Internal Medicine, Botucatu School of Medicine, UNESP, Botucatu, Brazil.
Perit Dial Int. 2013 Nov-Dec;33(6):635-45. doi: 10.3747/pdi.2012.00215.
Peritoneal dialysis (PD) is a treatment for selected acute kidney injury patients (AKI), but little is known about its metabolic implications. The aim of the present study was to evaluate the metabolic implications of glucose absorption, sodium removal, protein loss into the dialysate, and catabolism in AKI patients undergoing high-volume PD and to identify risk factors associated with those metabolic effects.
A prospective cohort study over 18 consecutive months evaluated 208 sessions of high-volume PD performed in 31 AKI patients. One session of high-volume PD lasted 24 hours. Repeated-measures analysis was performed, and correlations were calculated using the Spearman test for continuous variables and generalized linear models for categorical variables.
Glucose absorption remained at approximately 35.3% ± 10.5% per session. Protein loss measured 4.2 ± 6.1 g daily, with higher values initially, which declined significantly after 2 sessions. Nitrogen balance (NB) was initially negative, but stabilized at approximately zero after 3 sessions. Glucose uptake was positively correlated with the Acute Tubular Necrosis Individual Severity Score [ATNISS (r = 0.21, p = 0.0036)], C-reactive protein (r = 0.26, p = 0.0167), protein loss (r = 0.36, p < 0.0001), and sodium removal (r = 0.24, p = 0.002). Protein loss was positively correlated with sodium removal (r = 0.22, p = 0.0085) and gastrointestinal disease (p = 0.0004). Sodium removal was positively correlated with serum sodium (r = 0.21, p = 0.0064), ATNISS (r = 0.15, p = 0.0411), urea nitrogen appearance [UNA (r = 0.24, p = 0.0019)], and fluid overload as an indication for dialysis (p < 0.0001). Urea nitrogen appearance was positively correlated with the indication for dialysis (electrolyte disturbances: p = 0.0287) and negatively correlated with nephrotoxic AKI (p < 0.0001). Nitrogen balance was negatively correlated with UNA (r = -0.389, p < 0.0001) and ischemic AKI (p = 0.0047).
High-volume PD did not increase hypercatabolism in AKI patients, and protein loss and glucose uptake remained constant during treatment. Those parameters were influenced by the clinical condition of the patients, including the cause of AKI, inflammation, and comorbidities-factors that should be known before the prescription of dialysis and nutrition, thus avoiding metabolic complications such as hyperglycemia, hypernatremia, and worsening catabolism.
腹膜透析（PD）是治疗某些急性肾损伤（AKI）患者的一种方法，但对于其代谢影响知之甚少。本研究旨在评估高容量 PD 治疗 AKI 患者时葡萄糖吸收、钠去除、蛋白质丢失到透析液中和分解代谢的代谢影响，并确定与这些代谢影响相关的风险因素。
一项前瞻性队列研究在 18 个月内评估了 31 名 AKI 患者的 208 次高容量 PD 治疗。一次高容量 PD 持续 24 小时。采用重复测量分析，使用 Spearman 检验对连续变量进行相关性计算，使用广义线性模型对分类变量进行相关性计算。
葡萄糖吸收率始终保持在 35.3%±10.5%/次左右。每日蛋白质丢失量为 4.2±6.1 g，初始值较高，治疗 2 次后显著下降。氮平衡（NB）最初为负值，但在 3 次治疗后稳定在零左右。葡萄糖摄取与急性肾小管坏死个体严重程度评分（ATNISS）呈正相关（r=0.21，p=0.0036），与 C 反应蛋白（r=0.26，p=0.0167）、蛋白质丢失（r=0.36，p<0.0001）和钠去除（r=0.24，p=0.002）呈正相关。蛋白质丢失与钠去除呈正相关（r=0.22，p=0.0085）和胃肠道疾病（p=0.0004）呈正相关。钠去除与血清钠（r=0.21，p=0.0064）、ATNISS（r=0.15，p=0.0411）、尿素氮出现量[UNA（r=0.24，p=0.0019）]和作为透析指征的液体超负荷呈正相关（p<0.0001）。UNA 与透析指征呈正相关（电解质紊乱：p=0.0287），与肾毒性 AKI 呈负相关（p<0.0001）。NB 与 UNA（r=-0.389，p<0.0001）和缺血性 AKI（p=0.0047）呈负相关。
高容量 PD 并未增加 AKI 患者的高分解代谢，且治疗过程中蛋白质丢失和葡萄糖摄取保持稳定。这些参数受患者的临床状况影响，包括 AKI 的病因、炎症和合并症，在处方透析和营养之前应了解这些因素，从而避免出现高血糖、高钠血症和分解代谢恶化等代谢并发症。
