Imai H, Satoh K, Ohtani H, Hamai K, Haseyama T, Komatsuda A, Miura A B
Third Department of Internal Medicine, Akita University School of Medicine, Japan.
Kidney Int. 1998 Aug;54(2):546-53. doi: 10.1046/j.1523-1755.1998.00010.x.
Peritoneal damage has been reported since the beginning of CAPD therapy.
To clarify the change of peritoneal function in CAPD patients, we used the Personal Dialysis Capacity (PDC) test in 22 patients with 49 serial studies and 14 patients with single studies. The data were expressed at the condition of 2.5% (2.27 g/dl of glucose), four times at 2,000 ml/day.
In the mass analysis, the urea generation rate, creatinine generation rate, PNA/PCR, and water removal via the peritoneum (PD) were kept at the same level for almost eight years, and then gradually decreased. Urine volume and residual renal creatinine clearance (CCr) became zero at six years. On the other hand, PD CCr increased gradually with the time course of CAPD, and therefore the total CCr remained at the level of 6.0 ml/min even after six years. Weekly urea KT/V decreased gradually from almost 2.800 to 2.000. The protein loss remained approximately 7.0 g/day for the initial five years, then became 6.0 g/day, except in five patients who showed levels above 10.0 g/day on the first test of PDC. Weekly urea KT/V was correlated with residual renal CCr (P < 0.005), and significantly correlated with total CCr (weekly urea KT/V = -0.2798 + 0.3720 x total CCr; r = 0.915, P < 0.001). In the serial analysis, when the first and the last tests were compared, the urea generation rate increased significantly (mean +/- SD, 2.800 +/- 3.204 vs. 3.882 +/- 3.382; P < 0.0001); however, water removal via PD (1364 +/- 887 vs. 813 +/- 609; P = 0.021), total ultrafiltration (1762 +/- 841 vs. 1124 +/- 843; P = 0.042), and weekly urea KT/V (2.285 +/- 0.486 vs. 2.112 +/- 0.512; P = 0.026) decreased significantly. The delta water removal via PD/ duration became negative (-10.03 +/- 6.59 ml/week) in all 7 patients after more than four years, however, it was positive (+14.40 +/- 7.84 ml/week) in 6 of 10 patients after less than one year.
These results suggest that water removal via PD increases within one year, then decreases after four years. The PDC test is useful to evaluate the change of peritoneal function in mass and serial analyses.
自持续性非卧床腹膜透析（CAPD）治疗开始以来，已有腹膜损伤的报道。
为阐明CAPD患者腹膜功能的变化，我们对22例患者进行了49次连续研究，并对14例患者进行了单次研究，采用了个人透析能力（PDC）测试。数据以2.5%（葡萄糖2.27g/dl）、每天2000ml、四次交换的条件表示。
在总体分析中，尿素生成率、肌酐生成率、蛋白氮呈现率/蛋白分解代谢率以及通过腹膜（PD）的水清除量在近八年保持在同一水平，然后逐渐下降。尿量和残余肾肌酐清除率（CCr）在六年时降为零。另一方面，PD CCr随CAPD的病程逐渐增加，因此即使在六年之后，总CCr仍保持在6.0ml/分钟的水平。每周尿素KT/V从近2.800逐渐降至2.000。最初五年蛋白丢失量约为每天7.0g，之后变为6.0g，但在5例患者中，其在PDC首次测试时蛋白丢失量高于10.0g/天。每周尿素KT/V与残余肾CCr相关（P<0.005），且与总CCr显著相关（每周尿素KT/V = -0.2798 + 0.3720×总CCr；r = 0.915，P<0.001）。在连续分析中，当比较首次和末次测试时，尿素生成率显著增加（平均值±标准差，2.800±3.204 vs. 3.882±3.382；P<0.0001）；然而，通过PD的水清除量（1364±887 vs. 813±609；P = 0.021）、总超滤量（1762±841 vs. 1124±843；P = 0.042）以及每周尿素KT/V（2.285±0.486 vs. 2.112±0.512；P = 0.026）显著下降。四年后，所有7例患者通过PD的水清除量变化/时间均变为负值（-10.03±6.59ml/周），然而，在不到一年的时间里，10例患者中有6例为正值（+14.40±7.84ml/周）。
这些结果表明，通过PD的水清除量在一年内增加，四年后减少。PDC测试有助于在总体和连续分析中评估腹膜功能的变化。
