respectively. Conclusions. Inherent UFF is often unpredictable but transitory. On the other hand baseline lower RRF and previous RRT time independently impact on ultrafiltration failure free survival. In spite of these detrimental factors generally stable long-term peritoneal transport parameters is achievable with a 5-year cumulative UFF free survival of 83%. This study adds a further argument for a PD-first policy.
背景。尿毒症本身可引起腹膜变化。我们推测，开始腹膜透析时既往肾脏替代治疗（RRT）时间和残余肾功能（RRF）会影响超滤失败（UFF）。方法。采用混合线性模型评估123例新发病例患者的PET参数随时间的变化过程，随访时间中位数为26（4 - 105）个月。他们的标准治疗中未使用3.86%葡萄糖溶液。对性别、年龄、糖尿病、既往RRT时间、RRF、合并症评分、腹膜透析方式和腹膜炎发作情况进行调查，作为无超滤失败生存的可能决定因素。结果。随访期间PET参数保持稳定。CA125显著下降。8例患者被诊断为固有性超滤失败，5例自发恢复。获得性超滤失败组呈现I型超滤失败特征，钠筛过功能受损。基线时，他们的RRF较低，既往RRT时间较长，Cox多因素分析显示这两个因素仍与无超滤失败生存显著相关（风险比分别为0.648（0.428 - 0.980），P = 0.04）和（风险比1.016（1.004 - 1.028），P = 0.009）。1年、3年和5年的无超滤失败生存率分别为97%、87%和83%。结论。固有性超滤失败通常不可预测但具有一过性。另一方面，基线时较低的RRF和既往RRT时间独立影响无超滤失败生存。尽管存在这些不利因素，但长期腹膜转运参数通常仍可保持稳定，5年累积无超滤失败生存率为83%。本研究为优先选择腹膜透析策略提供了进一步的依据。
