Department of Renal Medicine, 26674Changi General Hospital, Singapore.
Department of Medicine, 5755Yale University, New Haven, CT, USA.
Perit Dial Int. 2021 May;41(3):307-312. doi: 10.1177/0896860820970066. Epub 2020 Nov 11.
Peritoneal dialysis (PD) is a viable option for renal replacement therapy in acute kidney injury (AKI), especially in challenging times during disasters and pandemics when resources are limited. While PD techniques are well described, there is uncertainty about how to determine the amount of PD to be prescribed toward a target dose. The aim of this study is to derive practical equations to assist with the prescription of PD for AKI.
Using established physiological principles behind PD clearance and membrane transport, a primary determinant of dose delivery, equations were mathematically derived to estimate dialysate volume required to achieve a target dose of PD.
The main derivative equation is = (1.2 × std-/ × TBW)/( + 4), where is the total dialysate volume per day, std-/ is the desired weekly dose, TBW is the total body water, and is the dwell time. can be expressed in terms of dwell volume, , by = (0.3 × std-/ × TBW) - (6 × ). Two further equations were derived which directly describe the mathematical relationship between and . A calculator is included as an Online Supplementary Material.
The equations are intended as a practical tool to estimate solute clearances and guide prescription of continuous PD. The estimated dialysate volume required for any dose target can be calculated from cycle duration or dwell volume. However, the exact target dose of PD is uncertain and should be adjusted according to the clinical circumstances and response to treatment. The equations presented in this article facilitate the adjustment of PD prescription toward the targeted solute clearance.
腹膜透析（PD）是急性肾损伤（AKI）肾脏替代治疗的可行选择，尤其是在资源有限的灾难和大流行时期，面临挑战时更是如此。虽然 PD 技术有详细的描述，但对于如何确定要规定的 PD 量以达到目标剂量，存在不确定性。本研究旨在得出实用的方程，以帮助确定 AKI 的 PD 处方。
利用 PD 清除和膜转运背后的既定生理原理，这些是剂量输送的主要决定因素，通过数学推导得出了估计达到 PD 目标剂量所需的透析液量的方程。
主要衍生方程为 = (1.2 × std-/ × TBW)/( + 4)，其中 是每天的总透析液量，std-/是所需的每周剂量，TBW 是总体水量， 是停留时间。 可以用停留体积 表示，即 = (0.3 × std-/ × TBW) - (6 × )。还推导出了另外两个直接描述 和 之间数学关系的方程。计算器作为在线补充材料提供。
这些方程旨在作为估计溶质清除率和指导持续 PD 处方的实用工具。可以根据周期持续时间或停留体积计算达到任何剂量目标所需的透析液量。然而，确切的 PD 目标剂量是不确定的，应根据临床情况和治疗反应进行调整。本文中提出的方程有助于调整 PD 处方以达到目标溶质清除率。
