Tzamaloukas A H, Malhotra D, Murata G H
Albuquerque Veterans Affairs Medical Center, Department of Medicine, University of New Mexico School of Medicine, 87108, USA.
ASAIO J. 1998 Nov-Dec;44(6):828-34.
The authors developed formulae calculating the daily drain volume (DV) required for a target normalized peritoneal clearance of urea (Kt/V(ur)) or creatinine (Ccr, Kt/Vcr) in peritoneal dialysis (PD). DV depends on the target clearance, the peritoneal solute transport type, and the size of the person as expressed by body surface area (BSA) or body water (V). To illustrate the formulae, we constructed nomograms for the following weekly target clearances: Ccr = 60 L/1.73 m2, Kt/V(ur) = 2.0, Kt/Vcr = 1.8 (the value corresponding to a Ccr of 60 L/1.73 m2 in a linear regression of the two parameters in 476 clearance studies in continuous ambulatory PD [CAPD] patients). The PD schedules studied included CAPD, continuous cycling PD (CCPD) with one 2 L daytime dwell, and a combination of daytime CAPD and nighttime automated PD (APD) with 2 hr dwell times. Peritoneal transport was characterized as low, low-average, high-average, or high by the dialysate-to-plasma (D/P) creatinine concentration ratio in a peritoneal equilibration test (PET). The D/P value entered for each transport type was the appropriate 95% lower confidence limit of the mean D/P in actual studies (2 hr and 4 hr D/P from 102 PET studies and 5.5 hr D/P from 476 clearance studies in CAPD patients). For high transport, the required DV values were similar in all three PD schedules studied. For low transport, the required DV was much larger, comparatively, for CCPD and CAPD-APD than for CAPD. Furthermore, the DV values required for a weekly Kt/V(ur) of 2.0 were comparatively less than the DV values required for a weekly Kt/Vcr of 1.8 (Ccr of 60 L/1.73 M2). Calculation of the DV required for different PD schedules, a target peritoneal clearance, and the patients's size is feasible when the patient's peritoneal transport characteristics are known. This calculation also allows the selection of the least costly PD schedule. Current target values for urea and creatinine clearance are incompatible in anuric PD patients.
作者们制定了公式，用于计算腹膜透析（PD）中达到目标尿素标准化腹膜清除率（Kt/V(ur)）或肌酐清除率（Ccr，Kt/Vcr）所需的每日引流液量（DV）。DV取决于目标清除率、腹膜溶质转运类型以及用体表面积（BSA）或身体水分（V）表示的个体大小。为说明这些公式，我们针对以下每周目标清除率构建了列线图：Ccr = 60 L/1.73 m²，Kt/V(ur) = 2.0，Kt/Vcr = 1.8（这是在476例持续性非卧床腹膜透析[CAPD]患者的清除率研究中，这两个参数线性回归中与Ccr为60 L/1.73 m²相对应的值）。所研究的PD方案包括CAPD、有一次2L日间驻留的持续性循环腹膜透析（CCPD）以及日间CAPD和夜间自动化腹膜透析（APD）且驻留时间为2小时的组合。通过腹膜平衡试验（PET）中透析液与血浆（D/P）肌酐浓度比，将腹膜转运特征分为低、低-平均、高-平均或高。为每种转运类型输入的D/P值是实际研究中平均D/P的合适的95%置信下限（来自102项PET研究的2小时和4小时D/P以及来自476例CAPD患者清除率研究的5.5小时D/P）。对于高转运，在所研究的所有三种PD方案中，所需的DV值相似。对于低转运，与CAPD相比，CCPD和CAPD - APD所需的DV相对要大得多。此外，每周Kt/V(ur)为2.0所需的DV值相对小于每周Kt/Vcr为1.8（Ccr为60 L/1.73 M²）所需的DV值。当已知患者的腹膜转运特征时，计算不同PD方案、目标腹膜清除率和患者大小所需的DV是可行的。这种计算还允许选择成本最低的PD方案。目前无尿PD患者中尿素和肌酐清除率的目标值不兼容。
