Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles, Torrance, California, USA.
Clin J Am Soc Nephrol. 2013 Feb;8(2):254-64. doi: 10.2215/CJN.05780612. Epub 2012 Nov 26.
Uremic metabolic acidosis is only partially corrected in many hemodialysis patients, and low serum bicarbonate predicts higher death risk. This study determined the comparative efficacy of peritoneal dialysis in correcting uremic metabolic acidosis and the association of serum bicarbonate and death risk with the two therapies.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were obtained from 121,351 prevalent ESRD patients (peritoneal dialysis, 10,400; hemodialysis, 110,951) treated in DaVita facilities between July 1, 2001 and June 30, 2006, with follow-up through June of 2007.
Serum bicarbonate was <22 mEq/L in 25% and 40% of peritoneal dialysis and hemodialysis patients, respectively. Thus, peritoneal dialysis patients were substantially less likely to have lower serum bicarbonate (adjusted odds ratio<20 mEq/L, 0.45 [0.42, 0.49]; <22 mEq/L, 0.41 [0.39, 0.43]). Time-averaged serum bicarbonate<19 mEq/L was associated with an 18% and 25% higher risk for all-cause and cardiovascular mortality, respectively, in prevalent peritoneal dialysis patients (reference group: serum bicarbonate between 24 and <25 mEq/L). In analyses using the entire cohort of peritoneal dialysis and hemodialysis patients, the adjusted risk for all-cause mortality was higher in most subgroups with serum bicarbonate<22 mEq/L, irrespective of dialysis modality.
The measured bicarbonate is significantly higher in peritoneal dialysis patients, suggesting that the therapy provides a more complete correction of metabolic acidosis than intermittent hemodialysis. Survival data suggest maintaining serum bicarbonate>22 mEq/L for all ESRD patients, irrespective of dialysis modality.
在许多血液透析患者中，尿毒症代谢性酸中毒仅部分得到纠正，而血清碳酸氢盐水平低预示着更高的死亡风险。本研究旨在比较腹膜透析纠正尿毒症代谢性酸中毒的效果，并确定血清碳酸氢盐与两种治疗方法的死亡风险之间的关联。
设计、地点、参与者和测量方法：数据来自于 2001 年 7 月 1 日至 2006 年 6 月 30 日期间在 DaVita 医疗机构接受治疗的 121351 例持续性终末期肾病（腹膜透析 10400 例，血液透析 110951 例）患者。随访至 2007 年 6 月。
腹膜透析和血液透析患者的血清碳酸氢盐分别有 25%和 40%<22mEq/L。因此，腹膜透析患者的血清碳酸氢盐水平较低的可能性显著降低（调整后的比值比<20mEq/L，0.45[0.42，0.49]；<22mEq/L，0.41[0.39，0.43]）。在腹膜透析患者中，时间平均血清碳酸氢盐<19mEq/L 与全因和心血管死亡率分别增加 18%和 25%相关（参考组：血清碳酸氢盐在 24 和<25mEq/L 之间）。在使用腹膜透析和血液透析患者的整个队列进行的分析中，无论透析方式如何，血清碳酸氢盐<22mEq/L 的大多数亚组中，全因死亡率的调整风险均较高。
腹膜透析患者的实测碳酸氢盐水平显著较高，表明该治疗方法比间歇性血液透析更能完全纠正代谢性酸中毒。生存数据表明，无论透析方式如何，所有终末期肾病患者均应维持血清碳酸氢盐>22mEq/L。
