Kaiser B A, Polinsky M S, Stover J, Morgenstern B Z, Baluarte H J
St. Christopher's Hospital for Children, Philadelphia, PA 19134.
Pediatr Nephrol. 1994 Dec;8(6):733-8. doi: 10.1007/BF00869106.
Maintenance dialysis usually serves as an interim treatment for children with end-stage renal disease (ESRD) until transplantation can take place. Some children, however, may require dialytic support for an extended period of time. Although dialysis improves some of the problems associated with growth failure in ESRD (acidosis, uremia, calcium, and phosphorus imbalance), many children continue to grow poorly. Therefore, three different dialysis modalities, continuous ambulatory peritoneal dialysis (CAPD), cycler/intermittent peritoneal dialysis (CPD), and hemodialysis (HD), were evaluated with regard to their effects on the growth of children initiating dialysis and remaining on that modality for 6-12 months. Growth was best for children undergoing CAPD when compared with the other two modalities with regard to the following growth parameters: incremental height standard deviation score for chronological age [-0.55 +/- 2.06 vs. -1.69 +/- 1.22 for CPD (P < 0.05) and -1.80 +/- 1.13 for HD (P < 0.05)]; incremental height standard deviation score for bone age [-1.68 +/- 1.71 vs. -2.45 +/- 1.43 for CPD (P = NS) and -2.03 +/- 1.28 for HD (P = NS)]; change in height standard deviation score during the dialysis period [0.00 +/- 0.67 vs. -0.15 +/- .29 for CPD (P = NS) and -0.23 +/- .23 for HD (P = NS)]. The reasons why growth appears to be best in children receiving CAPD may be related to its metabolic benefits: lower levels of uremia, as reflected by the blood urea nitrogen [50 +/- 12 vs. 69 +/- 16 mg/dl for CPD (P < 0.5) and 89 +/- 17 for HD (P < 0.05)], improved metabolic acidosis, as indicated by a higher serum bicarbonate concentration [24 +/- 2 mEq/l vs. 22 +/- 2 for CPD (P < 0.05) and 21 +/- 2 for HD (P < 0.05)]. In addition, children undergoing CAPD receive significant supplemental calories from the glucose absorbed during dialysis. CAPD, and possibly, other types of prolonged-dwell daily peritoneal dialysis appear to be most beneficial for growth, which may be of particular importance for the smaller child undergoing dialysis while awaiting transplantation.
维持性透析通常作为终末期肾病（ESRD）患儿移植前的过渡治疗。然而，一些患儿可能需要长时间的透析支持。尽管透析改善了一些与ESRD生长发育不良相关的问题（酸中毒、尿毒症、钙和磷失衡），但许多患儿仍生长缓慢。因此，对三种不同的透析方式，即持续非卧床腹膜透析（CAPD）、循环/间歇性腹膜透析（CPD）和血液透析（HD），就其对开始透析并持续使用该方式6至12个月的患儿生长发育的影响进行了评估。与其他两种方式相比，接受CAPD的患儿在以下生长参数方面生长情况最佳：按年龄计算的身高标准差增长评分[-0.55±2.06，CPD为-1.69±1.22（P<0.05），HD为-1.80±1.13（P<0.05）]；按骨龄计算的身高标准差增长评分[-1.68±1.71，CPD为-2.45±1.43（P=无显著性差异），HD为-2.03±1.28（P=无显著性差异）]；透析期间身高标准差评分的变化[0.00±0.67，CPD为-0.15±0.29（P=无显著性差异），HD为-0.23±0.23（P=无显著性差异）]。接受CAPD的患儿生长情况似乎最佳的原因可能与其代谢益处有关：尿毒症水平较低，如血尿素氮所示[CPD为50±12 vs. 69±16mg/dl（P<0.5），HD为89±17（P<0.05）]；代谢性酸中毒改善，如血清碳酸氢盐浓度较高所示[24±2mEq/l，CPD为22±2（P<0.05），HD为21±2（P<0.05）]。此外，接受CAPD的患儿在透析期间从吸收的葡萄糖中获得大量额外热量。CAPD以及可能的其他类型的长时间每日腹膜透析似乎对生长最为有益，这对于等待移植的较小透析患儿可能尤为重要。
