腹膜透析患者增量腹膜透析与残余肾功能下降的关联：balANZ 试验。
Association of Incremental peritoneal dialysis with residual kidney function decline in patients on peritoneal dialysis: The balANZ trial.
机构信息
Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.
Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.
出版信息
Perit Dial Int. 2023 Sep;43(5):374-382. doi: 10.1177/08968608231175826. Epub 2023 May 31.
BACKGROUND
Incremental peritoneal dialysis (PD), defined as less than Full-dose PD prescription, has several possible merits, including better preservation of residual kidney function (RKF), lower peritoneal glucose exposure and reduced risk of peritonitis. The aims of this study were to analyse the association of Incremental and Full-dose PD strategy with RKF and urine volume (UV) decline in patients commencing PD.
METHODS
Incident PD patients who participated in the balANZ randomised controlled trial (RCT) (2004-2010) and had at least one post-baseline RKF and UV measurement was included in this study. Patients receiving <56 L/week and ≥56 L/week of PD fluid at PD commencement were classified as Incremental and Full-dose PD, respectively. An alternative cut-point of 42 L/week was used in a sensitivity analysis. The primary and secondary outcomes were changes in measured RKF and daily UV, respectively.
RESULTS
The study included 154 patients (mean age 57.9 ± 14.1 years, 44% female, 34% diabetic, mean follow-up 19.5 ± 6.6 months). Incremental and Full-dose PD was commenced by 45 (29.2%) and 109 (70.8%) participants, respectively. RKF declined in the Incremental group from 7.9 ± 3.2 mL/min/1.73 m at baseline to 3.2 ± 2.9 mL/min/1.73 m at 24 months ( < 0.001), and in the Full-dose PD group from 7.3 ± 2.7 mL/min/1.73 m at baseline to 3.4 ± 2.8 mL/min/1.73 m at 24 months ( < 0.001). There was no difference in the slope of RKF decline between Incremental and Full-dose PD ( = 0.78). UV declined from 1.81 ± 0.73 L/day at baseline to 0.64 ± 0.63 L/day at 24 months in the Incremental PD group ( < 0.001) and from 1.38 ± 0.61 L/day to 0.71 ± 0.46 L/day in the Full-dose PD group ( < 0.001). There was no difference in the slope of UV decline between Incremental and Full-dose PD ( = 0.18).
CONCLUSIONS
Compared with Full-dose PD start, Incremental PD start is associated with similar declines in RKF and UV.
背景
增量腹膜透析（Incremental peritoneal dialysis，简称 IPd）定义为处方剂量不足全剂量，可能具有一些优势，包括更好地保留残余肾功能（Residual kidney function，简称 RKF）、减少腹膜葡萄糖暴露和降低腹膜炎风险。本研究旨在分析增量和全剂量 PD 策略与开始 PD 治疗的患者的 RKF 和尿排量（Urine volume，简称 UV）下降之间的关系。
方法
本研究纳入了参与 balANZ 随机对照试验（Randomized controlled trial，简称 RCT）（2004-2010 年）且至少有一次基线后 RKF 和 UV 测量值的新开始 PD 患者。以 PD 开始时接受 <56 L/周和≥56 L/周 PD 液的患者分别归类为增量和全剂量 PD。在敏感性分析中使用了 42 L/周的替代切点。主要和次要结局分别为测量的 RKF 和每日 UV 的变化。
结果
本研究纳入了 154 名患者（平均年龄 57.9±14.1 岁，44%为女性，34%患有糖尿病，平均随访 19.5±6.6 个月）。分别有 45 名（29.2%）和 109 名（70.8%）患者开始增量和全剂量 PD。增量组的 RKF 从基线时的 7.9±3.2 mL/min/1.73 m 下降到 24 个月时的 3.2±2.9 mL/min/1.73 m（<0.001），全剂量 PD 组从 7.3±2.7 mL/min/1.73 m 下降到 3.4±2.8 mL/min/1.73 m（<0.001）。增量和全剂量 PD 组之间 RKF 下降的斜率没有差异（=0.78）。增量 PD 组的 UV 从基线时的 1.81±0.73 L/天下降到 24 个月时的 0.64±0.63 L/天（<0.001），全剂量 PD 组从 1.38±0.61 L/天下降到 24 个月时的 0.71±0.46 L/天（<0.001）。增量和全剂量 PD 组之间 UV 下降的斜率没有差异（=0.18）。
结论
与全剂量 PD 起始相比，增量 PD 起始与 RKF 和 UV 相似的下降有关。
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