Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
Department of Pediatrics, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Pediatr Nephrol. 2023 Apr;38(4):1267-1273. doi: 10.1007/s00467-022-05720-0. Epub 2022 Sep 2.
Icodextrin has a lower absorption rate, and icodextrin peritoneal dialysate contributes to more water removal than glucose dialysate in patients with high peritoneal permeability. There are limited data on icodextrin dialysate use in children.
This study included all pediatric patients who received peritoneal equilibration tests and peritoneal dialysis with icodextrin dialysate at the study center. The factors related to ultrafiltration volume with icodextrin dialysate with long dwell time were statistically analyzed. Then the ultrafiltration volume with icodextrin and medium-concentration glucose dialysate was compared in individual cycles in the same patients.
Thirty-six samples were included in the icodextrin group, and nine samples were used to compare the ultrafiltration volume with icodextrin and glucose dialysate. Dwell time, D/P-creatinine, D/D-glucose, age, height, and weight correlated significantly with the ultrafiltration volume of icodextrin dialysate (p < 0.05). A dwell volume equal to or more than 550 mL/m was associated with a significantly higher ultrafiltration volume than a lower dwell volume (p = 0.039). Multiple regression analysis revealed that dwell time (p = 0.038) and height (p < 0.01) correlated with ultrafiltration volume significantly. In addition, the ultrafiltration volume was superior (p < 0.01), and dwell time was longer (p = 0.02), with icodextrin dialysate than with medium-concentration glucose dialysate.
The ultrafiltration volume with icodextrin dialysate decreases in patients with small stature. Providing sufficient dwell time and volume is important for maximal water removal even in children. Ultrafiltration volume is superior with icodextrin than medium-concentration glucose dialysate for long dwell times. A higher resolution version of the Graphical abstract is available as Supplementary information.
相对于葡萄糖透析液，艾考糊精腹膜透析液的吸收速率更低，在腹膜高通透性患者中，其更有助于清除水分。关于儿童使用艾考糊精透析液的数据有限。
本研究纳入了在研究中心接受长时程艾考糊精腹膜透析和腹膜平衡试验的所有儿科患者。对长时程艾考糊精透析液超滤量的相关因素进行了统计学分析。然后比较了同一患者中各循环使用艾考糊精和中浓度葡萄糖透析液的超滤量。
艾考糊精组纳入 36 例样本，9 例样本用于比较艾考糊精和葡萄糖透析液的超滤量。留置时间、D/P-肌酐、D/D-葡萄糖、年龄、身高和体重与艾考糊精透析液超滤量显著相关（p<0.05）。留置体积等于或大于 550 ml/m 与较低的留置体积相比，超滤量显著更高（p=0.039）。多元回归分析显示，留置时间（p=0.038）和身高（p<0.01）与超滤量显著相关。此外，与中浓度葡萄糖透析液相比，艾考糊精透析液超滤量更高（p<0.01），留置时间更长（p=0.02）。
身材矮小的患者使用艾考糊精透析液时超滤量减少。即使是儿童，提供足够的留置时间和体积对于最大限度地清除水分也很重要。对于长时程留置，艾考糊精透析液的超滤量优于中浓度葡萄糖透析液。可提供图文摘要的高分辨率版本，详见补充材料。
