Flanigan M J, Lim V S, Pflederer T A
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City.
Am J Kidney Dis. 1993 Nov;22(5):700-7. doi: 10.1016/s0272-6386(12)80433-1.
Some patients find automated peritoneal dialysis preferable to continuous ambulatory peritoneal dialysis (CAPD). Unfortunately, automated peritoneal dialysis prescriptions are time consuming and can impede rehabilitation. We wished to determine whether an 8-hour tidal peritoneal dialysis (TPD) prescription could maintain the time averaged blood urea nitrogen at 60 mg/dL or less while patients consumed a diet containing approximately 1.2 g protein/kg body weight/d. Ten home dialysis patients previously stabilized on continuous cyclic peritoneal dialysis volunteered for a metabolic balance study conducted at the University of Iowa's Clinical Research Center. A peritoneal equilibration test was conducted and mass transfer area coefficients (MTaCs) were derived for each subject. Nitrogen balance was measured during the last 5 days of a 12-day constant diet while patients underwent a series of monitored nocturnal dialyses. Mass transfer area coefficient measurements were reproducible and independent of the filling volume and ultrafiltration, but varied between subjects (normalized MTaCurea = 33.6 +/- 16.3 mL/min, normalized MTaCcrt = 16.3 +/- 9.5 mL/min). Tidal peritoneal dialysis urea and creatinine clearances could be predicted by these MTaC values (r2 = 0.70 urea, r2 = 0.91 creatinine). Nitrogen balance assumptions predicted, and we confirmed, a relationship between dietary protein intake and urea nitrogen generation (r2 = 0.82) during TPD. A normalized protein catabolic rate of 1.2 g/kg/d resulted in a urea nitrogen generation rate of approximately 100 mg/kg/d. If a patient's protein intake was approximately 1.2 g/kg/d, then TPD with a weekly urea clearance normalized to body volume (Kt/V(urea)) of approximately 2.1 (urea clearance, approximately 0.35 mL/kg/min) could maintain a time averaged blood urea nitrogen of approximately 60 mg/dL.(ABSTRACT TRUNCATED AT 250 WORDS)
一些患者认为自动腹膜透析比持续非卧床腹膜透析（CAPD）更可取。不幸的是，自动腹膜透析的处方很耗时，可能会妨碍康复。我们希望确定8小时潮式腹膜透析（TPD）处方能否在患者摄入约1.2 g蛋白质/千克体重/天的饮食时，将时间平均血尿素氮维持在60 mg/dL或更低。10名先前在持续循环腹膜透析中稳定的家庭透析患者自愿参加了在爱荷华大学临床研究中心进行的代谢平衡研究。进行了腹膜平衡试验，并得出了每个受试者的传质面积系数（MTaCs）。在12天恒定饮食的最后5天测量氮平衡，同时患者接受一系列监测的夜间透析。传质面积系数测量具有可重复性，且与填充量和超滤无关，但个体之间有所不同（标准化MTaC尿素 = 33.6 +/- 16.3 mL/分钟，标准化MTaC肌酐 = 16.3 +/- 9.5 mL/分钟）。这些MTaC值可以预测潮式腹膜透析的尿素和肌酐清除率（r2 = 0.70为尿素，r2 = 0.91为肌酐）。氮平衡假设预测并经我们证实，在TPD期间饮食蛋白质摄入量与尿素氮生成之间存在关系（r2 = 0.82）。1.2 g/千克/天的标准化蛋白分解代谢率导致尿素氮生成率约为100 mg/千克/天。如果患者的蛋白质摄入量约为1.2 g/千克/天，那么每周尿素清除率标准化为体容积（Kt/V(尿素)）约为2.1（尿素清除率，约0.35 mL/千克/分钟）的TPD可以将时间平均血尿素氮维持在约60 mg/dL。（摘要截断于250字）
