Gokal R, Mistry C D, Peers E M
Manchester Royal Infirmary, U.K.
Perit Dial Int. 1995 Jul-Sep;15(6):226-30.
To compare peritonitis occurrence and outcome in a large U.K. study Multicentre Investigation of Icodextrin in Ambulatory Dialysis (MIDAS).
Prospective, randomized, controlled 6-month comparison of icodextrin with glucose for the long dwell in continuous ambulatory peritoneal dialysis (CAPD) patients.
Eleven CAPD units in U.K. teaching hospital.
A total of 209 patients established on CAPD for at least 3 months (103 control, 106 icodextrin). Twenty-three control (C) and 22 icodextrin (I) patients experienced peritonitis during the study.
Patients who had peritonitis remained on treatment (unless CAPD was withdrawn, temporarily or permanently).
The main outcome measures were the rate of peritonitis and duration of CAPD treatment prestudy; the rate of peritonitis episodes and their outcome during study; the effect of peritonitis on laboratory variables, serum icodextrin metabolites, and ultrafiltration efficacy.
Prestudy: Nine (39%) of C but 14 (64%) of I patients had suffered previous peritonitis episode(s), with overall rates of 0.58 and 0.78 episodes per patient-year, respectively. DURING STUDY: There were 31 C episodes and 35 I episodes, with overall rates of 0.76 and 0.93 per patient-year, respectively. The increase in the C and I groups was 31% and 19%, respectively. Serum osmolality and sodium levels were unaffected by peritonitis, and there was no increase in serum icodextrin metabolites during peritonitis. Overnight ultrafiltration volume during peritonitis (mean +/- SD) declined slightly from 218 +/- 354 mL to 185 +/- 299 mL (NS) in the control group, but increased in the icodextrin group from 570 +/- 146 mL to 723 +/- 218 mL (p < 0.01).
Using icodextrin for the long dwell in CAPD does not increase the rate of peritonitis, nor does it alter the outcome of peritonitis. Peritonitis does not affect uptake of icodextrin from the peritoneum.
在一项大型英国研究——门诊透析中艾考糊精多中心研究（MIDAS）中比较腹膜炎的发生率及转归情况。
对持续非卧床腹膜透析（CAPD）患者进行为期6个月的前瞻性、随机、对照研究，比较艾考糊精与葡萄糖用于长留置期的效果。
英国教学医院的11个CAPD单位。
共有209例接受CAPD至少3个月的患者（103例为对照组，106例为艾考糊精组）。23例对照组（C）患者和22例艾考糊精组（I）患者在研究期间发生腹膜炎。
发生腹膜炎的患者继续接受治疗（除非暂时或永久停止CAPD）。
主要观察指标为研究前腹膜炎发生率及CAPD治疗时长；研究期间腹膜炎发作率及其转归情况；腹膜炎对实验室指标、血清艾考糊精代谢产物及超滤效果的影响。
研究前：对照组9例（39%）患者及艾考糊精组14例（64%）患者既往有腹膜炎发作史，患者年发作率分别为0.58次和0.78次。研究期间：对照组发生31次发作，艾考糊精组发生35次发作，患者年发作率分别为0.76次和0.93次。对照组和艾考糊精组的发作率分别增加了31%和19%。血清渗透压和钠水平不受腹膜炎影响，腹膜炎期间血清艾考糊精代谢产物无增加。对照组腹膜炎期间夜间超滤量（均值±标准差）从218±354ml略有下降至185±299ml（无统计学意义），而艾考糊精组从570±146ml增加至723±218ml（p<0.01）。
在CAPD长留置期使用艾考糊精不会增加腹膜炎发生率，也不会改变腹膜炎的转归。腹膜炎不影响艾考糊精从腹膜的吸收。
