Churchill D N, Thorpe K E, Nolph K D, Keshaviah P R, Oreopoulos D G, Pagé D
St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada.
J Am Soc Nephrol. 1998 Jul;9(7):1285-92. doi: 10.1681/ASN.V971285.
The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-yr patient survival probabilities were 91, 80, 72, and 71% for L, LA, HA, and H, respectively (P = 0.11). The 2-yr probabilities of both patient and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique failure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.33, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the mean 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and H, respectively (P < 0.001). The mean serum albumin values (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HA, and H, respectively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death. The decreased drain volume, increased albumin loss, and decreased serum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be considered in H and HA transporters.
本研究的目的是评估腹膜转运与技术及患者生存率之间的关联。在加拿大 - 美国关于持续性非卧床腹膜透析（CAPD）充分性的前瞻性队列研究中，在开始透析后约1个月进行腹膜平衡试验（PET）；患者被分为高转运（H）、高平均转运（HA）、低平均转运（LA）和低转运（L）。采用Cox比例风险法评估技术及患者生存率与自变量（人口统计学和临床变量、营养、充分性及转运状态）之间的关联。在606例接受PET评估的患者中，有41例L、192例LA、280例HA和93例H。L、LA、HA和H组的2年技术生存率分别为94%、76%、72%和68%（P = 0.04）。L、LA、HA和H组的2年患者生存率分别为91%、80%、72%和71%（P = 0.11）。L、LA、HA和H组的2年患者和技术生存率分别为86%、61%、52%和48%（P = 0.006）。与L组相比，LA组技术失败或死亡的相对风险为2.54，HA组为3.39，H组为4.00。PET中的平均引流液量（升），L组为2.53，LA组为2.45，HA组为2.33，H组为2.16（P < 0.001）。CAPD治疗1个月后，L、LA、HA和H组的平均24小时引流液量（升）分别为9.38、8.93、8.59和8.22（P < 0.001）；L、LA、HA和H组的平均24小时腹膜白蛋白丢失量（克）分别为3.1、3.9、4.3和5.6（P < 0.001）。L、LA、HA和H组的平均血清白蛋白值（克/升）分别为37.8、36.2、33.8和32.8（P < 0.001）。在CAPD患者中，较高的腹膜转运与技术失败或死亡风险增加相关。引流液量减少、白蛋白丢失增加和血清白蛋白浓度降低提示容量超负荷和营养不良是其机制。对于H和HA转运患者应考虑使用夜间循环腹膜透析。
