Heimbürger O, Bergström J, Lindholm B
Department of Renal Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
Perit Dial Int. 1994;14 Suppl 3:S123-32.
Similar to previous findings in HD patients, a markedly decreased serum albumin level has been found to be a strong predictor of morbidity and mortality in CAPD patients. However, a slight decrease in serum albumin levels (to about 30 g/L if measured with nephelometry or the bromcresol purple method) does not always seem to reflect impaired nutritional status or to be associated with an increased morbidity or mortality in CAPD patients. A low serum albumin level among CAPD patients is related to dialysate albumin loss, comorbidity, age, and a low dietary protein intake. The possible relation between the dialysis dose (as assessed by small solute clearances) and serum albumin levels among CAPD patients is much less established and needs further study, although serum albumin tends to increase in prospective studies of increased peritoneal dialysis dose. Although the plasma levels of amino acids seem to be lower in CAPD patients compared to HD patients, this does not reflect the intracellular amino acid pattern in muscle which is less abnormal in CAPD patients, possibly because of the sustained hyperinsulinemia during CAPD, resulting in an increased intracellular to extracellular gradient. It is at present not established to what extent the amino acid abnormalities are related to the dialysis dose. Malnourished and hypoalbuminemic CAPD patients should be recommended to increase the protein intake, and if this is not effective, the dialysis dose should be increased. Furthermore, the use of amino acid-based peritoneal dialysis solutions is a promising new tool for the treatment of malnourished CAPD patients and may become an important component of CAPD therapy in the future. On the other hand, if the nutritional status deteriorates in spite of these efforts, the patient should be transferred to hemodialysis if possible.
与既往对血液透析患者的研究结果相似，血清白蛋白水平显著降低已被发现是持续性非卧床腹膜透析（CAPD）患者发病和死亡的有力预测指标。然而，血清白蛋白水平略有下降（如果用散射比浊法或溴甲酚紫法测量，降至约30g/L）似乎并不总能反映营养状况受损，也与CAPD患者发病率或死亡率增加无关。CAPD患者血清白蛋白水平低与透析液白蛋白丢失、合并症、年龄及低蛋白饮食摄入有关。CAPD患者中透析剂量（通过小分子溶质清除率评估）与血清白蛋白水平之间的可能关系尚未明确确立，需要进一步研究，尽管在腹膜透析剂量增加的前瞻性研究中血清白蛋白往往会升高。虽然与血液透析患者相比，CAPD患者的血浆氨基酸水平似乎较低，但这并不能反映肌肉中的细胞内氨基酸模式，而CAPD患者的细胞内氨基酸模式异常程度较小，这可能是由于CAPD期间持续存在的高胰岛素血症，导致细胞内与细胞外梯度增加。目前尚不清楚氨基酸异常与透析剂量的相关程度。对于营养不良和低白蛋白血症的CAPD患者，应建议增加蛋白质摄入量，如果无效，则应增加透析剂量。此外，使用基于氨基酸的腹膜透析液是治疗营养不良的CAPD患者的一种有前景的新工具，未来可能成为CAPD治疗的重要组成部分。另一方面，如果尽管采取了这些措施，营养状况仍恶化，则应尽可能将患者转为血液透析。
