Parapiboon Watanyu, Jamratpan Treechada
Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakornratchasima, Thailand
Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakornratchasima, Thailand.
Perit Dial Int. 2017 Sep-Oct;37(5):523-528. doi: 10.3747/pdi.2016.00260. Epub 2017 May 25.
Dosage for peritoneal dialysis (PD) in acute kidney injury (AKI) is controversial. This study aims to find benefits and risks of intensive versus minimal standard dosage of PD in AKI.
In a tertiary-hospital, 93 AKI patients who required PD between May 2015 and January 2016 were enrolled in a randomized, open-label controlled study. Patients were randomized to intensive group (> 30 L) and minimal standard group (< 20 L) of PD volume per day for the first 2 consecutive days. The primary outcome was in-hospital mortality. The secondary outcomes were peritonitis rate, dialysis dependence, and PD leakage.
Seventy-five patients were analyzed (intensive PD = 39; minimal standard PD = 36). Mean age was 60 years. Most patients were in critical care (72% unstable hemodynamic, mean APACHE II score 26.2). Kt/V delivery per session was 0.61 and 0.38 in intensive and minimal standard PD dosage for the first 2 consecutive sessions. According to intention-to-treat analysis, the in-hospital mortality rate of intensive PD dosage was not significantly different from the minimal standard PD dosage (79% vs 63%, relative risk [RR] 1.11, 95% confidence interval [CI] 0.80 to 1.51, = 0.13). The dialysis dependence rate and PD leakage were not significantly different between the 2 groups. The rate of PD peritonitis was slightly higher in the intensive PD dosage group (15.3% vs 8.3%, = 0.34).
Among AKI patients who required PD, there was no significant difference in in-hospital mortality between intensive and minimal standard PD dosage.
急性肾损伤（AKI）患者腹膜透析（PD）的剂量存在争议。本研究旨在探讨AKI患者接受强化与最低标准剂量PD治疗的获益与风险。
在一家三级医院，对2015年5月至2016年1月期间93例需要进行PD的AKI患者开展了一项随机、开放标签对照研究。患者被随机分为强化组（每日PD量>30L）和最低标准组（每日PD量<20L），连续2天接受相应治疗。主要结局指标为住院死亡率。次要结局指标为腹膜炎发生率、透析依赖情况及PD渗漏情况。
共分析了75例患者（强化PD组=39例；最低标准PD组=36例）。平均年龄为60岁。大多数患者处于重症监护状态（72%血流动力学不稳定，急性生理与慢性健康状况评分系统II [APACHE II]平均评分为26.2）。强化组和最低标准组连续2个疗程的单次Kt/V值分别为0.61和0.38。根据意向性分析，强化PD剂量组的住院死亡率与最低标准PD剂量组无显著差异（79% vs 63%，相对危险度[RR] 1.11，95%置信区间[CI] 0.80至1.51，P = 0.13）。两组间透析依赖率和PD渗漏情况无显著差异。强化PD剂量组的PD腹膜炎发生率略高（15.3% vs 8.3%，P = 0.34）。
在需要进行PD的AKI患者中，强化PD剂量与最低标准PD剂量的住院死亡率无显著差异。
