Surgical, medical and dental department of morphological sciences, Section of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
Nephrology and Dialysis Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
BMC Nephrol. 2020 Oct 27;21(1):448. doi: 10.1186/s12882-020-02113-z.
Patients on continuous ambulatory peritoneal dialysis (PD) are encouraged to warm dialysate to 37 °C before peritoneal infusion; main international PD guidelines do not provide specific recommendation, and patients generally warm dialysate batches partially or do not warm them at all. Warming of dialysate is a time-consuming procedure, not free from potential risks (i.e. degradation of glucose), and should be justified by a clear clinical benefit.
We designed a single blind randomized controlled trial where 18 stable PD patients were randomized to receive a peritoneal equilibration test either with dialysate at a controlled temperature of 37 °C (intervention group) or with dialysate warmed with conventional methods (control group). Primary end-point was a higher peritoneal creatinine clearance in patients in the intervention group.
Patients in the intervention group did not show a significantly higher peritoneal creatinine clearance when compared to the control group (6.38 ± 0.52 ml/min vs 5.65 ± 0.37 ml/min, p = 0.2682). Similar results were obtained for urea peritoneal clearance, mass transfer area coefficient of creatinine and urea. There were no significant differences in total abdominal discomfort questionnaire score, blood pressure and body temperature between the two groups.
Using peritoneal dialysate at different temperatures without causing significant side effects to patients appears feasible. We report a lack of benefit of warming peritoneal dialysate to 37 °C on peritoneal clearances; future PD guidelines should not reinforce this recommendation.
NCT04302649, ClinicalTrials.gov ; date of registration 10/3/2020 (retrospectively registered).
接受持续非卧床腹膜透析（PD）的患者在进行腹腔内输注前被鼓励将透析液加热至 37°C；主要的国际 PD 指南并未提供具体建议，患者通常部分加热透析液批次或根本不加热。透析液的加热是一个耗时的过程，并非没有潜在风险（即葡萄糖降解），并且应该有明确的临床获益来证明其合理性。
我们设计了一项单盲随机对照试验，将 18 名稳定的 PD 患者随机分为两组，分别接受在受控温度为 37°C 的情况下进行腹膜平衡试验（干预组）或使用常规方法加热的透析液进行腹膜平衡试验（对照组）。主要终点是干预组患者的腹膜肌酐清除率更高。
与对照组相比，干预组患者的腹膜肌酐清除率没有显著升高（6.38±0.52ml/min 比 5.65±0.37ml/min，p=0.2682）。肌酐和尿素的腹膜清除率、质量传递面积系数也得到了类似的结果。两组间总腹部不适问卷评分、血压和体温均无显著差异。
在不引起患者明显副作用的情况下使用不同温度的腹膜透析液似乎是可行的。我们报告了将腹膜透析液加热至 37°C 对腹膜清除率没有益处；未来的 PD 指南不应强化这一建议。
NCT04302649，ClinicalTrials.gov；注册日期 2020 年 10 月 3 日（回顾性注册）。
