透析初始月的残肾功能及高转运特性对腹膜透析成功率的影响

Low level of residual renal function in the initial month and high transport characteristic as important cau ses of peritoneal dialysis failure

目的 尽管近年来腹腔感染率有所降低 ,但腹膜透析 (PD)仍有较高的失败率。探讨何种患者行PD有较高的失败率以望指导透析治疗。方法 选择 96例PD病人 ,平均腹透龄 ( 2 3 .1±10 0 )个月。分为两组 :A组为因各种原因 (脑血管意外、营养不良、失超滤、胸腔积液、反复感染等 )终止PD而改血液透析或死亡患者 ( 2 5例 ) ;B组 :PD持续至今者 ( 71例 )。两组的透析量 (DV)、体表面积(BSA)和年龄差异无显著性。对他们透析首月的营养状态、透析充分性、残肾功能及腹膜转运功能进行比较。同时用Kaplan Meier法进行生存率分析。结果 数据显示B组透析充分性明显好于A组 ,透析初始月的残肾功能 (RRF)在两组中有显著差异 ,残肾功能较好 (RRF≥ 2ml/min)的患者其生存率明显高于较差组 (RRF <2ml/min)。A组中高转运特性患者的比例 ( 4 0 0 % )高于B组 ( 2 3 .5 % )。结论 透析开始时达较高的清除率水平似可维持较长时间的透析 ,而这与透析开始时所具有较好的残肾功能不无相关。当患者残肾功能逐步下降 ,日间不卧床腹膜透析无法保证透析充分性 。

Objective To evaluate what kind of patients was at high risk on peritoneal dialysis (PD) treatment. Methods 96 patients on PD for (23.1±10 0) months were studied. The patients were divided into two groups. Group A: patients (25) who died or switched to hemodialysis because of cardiovascular disease, malnutrition, ultrafiltration inefficiency, hydrothora, relapsing peritonitis, etc. Group B: stable PD patients (71) up to now. Age, body surface area (BSA) and dialysate fill volume (DV) were not different between the two groups.The nutritional status, dialysis adequacy, peritoneal membrane transport characteristics, and residual renal function (RRF) in the initial month of dialysis were compared. Patient survial rate was studied by Kaplan Meier method. Results It was demonstrated that Kt/V and Ccr in group A were lower than those in group B ( P <0.05). Meanwhile, RRF was significantly different between the two groups ; patients with better RRF (≥2ml/min) had higher survival. The percentage of high transporters in group A was greater than in group B. Conclusion Higher clearance in the initial month of dialysis seems to keep PD successful. PD failure maybe related to high transport characteristic and its treatment modality is DAPD. Hemodialysis will be a better choice when RRF is very low as water balance is poorly controlled by DAPD.