Tzamaloukas A H, Dimitriadis A, Murata G H, Nicolopoulou N, Malhotra D, Balaskas E V, Kakavas J, Antoniou S, Dombros N V, Batzili E, Voudiklari S
Veterans Affairs Medical Center, Albuquerque, New Mexico 87108, USA.
Perit Dial Int. 1996 May-Jun;16(3):302-6.
To study whether or not continuous peritoneal dialysis (CPD) can provide acceptable levels of normalized urea and creatinine clearance in heavyweight individuals.
Retrospective analysis of urea and creatinine clearance studies.
CPD patients followed in four dialysis units in Albuquerque, two dialysis units in Thessaloniki, and two dialysis units in Athens.
One hundred and ninety-nine patients on CPD with 266 clearance determinations between 1991 and 1995.
The heavyweight group consisted of 22 patients (24 clearance studies) weighing 100 kg or more (109 +/- 8.7 kg) at the time of the clearance study. All subjects were obese. The reference group consisted of 177 CPD subjects (242 clearance studies) of normal weight (68.7 +/- 12.2 kg). Urea fractional clearance (KT/V) and normalized creatinine clearance (Ccr) were compared between the heavyweight and the reference groups.
The lowest acceptable weekly levels were set at 1.70 for KT/V and 54.4 L/1.73 m2 for Ccr.
Weekly KT/V was 1.75 +/- 0.41 in the heavyweight group and 1.94 +/- 0.52 in the reference group (p = 0.047). Corresponding weekly Ccr levels were 64.0 +/- 24.3 and 77.6 +/- 40.3 L/1.73 m2, respectively (p = 0.021). In the heavyweight group, 13 studies (54.2%) had acceptable KT/V values compared to 160 studies (66.1%) in the reference group (NS). Corresponding values for acceptable Ccr were 17 (70.8%) and 165 (68.2%), respectively (NS). Drain volume was 12.96 +/- 4.40 L/24 hours in the heavyweight group and 9.63 +/- 2.58 L/24 hours in the reference group (p = 0.001). High daily exchange volume was delivered by a combination of daily continuous ambulatory peritoneal dialysis (CAPD) and nocturnal automated peritoneal dialysis (APD) in 13/16 heavyweight studies. This combination was tolerated better than any other method of delivering a large daily exchange volume.
Although normalized urea and creatinine clearances are lower in obese, heavyweight individuals than in lean CPD subjects with lower weight, approximately equal percentages of these two groups achieve acceptable clearance levels. However, heavyweight individuals require larger-than-usual daily exchange volumes. The preferred way to deliver these large dialysate volumes is a combination of daily CAPD and nocturnal APD.
研究持续性腹膜透析（CPD）能否为重患者提供可接受水平的标准化尿素和肌酐清除率。
对尿素和肌酐清除率研究进行回顾性分析。
阿尔伯克基的四个透析单元、塞萨洛尼基的两个透析单元以及雅典的两个透析单元随访的CPD患者。
199例接受CPD治疗的患者，在1991年至1995年间进行了266次清除率测定。
重患者组由22例患者（24次清除率研究）组成，在清除率研究时体重为100千克或以上（109±8.7千克）。所有受试者均肥胖。参照组由177例体重正常（68.7±12.2千克）的CPD受试者（242次清除率研究）组成。比较重患者组和参照组的尿素清除分数（KT/V）和标准化肌酐清除率（Ccr）。
将KT/V的最低可接受每周水平设定为1.70，Ccr的最低可接受每周水平设定为54.4L/1.73m²。
重患者组的每周KT/V为1.75±0.41，参照组为1.94±0.52（p=0.047）。相应的每周Ccr水平分别为64.0±24.3和77.6±40.3L/1.73m²（p=0.021）。在重患者组中，13项研究（54.2%）的KT/V值可接受，而参照组为160项研究（66.1%）（无显著性差异）。可接受Ccr的相应值分别为17项（70.8%）和165项（68.2%）（无显著性差异）。重患者组的引流液量为12.96±4.40L/24小时，参照组为9.63±2.58L/24小时（p=0.001）。在13/16项重患者研究中，通过每日持续性非卧床腹膜透析（CAPD）和夜间自动化腹膜透析（APD）相结合的方式提供高每日交换量。这种组合比其他任何提供大每日交换量的方法耐受性更好。
尽管肥胖、体重较重的个体的标准化尿素和肌酐清除率低于体重较轻的瘦CPD受试者，但这两组达到可接受清除率水平的百分比大致相等。然而，体重较重的个体需要比平常更大的每日交换量。提供这些大量透析液的首选方法是每日CAPD和夜间APD相结合。
