Burkart J M, Schreiber M, Korbet S M, Churchill D N, Hamburger R J, Moran J, Soderbloom R, Nolph K D
Bowman Gray School of Medicine/Wake Forest University, Winston-Salem, North Carolina 27157-1053, USA.
Perit Dial Int. 1996 Sep-Oct;16(5):457-70.
To investigate the effect of dialysis prescription on patient outcome for peritoneal dialysis patients, the relationship between total solute clearance and the relative risk of death has been investigated. Preliminary studies have suggested that more clearance is better and that patient outcome is predicted by total solute clearance. The recently published Canada-U.S.A. (CANUSA) multicenter study, evaluating adequacy of dialysis and nutrition in peritoneal dialysis patients, has further defined this relationship. Although these publications allow us to establish guidelines for the treatment of peritoneal dialysis patients, they also define the limitation of our knowledge and raise new questions. In this article we review our current knowledge regarding the predicted value of total solute clearance with patient outcome and nutritional status. Furthermore, we attempt to outline a practical approach for optimizing total solute clearance in peritoneal dialysis patients. Based on a review of the published literature and clinical recommendations, we feel that the minimal target total solute clearance for continuous forms of peritoneal dialysis is a weekly total KT/V > 2.0 and/or a weekly total creatinine clearance > 60 L/week/1.73 m2. For intermittent therapies, a weekly total KT/V > 2.2 and/or a weekly total creatinine clearance > 70 L/week/1.73 m2 is recommended.
为研究透析处方对腹膜透析患者预后的影响，已对总溶质清除率与死亡相对风险之间的关系展开调查。初步研究表明，清除率越高越好，且患者预后可通过总溶质清除率来预测。最近发表的加拿大 - 美国（CANUSA）多中心研究评估了腹膜透析患者的透析充分性和营养状况，进一步明确了这种关系。尽管这些出版物使我们能够制定腹膜透析患者的治疗指南，但它们也明确了我们知识的局限性并提出了新问题。在本文中，我们回顾了当前关于总溶质清除率对患者预后和营养状况预测价值的知识。此外，我们试图概述一种优化腹膜透析患者总溶质清除率的实用方法。基于对已发表文献和临床建议的回顾，我们认为持续性腹膜透析的最小目标总溶质清除率为每周总 KT/V > 2.0 和/或每周总肌酐清除率 > 60 L/周/1.73 m²。对于间歇性治疗，建议每周总 KT/V > 2.2 和/或每周总肌酐清除率 > 70 L/周/1.73 m²。
