Nakayama M, Kawaguchi Y, Yokoyama K, Kubo H, Miura Y, Watanabe S, Sakai O
Second Department of Internal Medicine, Tokyo Jikei University School of Medicine, Japan.
Clin Nephrol. 1994 Jun;41(6):357-63.
In patients undergoing continuous ambulatory peritoneal dialysis (CAPD), transperitoneal sodium (Na) flux plays a crucial role in the control of blood pressure (BP), as it determines the net Na balance of the patient. However, with the conventional solution, Na removal into the effluent greatly depends on the drained ultrafiltration (UF) volume, and this can hinder the success of adequate Na removal in some patients. Therefore, we developed a low Na concentration solution to increase Na removal through diffusion force, and studied the clinical effect of this solution in patients with Na overload. The composition of the low Na solution is as follows: Na: 120 mEq/l, Ca: 3.5 mEq/l, Mg: 0.5 mEq/l, Cl: 84 mEq/l, lactate: 40 mEq/l, glucose (G) and osmolality: 1.36% (322 mOsm/l) and 2.27% (372 mOsm/l), vol: 2 l. Nine patients (age: 43 +/- 2 yr, oral Na intake: 3.4 +/- 0.3 g/day, mean arterial pressure: 123 +/- 6 mmHg, drained UF volume: 918 +/- 187 ml/day; mean +/- SEM) were studied. Compared to the conventional solution (Na: 132 mEq/l), Na removal using the low Na solution (4 h dwell) was increased from -7.8 +/- 8.7 to -2.3 +/- 5.7 mEq in 1.36% G solution, and from 25.3 +/- 3.1 to 35.4 +/- 4.7 mEq (p < 0.05) in 2.26% G solution. Patients were switched from the conventional solution to the low Na solution, exchanging four times daily for up to 4 weeks. Two patients discontinued low Na solution before the study ended, due to overhydration and hyponatremia, the remaining seven cases showed no adverse symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
在接受持续性非卧床腹膜透析（CAPD）的患者中，经腹膜钠（Na）通量在血压（BP）控制中起着关键作用，因为它决定了患者的净钠平衡。然而，使用传统溶液时，钠向流出液中的清除很大程度上取决于排出的超滤（UF）量，这可能会阻碍一些患者充分清除钠的成功。因此，我们开发了一种低钠浓度溶液，以通过扩散力增加钠的清除，并研究了该溶液对钠过载患者的临床效果。低钠溶液的成分如下：钠：120毫当量/升，钙：3.5毫当量/升，镁：0.5毫当量/升，氯：84毫当量/升，乳酸盐：40毫当量/升，葡萄糖（G）和渗透压：1.36%（322毫渗量/升）和2.27%（372毫渗量/升），体积：2升。研究了9名患者（年龄：43±2岁，口服钠摄入量：3.4±0.3克/天，平均动脉压：123±6毫米汞柱，排出的超滤量：918±187毫升/天；平均值±标准误）。与传统溶液（钠：132毫当量/升）相比，在1.36% G溶液中，使用低钠溶液（4小时驻留）的钠清除量从-7.8±8.7增加到-2.3±5.7毫当量，在2.26% G溶液中从25.3±3.1增加到35.4±4.7毫当量（p<0.05）。患者从传统溶液转换为低钠溶液，每天更换4次，持续4周。两名患者在研究结束前因水过多和低钠血症停止使用低钠溶液，其余7例未出现不良症状。（摘要截断于250字）
