Akonur Alp, Sloand James, Davis Ira, Leypoldt John
Medical Products, Global Technology and Innovation, Baxter Healthcare Corporation, Illinois, USA
Medical Products, Renal, Baxter Healthcare Corporation, Illinois, USA.
Perit Dial Int. 2016 Jan-Feb;36(1):79-84. doi: 10.3747/pdi.2013.00081. Epub 2014 Sep 2.
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In recent years, results from clinical studies have changed the focus of peritoneal dialysis (PD) adequacy from small solute clearance to volume control, resulting in continued efforts to improve fluid and sodium removal in PD patients. We used a modified 3-pore model to theoretically predict fluid and solute removal using glucose-based and icodextrin solutions for a wide range of transport characteristics with automated PD (APD) and continuous ambulatory PD (CAPD) therapies. ♦
Simulations were performed for the day (APD: 15-hr, 2.27% glucose and 7.5% icodextrin; CAPD: 3x5-hr, 1.36% and 2.27% glucose) and night (APD: 9-hr, 1.36% glucose; CAPD: 9-hr, 2.27% glucose and 7.5% icodextrin) dialysis periods separately. During APD, the number of night exchanges (N) was varied from 3 to 7. Ultrafiltration (UF), sodium removal (NaR), total carbohydrate absorption (CHO), UF efficiency (UFE), and sodium removal efficiency (NaRE) were calculated. Typical patients in fast (i.e. high, H), average (high-average, HA; low-average, LA), and slow (low, L) transport groups with no residual kidney function were considered. ♦
The effective dwell times varied between 1.0 and 14.7 hours depending on the number of exchanges. With glucose-based solutions, differences in UF and NaR between H and L transport patients ranged from 140 mL and 2 mmol (APD night, n = 7) to 778 mL and 56.4 mmol (CAPD day, 2.27%). With icodextrin, differences in UF and NaR ranged from 1 mL and 1.1 mmol (CAPD night) to 59 mL and 6.1 mmol (APD day). The use of icodextrin resulted in greater CHO than 2.27% glucose (APD: 27.1 - 35.6 g more; CAPD: 17.1 - 17.5 g more). The UFE and NaRE were greater for all patients with icodextrin than with glucose-based solution in both therapy modalities, except for slow transport patients in CAPD. ♦
This modeling study shows that the dependence of UF and NaR on patient transport type observed with glucose-based solutions can be minimized using icodextrin during the long dwells of APD and CAPD. While this approach simplifies the PD prescription by minimizing the dependencies of ultrafiltration and sodium removal on patient transport type when using icodextrin, it improves fluid and sodium removal efficiencies in fast and average transport patients without any added glucose exposure.
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近年来，临床研究结果已将腹膜透析（PD）充分性的重点从小分子溶质清除转变为容量控制，这促使人们不断努力改善PD患者的液体和钠清除。我们使用改良的三孔模型，从理论上预测了使用葡萄糖基溶液和艾考糊精溶液对具有广泛转运特征的患者进行自动化腹膜透析（APD）和持续性非卧床腹膜透析（CAPD）治疗时的液体和溶质清除情况。♦
分别对日间（APD：15小时，2.27%葡萄糖和7.5%艾考糊精；CAPD：3×5小时，1.36%和2.27%葡萄糖）和夜间（APD：9小时，1.36%葡萄糖；CAPD：9小时，2.27%葡萄糖和7.5%艾考糊精）透析时段进行模拟。在APD期间，夜间交换次数（N）从3次变化到7次。计算超滤量（UF）、钠清除量（NaR）、总碳水化合物吸收量（CHO）、超滤效率（UFE）和钠清除效率（NaRE）。考虑了无残余肾功能的快速（即高转运，H）、平均（高平均转运，HA；低平均转运，LA）和缓慢（低转运，L）转运组的典型患者。♦
有效驻留时间根据交换次数在1.0至14.7小时之间变化。使用葡萄糖基溶液时，H和L转运患者之间的UF和NaR差异范围为140 mL和2 mmol（APD夜间，n = 7）至778 mL和56.4 mmol（CAPD日间，2.27%葡萄糖）。使用艾考糊精时，UF和NaR差异范围为1 mL和1.1 mmol（CAPD夜间）至59 mL和6.1 mmol（APD日间）。使用艾考糊精导致的CHO比2.27%葡萄糖更多（APD：多27.1 - 35.6 g；CAPD：多17.1 - 17.5 g）。在两种治疗方式中，除了CAPD中的低转运患者外，所有使用艾考糊精的患者的UFE和NaRE均高于使用葡萄糖基溶液的患者。♦
该模型研究表明，在APD和CAPD的长时间驻留期间，使用艾考糊精可将基于葡萄糖溶液观察到的UF和NaR对患者转运类型的依赖性降至最低。虽然这种方法通过在使用艾考糊精时将超滤和钠清除对患者转运类型的依赖性降至最低来简化PD处方，但它提高了快速和平均转运患者的液体和钠清除效率，且无需额外的葡萄糖暴露。
