Harty J, Boulton H, Venning M, Gokal R
Department of Nephrology, Manchester Royal Infirmary, United Kingdom.
J Am Soc Nephrol. 1997 Aug;8(8):1304-10. doi: 10.1681/ASN.V881304.
Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in continuous ambulatory peritoneal dialysis patients. The conventional continuous ambulatory peritoneal dialysis regimen, which uses four 2-L exchanges per day, has resulted in up to 40% of such patients failing to achieve proposed targets for weekly Kt/V of 1.7 and weekly creatinine clearance (WCC) of 50 L. In a prospective study, the impact of increasing prescribed volumes by 0.5 L per exchange was evaluated on attaining urea and creatinine clearance targets over a 1-yr period. At 1 yr, 17 patients remaining on the increased dialysis prescription were compared with 18 patients remaining on an unchanged regimen. The mean increase in daily prescribed volume was 1.5 L (22%). This resulted in a significant increase in both peritoneal dialysis Kt/V (1.59 to 1.78 L = 12%) and peritoneal dialysis WCC (45.8 to 50.1 L = 10%) by 1 yr. Because of loss of renal function, there was no significant increase in total clearance at 1 yr, but this loss of renal clearance was offset by the gain in peritoneal clearance. Residual renal function fell at a similar rate in both the increased dialysis and control groups. In the latter, although peritoneal clearance remained stable over the 1-yr period, loss of renal function resulted in reductions in both total Kt/V and WCC. In conclusion, exchange volume can be increased to compensate for loss of renal function over a 1-yr period. Progressive loss of renal clearance resulted in only a modest gain in total solute clearance. It was the larger patients who tolerated the increase in exchange volumes. However, such patients (by virtue of their size) tended not to achieve target values for solute clearance, and the modest gain in peritoneal clearance was insufficient to increase the number of patients in this group achieving such targets for dialysis adequacy.
在持续非卧床腹膜透析患者中，未能达到尿素清除率（Kt/V）和肌酐清除率的目标值与发病率和死亡率增加相关。传统的持续非卧床腹膜透析方案，即每天进行4次2升的换液，导致高达40%的此类患者未能达到每周Kt/V为1.7以及每周肌酐清除率（WCC）为50升的建议目标。在一项前瞻性研究中，评估了每次换液将规定容量增加0.5升对1年内实现尿素和肌酐清除率目标的影响。1年后，将17名继续采用增加透析处方的患者与18名继续采用不变方案的患者进行比较。每日规定容量的平均增加量为1.5升（22%）。这导致到1年时腹膜透析Kt/V（从1.59升至1.78升 = 12%）和腹膜透析WCC（从45.8升至50.1升 = 10%）均显著增加。由于肾功能丧失，1年时总清除率无显著增加，但这种肾脏清除率的损失被腹膜清除率的增加所抵消。增加透析组和对照组的残余肾功能下降速率相似。在对照组中，尽管腹膜清除率在1年期间保持稳定，但肾功能丧失导致总Kt/V和WCC均下降。总之，在1年期间可以增加换液量以补偿肾功能丧失。肾脏清除率的逐渐丧失仅导致总溶质清除率有适度增加。能耐受换液量增加的是体型较大的患者。然而，这类患者（因其体型）往往无法达到溶质清除率的目标值，并且腹膜清除率的适度增加不足以增加该组中达到透析充分性目标的患者数量。
