Flanigan M J, Bailie G R, Frankenfield D L, Frederick P R, Prowant B F, Rocco M V
Department of Medicine, University of Iowa College of Medicine, Iowa City, USA.
Perit Dial Int. 1998 Sep-Oct;18(5):489-96.
The 1996 Peritoneal Dialysis Core Indicators Study illustrates the conduct of peritoneal dialysis in the United States during 1996. DESIGN AND PATIENT POPULATION: The survey is a medical records audit of 1317 randomly selected adult U.S.A. Medicare patients using peritoneal dialysis during 1996.
Abstracted data included basic demographic characteristics, dialysis prescription, delivered dialysis dose, residual renal function, serum albumin, hematocrit, anemia management, and patient status.
The survey included 785 patients using continuous ambulatory peritoneal dialysis (CAPD) and 423 using automated peritoneal dialysis (APD) primarily in the form of continuous cycling peritoneal dialysis (CCPD). Except for the prescription mechanics and a greater likelihood that African-Americans would use CAPD, the groups did not differ substantially from one another. Evaluation of patient weight (W), body mass index (BMI), residual renal function, average serum albumin, protein equivalent of nitrogen appearance (nPNA), and dialysis efficiency as weekly fractional urea nitrogen removal (wKt/Vurea) and weekly creatinine clearance (wCrCl) revealed a picture of reasonable dialysis delivery and marginal protein nutrition. Additionally, there was little evidence that "dialysis efficiency," over the range assessed, had a major influence on nutritional status. Despite a tendency toward obesity (body weight = 76.6+/-20.0 kg and BMI = 27+/-7), 47% of patients had an average serum albumin below"normal" (3.5 g/dL by bromcresol green) and 70% had a nPNA below 1.0 g/kg/day.
Peritoneal dialysis patients appear to have marginal protein reserves despite surfeit energy stores.
1996年腹膜透析核心指标研究阐述了1996年美国腹膜透析的开展情况。
该调查是对1996年随机选取的1317例美国成年医疗保险腹膜透析患者的病历审核。
提取的数据包括基本人口统计学特征、透析处方、实际透析剂量、残余肾功能、血清白蛋白、血细胞比容、贫血管理及患者状态。
该调查包括785例使用持续性非卧床腹膜透析（CAPD）的患者和423例主要采用持续循环腹膜透析（CCPD）形式的自动化腹膜透析（APD）患者。除了处方机制以及非裔美国人更有可能使用CAPD外，两组之间没有实质性差异。对患者体重（W）、体重指数（BMI）、残余肾功能、平均血清白蛋白、蛋白质氮出现率（nPNA）以及作为每周尿素氮清除分数（wKt/Vurea）和每周肌酐清除率（wCrCl）的透析效率进行评估后发现，透析实施情况合理，但蛋白质营养状况处于临界水平。此外，几乎没有证据表明在所评估范围内的“透析效率”对营养状况有重大影响。尽管有肥胖倾向（体重=76.6±20.0 kg，BMI=27±7），但47%的患者平均血清白蛋白低于“正常”水平（溴甲酚绿法测定为3.5 g/dL），70%的患者nPNA低于1.0 g/kg/天。
腹膜透析患者尽管能量储备过剩，但蛋白质储备似乎处于临界水平。
