Almeida Cibele Puato, Balbi André Luís, Ponce Daniela
Department of Internal Medicine, Botucatu Medical School, UNESP, Univ Estadual Paulista, Botucatu, Brazil.
Clin Exp Nephrol. 2018 Dec;22(6):1420-1426. doi: 10.1007/s10157-018-1598-7. Epub 2018 Jun 11.
Peritoneal dialysis (PD) and hemodialysis (HD) are options for the treatment of acute kidney injury (AKI) patients. The aim of this study was to compare the effects of PD and daily HD on respiratory mechanics of AKI patients undergoing invasive mechanical ventilation (IMV).
A prospective cohort study evaluated 154 patients, 37 on continuous PD and 94 on HD. Respiratory mechanics parameters such as pulmonary static compliance (Psc) and resistance of the respiratory system (Rsr) and oxygenation index (OI) were assessed for 3 days. Patients were evaluated at moments 1, 2 and 3 (pre- and post-dialysis).
The initial clinical parameters were similar in the two groups, except the age that was higher in continuous PD group (70.8 ± 11.6 vs. 60 ± 15.8; p < 0.0001). In both groups, Psc increased significantly, with no difference between the two groups-pre-dialysis (continuous PD 40 ± 17.4, 42.8 ± 17.2, 48 ± 19; HD 39.1 ± 21.3, 39. 5 ± 18.9, 45.2 ± 21) and post-dialysis (continuous PD 42.8 ± 7.2, 48 ± 19, 57.1 ± 18.3; HD 42 ± 19, 45 ± 18.5, 56 ± 24.8). Rsr remained stable among patients on continuous PD (pre-dialysis 10.4 ± 5.1, 13.3 ± 7.7, 13.5 ± 10.3, post-dialysis 13.3 ± 7.7, 13.5 ± 10.3, 11.1 ± 5.9) and decreased among HD patients (pre-dialysis 10.4 ± 5.1, 10.4 ± 5.1, 10.4 ± 5, 1, post-dialysis 10.5 ± 6.8, 10 ± 4.9, 8.9 ± 4.2). There was difference in Rsr between the two groups at the post-dialysis moments 1 and 2 (p = 0.03). OI increased in both groups (continuous PD 260.7 ± 119, 252.7 ± 87.1, 287.3 ± 88.4; HD 228 ± 85, 257 ± 84, 312.1 ± 111.5, p > 0.05), although there was no difference between them.
AKI patients undergoing IMV and HD or PD had improvement in the mechanical ventilation and oxygenation, with no difference between the two groups.
腹膜透析（PD）和血液透析（HD）是治疗急性肾损伤（AKI）患者的选择。本研究的目的是比较PD和每日HD对接受有创机械通气（IMV）的AKI患者呼吸力学的影响。
一项前瞻性队列研究评估了154例患者，37例接受持续PD治疗，94例接受HD治疗。连续3天评估呼吸力学参数，如肺静态顺应性（Psc）、呼吸系统阻力（Rsr）和氧合指数（OI）。在第1、2和3个时间点（透析前和透析后）对患者进行评估。
两组患者的初始临床参数相似，但持续PD组患者的年龄较高（70.8±11.6 vs. 60±15.8；p<0.0001）。两组患者的Psc均显著增加，透析前两组之间无差异（持续PD组分别为40±17.4、42.8±17.2、48±19；HD组分别为39.1±21.3、39.5±18.9、45.2±21），透析后也无差异（持续PD组分别为42.8±7.2、48±19、57.1±18.3；HD组分别为42±19、45±18.5、56±24.8）。持续PD患者的Rsr保持稳定（透析前为10.4±5.1、13.3±7.7、13.5±10.3，透析后为13.3±7.7、13.5±10.3、11.1±5.9），而HD患者的Rsr则下降（透析前为10.4±5.1、10.4±5.1、10.4±5.1，透析后为10.5±6.8、10±4.9、8.9± 4.2）。透析后第1和第2个时间点两组之间的Rsr存在差异（p=0.03）。两组患者的OI均升高（持续PD组分别为260.7±119、252.7±87.1、287.3±88.4；HD组分别为228±85、257±84、312.1±111.5，p>0.05），尽管两组之间无差异。
接受IMV和HD或PD治疗的AKI患者的机械通气和氧合情况有所改善，两组之间无差异。
