Cižman Borut, Lindo Steve, Bilionis Brian, Davis Ira, Brown Aaron, Miller Jennifer, Phillips Gerald, Kriukov Alex, Sloand James A
Baxter Healthcare Corporation, Deerfield, IL 60015, USA; SIM Solutions, Inc, Chicago, IL 60641, USA; and Lakefront Consulting, LLC, Libertyville, IL 60048, USA.
Perit Dial Int. 2014 Jun;34(4):434-42. doi: 10.1177/089686081403400401.
BACKGROUND, OBJECTIVES AND METHODS: Increased intraperitoneal volume (IIPV) can occur during automated peritoneal dialysis (APD). The contribution of factors such as cycler programming and patient/user actions to IIPV has not been previously explored. The relationship between IIPV and cycler programming, patient/user actions, and ultrafiltration over a two-year period was investigated using US data from Baxter cyclers. Drain/fill volume ratios of > 1.6 to ≤ 2.0 and > 2.0 were defined as Level I and Level II IIPV events, respectively.
Level I IIPV events occurred in 2.39% of standard and 4.73% of small fill volume therapies, while Level II IIPV events occurred in 0.26% and 1.33% of therapies, respectively. IIPV events occurred significantly more often in association with tidal peritoneal dialysis (PD) compared to non-tidal PD therapies. In tidal therapies, IIPV events were primarily related to suboptimal programming of total ultrafiltration volume. Factors that increased the odds of IIPV events during standard therapies included programming the initial drain volume target to < 70% of the last fill, and setting minimum drain volumes to < 85% of the fill volume. Bypass of initial drain by patients/users was also associated with a significant increase in the odds of IIPV events in non-tidal, but not tidal PD. An increase in the odds for IIPV was also seen for standard therapies within the highest (> 1,245 mL) versus the lowest (< 427 mL) quartile of ultrafiltration. Similar trends were seen in small fill volume therapies. Clinical presentations associated with IIPV events were not assessed.
IIPV events are more frequent in tidal and small fill volume therapies. The greatest potential for IIPV occurred when the total ultrafiltration was set too low for the patient's UF requirements during tidal therapy. Patient/user bypass of drains without reaching the target drain volume contributes significantly to IIPV events in non-tidal PD therapies. Poorly functioning PD catheters may be central to the cycler programming and patient/user actions that lead to IIPV.
背景、目的与方法：在自动化腹膜透析（APD）过程中可能会出现腹腔内体积增加（IIPV）的情况。此前尚未探讨诸如循环器编程和患者/用户操作等因素对IIPV的影响。利用百特循环器的美国数据，研究了两年期间IIPV与循环器编程、患者/用户操作以及超滤之间的关系。排水/填充体积比>1.6至≤2.0以及>2.0分别被定义为I级和II级IIPV事件。
I级IIPV事件在标准治疗中发生率为2.39%，在小填充体积治疗中为4.73%，而II级IIPV事件在治疗中发生率分别为0.26%和1.33%。与非潮式腹膜透析（PD）治疗相比，IIPV事件在潮式PD治疗中显著更频繁发生。在潮式治疗中，IIPV事件主要与总超滤体积的编程不理想有关。标准治疗期间增加IIPV事件发生几率的因素包括将初始排水体积目标设定为小于上次填充量的70%，以及将最小排水体积设定为小于填充体积的85%。患者/用户跳过初始排水在非潮式而非潮式PD中也与IIPV事件发生几率的显著增加相关。在超滤最高（>1245 mL）与最低（<427 mL）四分位数的标准治疗中，IIPV发生几率也有所增加。在小填充体积治疗中也观察到类似趋势。未评估与IIPV事件相关的临床表现。
IIPV事件在潮式和小填充体积治疗中更频繁。当在潮式治疗中总超滤量设定得低于患者的超滤需求时，IIPV发生的可能性最大。患者/用户在未达到目标排水体积的情况下跳过排水对非潮式PD治疗中的IIPV事件有显著影响。功能不良的PD导管可能是导致IIPV的循环器编程和患者/用户操作的核心因素。
