Wu C H, Huang C C, Huang J Y, Wu M S, Leu M L
Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Adv Perit Dial. 1996;12:105-9.
A high dropout rate is a major problem of continuous ambulatory peritoneal dialysis (CAPD) treatment. Serum albumin is both a significant parameter of dropout in CAPD and a predictor of peritoneal transport category based on the peritoneal equilibration test (PET). High flux peritoneal membrane (HFPM) may lose more protein in the dialysate. We examined the effect of HFPM on the survival of treatment of CAPD. The study was composed of 171 adult patients who had standard PET. The peritoneal transport category was based on their first PET after starting CAPD. The HFPM was defined as the dialysate-to-plasma creatinine concentration ratio (D/P) of more than one standard deviation of the mean (0.702 +/- 0.114; D/P > 0.816). Twenty-two patients had HFPM. The other 149 patients were categorized as the non-high flux group. The high flux group had a significantly lower serum albumin at PET (3.07 +/- 0.15 vs 3.68 +/- 0.05 g/dL, respectively p < 0.0001) and lower mean serum albumin during treatment than the non-high flux group (3.40 +/- 0.20 vs 3.70 +/- 0.04 g/dL, respectively, p = 0.020), and lower net drainage volume (p = 0.0007), but age, diabetes, total Kt/V, and total normalized weekly creatinine clearance were not different between groups. The risk of dropout was higher in the high flux group (p = 0.0127, Cox-Mantel log rank test), and the risk increased, especially after 1.5 years of treatment. Corrected for other risk factors, patients who had HFPM have two times the risk of dropout compared to the non-high flux groups (p = 0.0401, Cox proportional hazards model).
高退出率是持续性非卧床腹膜透析（CAPD）治疗的一个主要问题。血清白蛋白既是CAPD治疗退出的一个重要参数，也是基于腹膜平衡试验（PET）的腹膜转运类型的一个预测指标。高通量腹膜（HFPM）可能在透析液中丢失更多蛋白质。我们研究了HFPM对CAPD治疗存活情况的影响。该研究由171例进行标准PET的成年患者组成。腹膜转运类型基于开始CAPD后的首次PET。HFPM定义为透析液与血浆肌酐浓度比（D/P）超过均值一个标准差（0.702±0.114；D/P>0.816）。22例患者为HFPM。其他149例患者被归类为非高通量组。高通量组在PET时的血清白蛋白显著低于非高通量组（分别为3.07±0.15与3.68±0.05 g/dL，p<0.0001），且治疗期间的平均血清白蛋白也低于非高通量组（分别为3.40±0.20与3.70±0.04 g/dL，p=0.020），净引流体积也更低（p=0.0007），但两组之间的年龄、糖尿病、总Kt/V和总标准化每周肌酐清除率无差异。高通量组的退出风险更高（p=0.0127，Cox-Mantel对数秩检验），且风险增加，尤其是在治疗1.5年后。校正其他风险因素后，与非高通量组相比，有HFPM的患者退出风险增加两倍（p=0.0401，Cox比例风险模型）。
