Velasquez M T, Lew S Q, von Albertini B, Mishkin G J, Bosch J P
Department of Medicine, George Washington University Medical Center Washington, DC 20037, USA.
Clin Nephrol. 1997 Dec;48(6):341-5.
This study compared the status and adequacy of blood pressure (BP) control in 21 ESRD patients treated with HD and CAPD at different time periods. Patients were considered to be hypertensive it they were receiving antihypertensive medications during the study period. During HD, 9 of the 21 patients (43%) required antihypertensive drugs to control their hypertension; whereas, during CAPD, the number of patients taking antihypertensive drugs increased to 15 (71%) (p < 0.05). Adequate control of hypertension (systolic BP < 150 mmHg and/or diastolic BP < 90 mmHg) was achieved in 17 patients (81%) during HD compared to 11 patients (52%) during CAPD (p < 0.05). Average ultrafiltration rate was 1.28 +/- 0.1 l/day during HD and 1.30 +/- 0.2 l/day during CAPD (p = NS). Mean Kt/V during HD was 1.24 +/- 0.1; whereas, mean weekly Kt/V during CAPD was 1.81 +/- 0.2. There were no significant differences in hematocrit or usage of recombinant human erythropoietin (rHuEPo) between the two treatment modalities. However, the weekly dose of rHuEpo was higher during HD than during CAPD (p < 0.05). Mean body weight was significantly higher (p < 0.01) and serum albumin was lower (p < 0.05) during CAPD than during HD in the same group of patients. We conclude that hypertension appears to be controlled better by HD than by CAPD in ESRD patients. The gain in body weight observed with CAPD treatment may reflect an increase in total body fluid volume which may partly explain why hypertension is less adequately controlled during CAPD than during HD treatment.
本研究比较了21例接受血液透析（HD）和持续性非卧床腹膜透析（CAPD）治疗的不同时间段的终末期肾病（ESRD）患者的血压（BP）控制状况及达标情况。在研究期间，若患者正在接受抗高血压药物治疗，则被视为高血压患者。在血液透析期间，21例患者中有9例（43%）需要抗高血压药物来控制高血压；而在持续性非卧床腹膜透析期间，服用抗高血压药物的患者人数增加至15例（71%）（p<0.05）。血液透析期间，17例患者（81%）实现了高血压的充分控制（收缩压<150 mmHg和/或舒张压<90 mmHg），而持续性非卧床腹膜透析期间为11例患者（52%）（p<0.05）。血液透析期间的平均超滤率为1.28±0.1升/天，持续性非卧床腹膜透析期间为1.30±0.2升/天（p=无显著性差异）。血液透析期间的平均Kt/V为1.24±0.1；而持续性非卧床腹膜透析期间的平均每周Kt/V为1.81±0.2。两种治疗方式在血细胞比容或重组人促红细胞生成素（rHuEPo）的使用方面无显著差异。然而，血液透析期间rHuEpo的每周剂量高于持续性非卧床腹膜透析期间（p<0.05）。在同一组患者中，持续性非卧床腹膜透析期间的平均体重显著更高（p<0.01），血清白蛋白更低（p<0.05）。我们得出结论，在ESRD患者中，血液透析对高血压的控制似乎优于持续性非卧床腹膜透析。持续性非卧床腹膜透析治疗中观察到的体重增加可能反映了总体液量的增加，这可能部分解释了为什么持续性非卧床腹膜透析期间高血压的控制不如血液透析期间充分。
