腹膜透析初透剂量对患者残余肾功能的影响

Impact of initial dialysis dose on the residual renal function in peritoneal dialysis patients

目的探讨腹膜透析（腹透）初透剂量对患者残余肾功能的影响。方法追踪观察我院3个月内连续门诊随访的178例开始腹透的患者，测定24h尿量。根据透析第1、3个月尿量的变化分为少尿组（LU，97例）、尿量减少组（DU，19例）、尿量正常组（NU，62例），记录并分析其透析剂量、腹透液葡萄糖含量、超滤量、尿素清除指数（Kt／V）、体质量、水肿程度及尿量变化等的相关性。结果3组患者的年龄和性别比例差异无统计学意义。透析1个月后，DU组的体质量和水肿程度大于LU和NU组（P〈0.05）；腹透液总入量、腹透液葡萄糖含量、超滤量、残余肾尿素清除指数Kt／V（rKt／V）高于LU组，与NU组差异无统计学意义。透析3个月后，DU组的体质量和水肿程度有所下降（P〈0.05），但仍高于LU和NU组（P〈0.05）；腹透液总人量、超滤量、尿量下降速度比LU组和NU组高（P〈0.05）；rKt／V比腹透前显著下降（P〈0.05）。3组的血清白蛋白和tKt／V差异无统计学意义。结论开始腹透患者过度超滤可引起残余肾功能下降。对于有一定残余肾功能的患者要注意避免快速或过多超滤。

Objective To investigate the impact of initial dialysis dose on residual renal function of peritoneal dialysis patients. Methods Clinical data of 178 consecutive patients on initial peritoneal dialysis received follow-up for 3 months in our department were analyzed retrospectively. According to urinary volume after peritoneal dialysis, patients were divided into three groups： lower urine group （LU, n=97）, decreased urine group （DU, n=19）, and normal urine group （NU, n=62）. Their dialysate volume, dialysate glucose content, ultrafihration, weekly renal urea clearance normalized to total body water （Kt/V）, body weight, edema degree and daily urinary volume were recorded and association among these parameters were examined. Results There were no significant differences in age, gender, serum albumin and total Kt/V among three groups. One month after dialysis, body weight and edema degree in DU group were significantly higher than those in LU and NU groups （all P〈0.05）; the dialysate volume, dialysate glucose content, uhrafiltration and renal Kt/V in DU group were significantly higher than those in LU group （all P〈0.05）, but were not significantly different from NU group. Three months after dialysis, in DU group, dialysate volume, ultrafiltration and urinary volume decreased significantly （P〈O.05） as compared with LU and NU groups, but body weight and edema degree were still higher, and Kt/V decreased significantly as well. Conclusions The residual renal function （urinary volume and Kt/V value） of initial patients will be deteriorated by over uhrafihration in early stage of peritoneal dialysis. Excess ultrafiltration should be avoided for the initial peritoneal dialysis patients.