Nourse Peter, Sinclair Gina, Gajjar Priya, du Plessis Mandi, Argent Andrew Charles
Division of Paediatric Nephrology, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein road, Rondebosch, Cape Town, 7700, South Africa.
Division of Paediatric Intensive Care, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Pediatr Nephrol. 2016 Jul;31(7):1137-43. doi: 10.1007/s00467-016-3341-5. Epub 2016 Feb 15.
Criticism against the use of acute peritoneal dialysis (PD) has been its low clearance and low ultrafiltration (UF) volumes compared to extracorporeal techniques. The aim of our study was to determine whether continuous flow peritoneal dialysis (CFPD) would improve UF in children with acute kidney injury (AKI) in cases where UF on conventional PD was inadequate using 4.25 % glucose concentrations.
Five infants were prospectively studied. All had AKI with fluid overload. The median age of the patients was 6 (range 0.43-9) months; the median weight was 6.5 (range 2.7-8.4) kg. Each patient served as his or her own control, undergoing both CFPD and conventional PD. CFPD was performed with two bedside-placed catheters using a 2.5 % glucose concentration. After initial filling, a dialysate flow rate of 100 ml/min/1.73 m(2) was maintained with an adapted continuous venovenous haemofiltration machine. The UF flow rate was set at 2.5 ml/min/1.73 m(2) and adapted as necessary. UF and clearance rates were measured for both PD and CFPD.
The median UF rate achieved was 1.7 (range 0.01-5.30) mg/kg/h with conventional PD versus 6.7 (range 2.17-15.7) mg/kg/h with CFPD (p = 0.042). The clearances of urea and creatinine were 6.89 (range 4.50-7.55) and 7.46 (range 4.79-10.50) mL/min/1.73 m(2), respectively, with conventional PD and 19 (17.0-30.0) and 41 (standard deviation17.4, range 12.0-52.0) mL/min/1.73 m(2), respectively, with CFPD (both p = 0.043).
Continuous flow peritoneal dialysis improves UF in fluid overloaded infants who are not achieving adequate UF on conventional PD.
与体外技术相比，急性腹膜透析（PD）的使用受到批评之处在于其清除率低和超滤（UF）量低。我们研究的目的是确定在使用4.25%葡萄糖浓度时，常规PD超滤不足的急性肾损伤（AKI）患儿中，持续流动腹膜透析（CFPD）是否能改善超滤。
对5名婴儿进行前瞻性研究。所有患儿均患有AKI且存在液体超负荷。患儿的中位年龄为6（范围0.43 - 9）个月；中位体重为6.5（范围2.7 - 8.4）千克。每位患者均作为自身对照，分别接受CFPD和常规PD。CFPD使用两个床边放置的导管，采用2.5%葡萄糖浓度。初始充盈后，使用适配的连续性静脉 - 静脉血液滤过机维持透析液流速为100 ml/min/1.73 m² 。超滤流速设定为2.5 ml/min/1.73 m² ，并根据需要进行调整。测量了PD和CFPD的超滤和清除率。
常规PD时超滤率中位数为1.7（范围0.01 - 5.30）mg/kg/h，而CFPD时为6.7（范围2.17 - 15.7）mg/kg/h（p = 0.042）。常规PD时尿素和肌酐清除率分别为6.89（范围4.50 - 7.55）和7.46（范围4.79 - 10.50）mL/min/1.73 m² ，CFPD时分别为19（17.0 - 30.0）和41（标准差17.4，范围12.0 - 52.0）mL/min/1.73 m² （p均 = 0.043）。
持续流动腹膜透析可改善常规PD超滤不足的液体超负荷婴儿的超滤情况。
