Edefonti A, Picca M, Consalvo G, Ghio L, Damiani B, Dal Col A, Galato R
Department of Pediatrics II, University of Milan, Italy.
Perit Dial Int. 1996 May-Jun;16(3):295-301.
To propose a simplified equilibration test specific for tidal peritoneal dialysis (TPD) that will overcome the inconveniences of the measurement of TPD peritoneal solute clearances through whole dialysate collection. This will enable the prediction of peritoneal creatinine and urea clearances, the suitability of patients for TPD, and routine assessment of TPD delivery.
In a prospective study, patients had a standardized TPD run, and dialysate-to-plasma (D/P) ratios for creatinine and urea were calculated at various TPD and peritoneal equilibration test (PET) time points and on total TPD dialysate. Solute clearances were estimated and measured, and correlation coefficients were obtained among all these variables.
Dialysis unit of a pediatric nephrology department and patients' homes.
Eleven pediatric patients with end-stage renal disease in stable clinical conditions treated with TPD.
Dialysate and blood sample collections.
D/P ratios for creatinine and urea at the fifth and seventh TPD exchanges, at 15-, 30-, 60-, and 120-minute PET times, and on total TPD dialysate and TPD peritoneal creatinine and urea clearances.
Correlation coefficients between PET-derived and total TPD dialysate-derived D/P ratios, and those between PET-derived and measured creatinine and urea clearances were more significant at the 120-minute PET time point compared with the other PET time points. Best correlations were obtained at the fifth and seventh TPD exchanges. D/P ratios for creatinine and urea of the fifth and seventh TPD exchanges correlated significantly with the D/P ratios calculated from total TPD dialysate. A significant correlation was also found between peritoneal creatinine and urea clearances on total dialysate volume (measured clearances) and those derived from the dialysate collection of the fifth and seventh TPD exchanges (estimated clearances)--that based on the seventh exchange being slightly more significant. Moreover, the estimated clearances derived from the seventh exchange were within 10% of the measured value in 90.9% of patients both for creatinine and urea.
The significant correlation between measured and estimated peritoneal creatinine and urea clearances and the low percentage of underestimates of measured clearances obtained using the seventh TPD exchange-derived indices confirm the accuracy of the D/P ratios for creatinine and urea derived from any exchange after the fifth (preferably the seventh) of a standardized TPD run in estimating peritoneal creatinine and urea clearances. This method could represent a simple and accurate means for prescribing TPD and routinely assessing TPD delivery.
提出一种专门针对潮式腹膜透析（TPD）的简化平衡试验，以克服通过收集全部透析液来测量TPD腹膜溶质清除率的不便之处。这将能够预测腹膜肌酐和尿素清除率、患者对TPD的适用性以及对TPD输送情况进行常规评估。
在一项前瞻性研究中，患者进行标准化的TPD治疗过程，在不同的TPD和腹膜平衡试验（PET）时间点以及全部TPD透析液中计算肌酐和尿素的透析液与血浆（D/P）比值。估算并测量溶质清除率，得出所有这些变量之间的相关系数。
儿科肾脏病科透析单元及患者家中。
11例接受TPD治疗且临床病情稳定的终末期肾病儿科患者。
收集透析液和血样。
第5次和第7次TPD交换时、PET时间为15分钟、30分钟、60分钟和120分钟时、全部TPD透析液中的肌酐和尿素D/P比值，以及TPD腹膜肌酐和尿素清除率。
与其他PET时间点相比，在PET时间为120分钟时，PET得出的与全部TPD透析液得出的D/P比值之间的相关系数，以及PET得出的与测量的肌酐和尿素清除率之间的相关系数更为显著。在第5次和第7次TPD交换时获得了最佳相关性。第5次和第7次TPD交换时的肌酐和尿素D/P比值与根据全部TPD透析液计算得出的D/P比值显著相关。还发现全部透析液体积的腹膜肌酐和尿素清除率（测量清除率）与第5次和第7次TPD交换的透析液收集得出的清除率（估算清除率）之间存在显著相关性——基于第7次交换的相关性略强。此外，对于肌酐和尿素，在90.9%的患者中，第7次交换得出的估算清除率在测量值的10%以内。
测量的和估算的腹膜肌酐和尿素清除率之间的显著相关性，以及使用第7次TPD交换得出的指标对测量清除率的低估比例较低，证实了标准化TPD治疗过程中第5次（最好是第7次）交换后得出的肌酐和尿素D/P比值在估算腹膜肌酐和尿素清除率方面的准确性。该方法可代表一种简单而准确的方式来制定TPD方案并对TPD输送情况进行常规评估。
