Selgas R, Fernandez-Reyes M J, Bosque E, Bajo M A, Borrego F, Jimenez C, Del Peso G, De Alvaro F
Servicio de Nefrologia, Hospital La Paz, Madrid, Spain.
Am J Kidney Dis. 1994 Jan;23(1):64-73. doi: 10.1016/s0272-6386(12)80814-6.
Long-term peritoneal dialysis requires the maintenance of the transport function of the peritoneal membrane, and appropriate studies of possible changes are necessary. The quantification of peritoneal mass transfer coefficients (MTCs) has been judged to be the ideal method for the evaluation of peritoneal diffusion. The aim of the present study was to show the results of the prospective evaluations in long-term continuous ambulatory peritoneal dialysis patients. We have studied the clinical incidents and peritoneal function of 56 patients who started continuous ambulatory peritoneal dialysis between 1980 and 1988, and have completed at least 3 years of follow-up. Ultrafiltration capacity was calculated with a standardized formula. All patients were studied for peritoneal diffusion of urea and creatinine at least once a year. The evaluation consisted of a kinetic study done by means of a peritoneal equilibration curve for urea and creatinine, applying a bicompartmental mathematical model to calculate the MTCs. The sequential mean values for urea-MTC did not show significant changes over the observation period (20.7 +/- 5.9 mL/min for the first year v 19.8 +/- 6 mL/min for the fifth year). Creatinine-MTC values showed a significant increase over this period in the paired data analysis. The decrease of the urea-MTC to creatinine-MTC ratio may be an early and appropriate index for measuring these changes when the individual values are in the normal range. On the other hand, peritoneal ultrafiltration capacity significantly decreased over this period (1,800 +/- 530 mL/d v 1,400 +/- 600 mL/d, P < 0.01). The high rate of accumulated days of peritoneal inflammation was related to these significant changes, and thus may be proposed to be a good prognostic index of long-term peritoneal survival. These long-term functional changes might be related to the effect of injuries on the preservation of the normal peritoneal structure. We conclude that after 5 to 11 years, the human peritoneum shows functional stability (diffusion and water transport) in patients with low rates of peritoneal inflammation. With a few exceptions, represented by patients with a high rate of peritoneal inflammation, long-term peritoneal dialysis accomplished its newly entrusted task.
长期腹膜透析需要维持腹膜的转运功能，因此有必要对可能出现的变化进行适当研究。腹膜质量转移系数（MTC）的量化已被认为是评估腹膜扩散的理想方法。本研究的目的是展示对长期持续性非卧床腹膜透析患者进行前瞻性评估的结果。我们研究了1980年至1988年间开始进行持续性非卧床腹膜透析且已完成至少3年随访的56例患者的临床事件和腹膜功能。超滤能力通过标准化公式计算得出。所有患者每年至少接受一次尿素和肌酐腹膜扩散情况的研究。评估包括通过尿素和肌酐的腹膜平衡曲线进行动力学研究，应用双室数学模型计算MTC。在观察期内，尿素-MTC的连续平均值未显示出显著变化（第一年为20.7±5.9 mL/分钟，第五年为19.8±6 mL/分钟）。在配对数据分析中，肌酐-MTC值在此期间显著增加。当个体值处于正常范围时，尿素-MTC与肌酐-MTC比值的降低可能是衡量这些变化的早期且合适的指标。另一方面，在此期间腹膜超滤能力显著下降（1800±530 mL/天对1400±600 mL/天，P<0.01）。腹膜炎症累积天数的高发生率与这些显著变化相关，因此可能被认为是长期腹膜存活的良好预后指标。这些长期功能变化可能与损伤对正常腹膜结构保存的影响有关。我们得出结论，在5至11年后，腹膜炎症发生率低的患者的人体腹膜显示出功能稳定性（扩散和水转运）。除了以腹膜炎症发生率高的患者为代表的少数例外情况外，长期腹膜透析完成了其新赋予的任务。
