Gao H, Lew S Q, Bosch J P
Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, USA.
Clin Nephrol. 1998 Dec;50(6):375-80.
Peritoneal dialysis adequacy guidelines are generally not met with the standard prescription of continuous ambulatory peritoneal dialysis (CAPD), four 2-liter (1) exchanges daily. The aim of this study is to determine the effects of increasing exchange volume singularly or in combination with frequency on peritoneal dialysis adequacy.
Fourteen stable ESRD patients receiving peritoneal dialysis were evaluated for adequacy and nutritional status between the fourth and sixth months during a six-month baseline period in which the dialysis prescription was four two-liter exchanges daily and during a six-month intervention period in which patients (n = 7) from group 1 were prescribed CAPD four 2.5-liter exchanges daily while patients (n = 7) from group 2 were prescribed continuous cycling peritoneal dialysis (CCPD - 12 l) using four 2.5 liters during the night and a 2-liter wet day.
Mean total weekly urea Kt/V (TWKt/V) increased significantly from 1.6 +/- 0.2 to 2.1 +/- 0.2, p <0.01 in group 1, and from 1.6 +/- 0.4 to 2.1 +/- 0.5, p <0.001 in group 2. Mean normal total weekly creatinine clearance increased significantly from 51 +/- 11 to 60 +/- 8 l/1.73 m2, p <0.05 in group 1, and from 45 +/- 6 to 58 +/- 9 l/1.73 m2, p <0.01 in group 2. Serum albumin of almost all patients in the intervention groups were higher than in the baseline groups. Mean serum albumin increased from 3.6 +/- 0.4 to 4.0 +/- 0.4 g/dl, p <0.01 in group 1, and from 3.8 +/- 0.2 to 4.0 +/- 0.4, p <0.05 in group 2. The magnitude of the decrement in BUN and serum creatinine were greater in group 2 than group 1 (p <0.001 and p <0.05, respectively). When the two intervention groups were compared to each other, no significant differences in the delivered dialysis dose or nutritional status were noted.
In conclusion, it is possible to achieve currently proposed adequacy target by increasing the exchange volume singularly or in combination with frequency in most peritoneal dialysis patients.
持续性非卧床腹膜透析（CAPD）标准处方为每日4次2升（1）交换，通常无法达到腹膜透析充分性指南要求。本研究旨在确定单独增加交换量或联合增加频率对腹膜透析充分性的影响。
14例接受腹膜透析的稳定终末期肾病（ESRD）患者在为期6个月的基线期（透析处方为每日4次2升交换）的第4至6个月以及干预期接受了充分性和营养状况评估。干预期，第1组7例患者处方为每日4次2.5升的CAPD，第2组7例患者处方为夜间4次2.5升的持续循环腹膜透析（CCPD - 12升）及1次2升日间湿腹透析。
第1组平均每周总尿素Kt/V（TWKt/V）从1.6±0.2显著增至2.1±0.2，p<0.01；第2组从1.6±0.4显著增至2.1±0.5，p<0.001。第1组平均正常每周肌酐清除率从51±11显著增至60±8 l/1.73 m2，p<0.05；第2组从45±6显著增至58±9 l/1.73 m2，p<0.01。干预组几乎所有患者的血清白蛋白均高于基线组。第1组平均血清白蛋白从3.6±0.4增至4.0±0.4 g/dl，p<0.01；第2组从3.8±0.2增至4.0±0.4，p<0.05。第2组血尿素氮（BUN）和血清肌酐的下降幅度大于第1组（分别为p<0.001和p<0.05）。两组干预组相互比较时，透析剂量或营养状况无显著差异。
总之，多数腹膜透析患者单独增加交换量或联合增加频率有可能达到目前建议的充分性目标。
