Fung L, Pollock C A, Caterson R J, Mahony J F, Waugh D A, Macadam C, Ibels L S
Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.
J Am Soc Nephrol. 1996 May;7(5):737-44. doi: 10.1681/ASN.V75737.
Peritoneal membrane function was assessed in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using parameters derived from urea kinetic modeling and the peritoneal equilibration test (PET). Their relationships with other nutritional markers and overall morbidity were determined. Data regarding the patients' nutritional status as determined by total body nitrogen (TBN) measurements, hospital admissions, and infectious complications within the last 12 months were reviewed. Total dialysate clearance (Kt/V) delivered was highly dependent on residual renal function (P < 0.0001). Kt/V derived from peritoneal clearance diminished with increasing age (P < 0.05). A higher delivered total Kt/V was associated with higher normalized protein catabolic rates (P < 0.002), which in turn were associated with improved TBN (P < 0.05). Hospital admissions decreased with improved normalized protein catabolic rates (P < 0.05), and higher serum albumin and total protein levels (P < 0.01 and P < 0.002, respectively). Infectious complications correlated positively with time on dialysis (P < 0.01), and correlated negatively with TBN measurements (P = 0.05). No correlations were found between infectious complications and serum albumin level or peritoneal protein loss. However, the total duration of hospitalization was shortened with higher serum albumin and total protein levels (P < 0.0001 and P < 0.002, respectively). Although Kt/V determinations did not correlate with clearances determined by the PET, the PET-determined creatinine transport rate correlated with TBN (P < 0.05) but not with infectious complications. In conclusion, nutritional parameters correlate with outcome on continuous ambulatory peritoneal dialysis. An integral relationship exists between nutritional status and dialysis delivery, which is best assessed by urea kinetic modeling.
使用源自尿素动力学模型和腹膜平衡试验（PET）的参数，对接受持续性非卧床腹膜透析（CAPD）的患者的腹膜功能进行了评估。确定了它们与其他营养指标及总体发病率的关系。回顾了有关患者营养状况的数据，这些数据由全身氮（TBN）测量、住院情况以及过去12个月内的感染并发症确定。透析液总清除率（Kt/V）高度依赖于残余肾功能（P < 0.0001）。腹膜清除率得出的Kt/V随着年龄增长而降低（P < 0.05）。较高的透析液总Kt/V与较高的标准化蛋白分解代谢率相关（P < 0.002），而标准化蛋白分解代谢率又与TBN改善相关（P < 0.05）。随着标准化蛋白分解代谢率的改善，住院次数减少（P < 0.05），血清白蛋白和总蛋白水平升高时住院次数也减少（分别为P < 0.01和P < 0.002）。感染并发症与透析时间呈正相关（P < 0.01），与TBN测量值呈负相关（P = 0.05）。未发现感染并发症与血清白蛋白水平或腹膜蛋白丢失之间存在相关性。然而，血清白蛋白和总蛋白水平较高时，总住院时间缩短（分别为P < 0.0001和P < 0.002）。虽然Kt/V测定值与PET测定的清除率不相关，但PET测定的肌酐转运率与TBN相关（P < 0.05），与感染并发症不相关。总之，营养参数与持续性非卧床腹膜透析的预后相关。营养状况与透析效果之间存在内在关系，通过尿素动力学模型评估最为合适。
