Wideröe T E, Smeby L C, Mjåland S, Dahl K, Berg K J, Wessel Aas T
Nephron. 1984;38(4):238-47. doi: 10.1159/000183316.
9 patients were observed prospectively during 14-40 months 003 continuous ambulatory peritoneal dialysis (CAPD) treatment. From start of CAPD, each patient recorded dwell time, drained ultrafiltration volume (delta V), initial glucose concentration in dialysate, dialy fluid intake, body weight and blood pressure on a special form. These data, together with monthly values for albumin, urea, creatinin, phosphate, glucose and beta 2-microglobulin in plasma and in instilled dialysate, were later fed into a specially designed computer program to compare changes in the monthly mean (+/- SEM) values. During 5 episodes of peritonitis, daily changes in delta V were also computed. A long-term increase in delta V was found in 4 and a decrease in 5 patients. In all 9 patients delta V changed intermittently. All changes were most pronounced for long dwell times as compared to shorter dwell exchanges. The decrease in delta V started within the first 12 months of treatment. In the daily routine were aware of decreased ultrafiltration capacity in 3 patients only. Intermittent monthly changes in delta V could partly be correlated to changes in daily fluid intake. No correlations were found between long-term changes in delta V and fluid intake. All except 1 patient gained progressively in body weight, but without correlations to fluid balance, blood pressure and plasma albumin concentration. At the start of the observation period, most patients loosing delta V during this study appeared to have a more permeable membrane with a higher absorption rate of glucose and higher equilibration ratios for creatinine and beta 2-microglobulin in 5-hours drained dialysate as compared with the other patients. However, this was not statistically different between the two groups of patients. During the observation period, most patients with decreased delta V also increased transperitoneal solute transport, while the solute transport decreased in patients with increasing delta V, but these changes were only significant for some patients. During peritonitis, delta V decreased significantly 1 day before any other signs of peritonitis. All changes in delta V were most pronounced for long dwell times as compared with short dwell times. It is suggested that changes in ultrafiltration can be related to altered permeability of the peritoneal membrane, which appear earlier and more frequent than suggested by others, and any loss of delta V can be explained by a more permeable ('open') peritoneal membrane. It is also possible that different diseases act differently on the permeability of the peritoneal membrane.
对9例患者进行了为期14 - 40个月的持续性非卧床腹膜透析（CAPD）治疗的前瞻性观察。自CAPD开始，每位患者使用特殊表格记录驻留时间、引流超滤量（ΔV）、透析液初始葡萄糖浓度、透析液摄入量、体重和血压。这些数据，连同血浆和注入透析液中白蛋白、尿素、肌酐、磷酸盐、葡萄糖和β2 -微球蛋白的月度值，随后被输入一个专门设计的计算机程序，以比较月度均值（±标准误）的变化。在5次腹膜炎发作期间，还计算了ΔV的每日变化。发现4例患者的ΔV长期增加，5例患者的ΔV长期减少。在所有9例患者中，ΔV均间歇性变化。与较短驻留交换相比，所有变化在长驻留时间时最为明显。ΔV的减少在治疗的前12个月内开始。在日常工作中，仅3例患者意识到超滤能力下降。ΔV的间歇性月度变化部分与每日液体摄入量的变化相关。未发现ΔV的长期变化与液体摄入量之间存在相关性。除1例患者外，所有患者体重均逐渐增加，但与液体平衡、血压和血浆白蛋白浓度无关。在观察期开始时，在本研究中ΔV下降的大多数患者与其他患者相比，似乎具有更具通透性的腹膜，在5小时引流透析液中葡萄糖吸收率更高，肌酐和β2 -微球蛋白的平衡率更高。然而，两组患者之间这并无统计学差异。在观察期内，大多数ΔV下降的患者腹膜溶质转运也增加，而ΔV增加的患者溶质转运减少，但这些变化仅在部分患者中显著。在腹膜炎期间，在出现任何其他腹膜炎迹象前1天，ΔV显著下降。与短驻留时间相比，所有ΔV的变化在长驻留时间时最为明显。提示超滤的变化可能与腹膜通透性改变有关，其出现比其他人所提示的更早且更频繁，任何ΔV的降低都可以用更具通透性（“开放”）的腹膜来解释。不同疾病对腹膜通透性的作用方式也可能不同。
