Fernandes Ana, Ribera-Sanchez Roi, Rodríguez-Carmona Ana, López-Iglesias Antía, Leite-Costa Natacha, Pérez Fontán Miguel
Division of Nephrology, Centro Hospitalar de Setúbal, Setúbal, Portugal.
Am J Nephrol. 2017;46(1):47-54. doi: 10.1159/000477829. Epub 2017 Jun 21.
Volume overload is frequent in diabetics undergoing peritoneal dialysis (PD), and may play a significant role in the excess mortality observed in these patients. The characteristics of peritoneal water transport in this population have not been studied sufficiently.
Following a prospective, single-center design we made cross-sectional and longitudinal comparisons of peritoneal water transport in 2 relatively large samples of diabetic and nondiabetic PD patients. We used 3.86/4.25% glucose-based peritoneal equilibration tests (PET) with complete drainage at 60 min, for these purposes.
We scrutinized 59 diabetic and 120 nondiabetic PD patients. Both samples showed relatively similar characteristics, although diabetics were significantly more overhydrated than nondiabetics. The baseline PET disclosed lower ultrafiltration (mean 439 mL diabetics vs. 532 mL nondiabetics, p = 0.033) and sodium removal (41 vs. 53 mM, p = 0.014) rates in diabetics. One hundred and nine patients (36 diabetics) underwent a second PET after 12 months, and 45 (14 diabetics) underwent a third one after 24 months. Longitudinal analyses disclosed an essential stability of water transport in both groups, although nondiabetic patients showed a trend where an increase in free water transport (p = 0.033) was observed, which was not the case in diabetics.
Diabetic patients undergoing PD present lower capacities of ultrafiltration and sodium removal than their nondiabetic counterparts. Longitudinal analyses disclose an essential stability of water transport capacities, both in diabetics and nondiabetics. The clinical significance of these differences deserves further analysis.
容量超负荷在接受腹膜透析（PD）的糖尿病患者中很常见，可能在这些患者观察到的额外死亡率中起重要作用。该人群腹膜水转运的特征尚未得到充分研究。
采用前瞻性单中心设计，我们对2个相对较大样本的糖尿病和非糖尿病PD患者的腹膜水转运进行了横断面和纵向比较。为此，我们使用了3.86/4.25%葡萄糖基腹膜平衡试验（PET），在60分钟时完全引流。
我们仔细研究了59例糖尿病和120例非糖尿病PD患者。两个样本显示出相对相似的特征，尽管糖尿病患者的水合过度程度明显高于非糖尿病患者。基线PET显示糖尿病患者的超滤率（糖尿病患者平均439 mL，非糖尿病患者532 mL，p = 0.033）和钠清除率（41 vs. 53 mM，p = 0.014）较低。109例患者（36例糖尿病患者）在12个月后进行了第二次PET，45例（14例糖尿病患者）在24个月后进行了第三次PET。纵向分析显示两组水转运基本稳定，尽管非糖尿病患者呈现出自由水转运增加的趋势（p = 0.033），而糖尿病患者并非如此。
接受PD的糖尿病患者的超滤和钠清除能力低于非糖尿病患者。纵向分析显示糖尿病患者和非糖尿病患者的水转运能力基本稳定。这些差异的临床意义值得进一步分析。
