Strauss F G, Holmes D L, Dennis R L
Los Angeles Dialysis Training Center, California, USA.
Adv Perit Dial. 1995;11:110-3.
Treatment of high-membrane transporters with continuous ambulatory peritoneal dialysis (CAPD) is associated with ineffective ultrafiltration, increased dialysate protein loss, lower serum albumin levels, and lower protein catabolic rates, suggesting development of inadequate dialysis. The use of short-dwell nightly intermittent peritoneal dialysis (NIPD) and daytime ambulatory peritoneal dialysis (DAPD) has not been evaluated. Patients with inadequate ultrafiltration secondary to rapid membrane transport [peritoneal equilibration test (PET) confirmation] were managed with NIPD and DAPD (group A, n = 32) and compared to patients on CAPD and continuous cycling peritoneal dialysis (CCPD) (group B, n = 53) after at least 3 months of therapy. Groups A and B were similar in age, gender, diabetic status, prestudy months on peritoneal dialysis (PD), and residual renal function. No significant differences were observed between the groups with respect to serum albumin, daily protein loss, normalized protein catabolic rate (PCRN), or weekly KT/V urea indices. Diabetics demonstrated lower levels of serum albumin and PCRN than nondiabetics while maintaining equivalent KT/V urea indices. Reassessment of patients 6 months later also revealed no differences in outcome measures between group A (n = 20) and group B (n = 36). High transporters treated with NIPD and DAPD appear to have similar dialysate protein loss, adequacy, and nutrition indices when compared to patients on CAPD and CCPD. Future studies will determine if delivery of higher target small-solute clearances benefits patients on NIPD/DAPD as contrasted with continuous PD modalities (CAPD/CCPD), or diabetics compared to nondiabetics.
持续非卧床腹膜透析（CAPD）治疗高转运膜患者与超滤无效、透析液蛋白丢失增加、血清白蛋白水平降低和蛋白分解代谢率降低相关，提示透析不充分。短期夜间间歇性腹膜透析（NIPD）和日间非卧床腹膜透析（DAPD）的应用尚未得到评估。对因快速膜转运继发超滤不充分（经腹膜平衡试验[PET]证实）的患者采用NIPD和DAPD进行治疗（A组，n = 32），并在至少3个月的治疗后与接受CAPD和持续循环腹膜透析（CCPD）的患者（B组，n = 53）进行比较。A组和B组在年龄、性别、糖尿病状态、腹膜透析（PD）治疗前的月数以及残余肾功能方面相似。两组在血清白蛋白、每日蛋白丢失、标准化蛋白分解代谢率（PCRN）或每周尿素清除率（KT/V）指标方面未观察到显著差异。糖尿病患者的血清白蛋白和PCRN水平低于非糖尿病患者，而尿素清除率（KT/V）指标相当。6个月后对患者的重新评估也显示，A组（n = 20）和B组（n = 36）在结局指标上没有差异。与接受CAPD和CCPD的患者相比，采用NIPD和DAPD治疗的高转运患者似乎具有相似的透析液蛋白丢失、充分性和营养指标。未来的研究将确定，与持续腹膜透析模式（CAPD/CCPD）相比，更高的目标小分子溶质清除率对接受NIPD/DAPD治疗的患者是否有益，以及糖尿病患者与非糖尿病患者相比是否有益。
