Jones C H, Newstead C G, Will E J
Department of Renal Medicine, St. James's University Hospital, Leeds, United Kingdom.
Perit Dial Int. 1997 May-Jun;17(3):250-4.
To establish whether estimation of creatinine clearance (CrCl) from serum creatinine, gender, age, and weight might reduce the number of 24-hour urine and dialysate collections required to monitor adequacy of delivered dialysis on continuous ambulatory peritoneal dialysis (CAPD).
Retrospective single-center study.
University Hospital.
Creatinine excretion and CrCl were measured in 187 24-hour urine and dialysate collections from 99 CAPD patients (55 male, 44 female). Multiple regression analysis was used to estimate creatinine excretion from age and weight in males and females. CrCl was derived and also calculated using the Cockcroft-Gault and Mitch-Walser formulas. Positive and negative predictive values for indicating adequacy of dialysis were determined.
Measured and derived CrCl were correlated (males: r = 0.85; females: r = 0.83; p < 0.001), but agreement was poor (95% limits of agreement: males, 26.05 to -25.75 L/wk; females, 37.47 to -19.49 L/wk). Taking the minimum acceptable CrCl as 60 L/week, the respective positive predictive values of the derived, Cockcroft, and Mitch methods in predicting underdialysis were 88%, 100%, and 100% in males and 88%, 88%, and 89% in females. Negative predictive values were 83%, 57%, and 53% in males and 53%, 48%, and 45% in females.
A derived CrCl > 60 was not predictive of adequate dialysis. Because the detection of underdialysis is our objective, formal clearance studies should be performed in this group. A derived CrCl < 60 L/wk was predictive of underdialysis in males and females and an increase in dialysis dose without formal clearance measurements could be suggested in these patients. The use of this approach could allow an important reduction in the number of clearance studies required to monitor CAPD adequacy.
确定根据血清肌酐、性别、年龄和体重估算肌酐清除率（CrCl）是否可减少持续非卧床腹膜透析（CAPD）中监测透析充分性所需的24小时尿液和透析液收集次数。
回顾性单中心研究。
大学医院。
对99例CAPD患者（55例男性，44例女性）的187份24小时尿液和透析液样本进行肌酐排泄量和CrCl测量。采用多元回归分析根据年龄和体重估算男性和女性的肌酐排泄量。计算得出CrCl，并使用Cockcroft-Gault公式和Mitch-Walser公式进行计算。确定提示透析充分性的阳性和阴性预测值。
测量的CrCl与计算得出的CrCl具有相关性（男性：r = 0.85；女性：r = 0.83；p < 0.001），但一致性较差（95%一致性界限：男性为26.05至 -25.75 L/周；女性为37.47至 -19.49 L/周）。将最低可接受的CrCl设定为60 L/周，计算得出的方法、Cockcroft方法和Mitch方法在预测男性透析不充分方面的各自阳性预测值分别为88%、100%和100%，女性分别为88%、88%和89%。男性的阴性预测值分别为83%、57%和53%，女性分别为53%、48%和45%。
计算得出的CrCl > 60并不能预测透析充分。由于我们的目标是检测透析不充分，因此应对该组患者进行正式的清除率研究。计算得出的CrCl < 60 L/周可预测男性和女性透析不充分，对于这些患者，在未进行正式清除率测量的情况下可建议增加透析剂量。采用这种方法可大幅减少监测CAPD充分性所需的清除率研究次数。
