基于残余肾功能的腹膜透析剂量评估

doi:10.3969/cndt.j.issn.1006-298X.2018.01.007

肾脏病与透析肾移植杂志 ›› 2018, Vol. 27 ›› Issue (1): 35-40.DOI: 10.3969/cndt.j.issn.1006-298X.2018.01.007

基于残余肾功能的腹膜透析剂量评估

出版日期:2018-02-28 发布日期:2018-03-01

Evaluation significance of peritoneal dialysis volume calculation based on residual renal function

Online:2018-02-28 Published:2018-03-01

摘要/Abstract

摘要：

目的：探讨利用残余肾功能（RRF）计算个体化透析剂量在腹膜透析（PD）治疗中的意义。
方法：557例腹膜透析患者，每3～6个月随访一次，共进行5 476次测定。根据残余肾小球滤过率（rGFR）分为A组[rGFR<2 ml/(min·173m2)]、B组[rGFR 2~4 ml/(min·173m2)]、C组[rGFR 4~6 ml/(min·173m2)]、D组[rGFR >6 ml/(min·173m2)]，观察四组透析参数、部分实验室指标及心脏指标的变化。
结果：四组间透析剂量（PDV）、单位体质量指数透析剂量（PDV/BMI）、单位体表面积透析剂量（PDV/BSA）、尿量（UV）、尿素清除指数（Kt/V）、每周肌酐清除率（WCcr）有显著性差异（P=0000）；标准蛋白分解率（nPCR）、血白蛋白（Alb）、血红蛋白（Hb）四组间亦有显著性差异（P=0000）；随着RRF下降，炎症指标超敏C反应蛋白（hsCRP）、白细胞介素6（IL6）及血清磷有显著增加趋势（P=0000）；A组左心室射血分数（LVEF）明显低于其他三组（P=0000），而左心室质量指数（LVMI）、心胸比（CTR）明显高于其他三组（P=0000）。根据透析充分与否分为透析不充分组[尿素清除指数（Kt/V）<17且每周肌酐清除率（WCcr）<50 L/(周·173m2)]（1 301，238%）和充分组[Kt/V≥ 17或WCcr≥ 50 L/(周·173m2)]（4 175，762%），两组PDV、PDV/BMI、PDV/BSA、rGFR、UV有显著差异（P<0000）。Pearson相关分析发现，透析充分状态下PDV/BMI与rGFR具有直线相关性，即PDV/BMI=3237-1015rGFR （r=-0615，P=0000）；由此得出腹膜透析患者个体化透析剂量的计算公式：PDV(mL/d)=(3237-1015rGFR)×BMI。
结论：依据RRF、BMI来计算透析剂量，不仅可以达到个体化透析的目的，还可以最大程度地发挥RRF在PD中的优势，提高透析质量。

关键词: 腹膜透析, 透析充分性, 残余肾功能, 体质量指数

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To investigate the role of residual renal function (RRF) status in calculating the individualized peritoneal dialysis volume (PDV).
Ｍｅｔｈｏｄｏｌｏｇｙ：Measurement has been made for 5 476 times in 557 patients with peritoneal dialysis who were followed up every 3 to 6 month, and all measurement was divided into four groups according to residual glomerular filtration rate (rGFR): group A<2; group B 2~4; group C 4~6; and group D>6 ml/(min·173m2). The changes of dialysis parameters, biochemical indicators and cardiac parameters of each group were investigated.
Ｒｅｓｕｌｔｓ：PDV,PDV of unit BMI (PDV/BMI), PDV of unit BSA (PDV/BSA),urine volume (UV), Kt/V urea, weekly Ccr (WCcr), nPCR, Alb, Hb, serum phosphorus were significantly different (P=0000) in group A, B, C and D. Left ventricular mass index (LVMI), cardiothoracic ratio (CTR) were significantly higher in group A than that in group B, C, D (P=0.000), and LVEF was significantly lower in group A than that in group B, C, D (P=0000). All measurements was divided into two groups according to peritoneal dialysis adequacy: group adequacy, Kt/V urea≥17 or WCcr≥50 (L/w), and in adequacy, Kt/V urea<17 and WCcr<50 (L/w). With measurement for 5 476 times, the majority of patients have been dialyzed adequately, while only 1 301 times have been dialyzed inadequately, covering 238%. There were significant differences rGFR，as well as PDV, PDV/BMI and PDV/BSA between group inadequacy and adequacy (P=0000). Pearson correlation analysis showed that there was a linear correlation between rGFR and PDV/BMI in the state of adequate dialysis, and being formulated as follows: PDV/BMI=3237-1015rGFR (r=-0615,P=0000). Therefore, the formula for calculating individual PDV of PD patients was got as follows: PDV (mL/d)=(3237-1015rGFR)×BMI.
Ｃｏｎｃｌｕｓｉｏｎ：
Calculating dialysis dose based on RRF and BMI, not only achieve the goal of personalized dialysis, but also exert the advantages of RRF in PD to the maximum and improve the quality of dialysis.

Key words: peritoneal dialysis, dialysis adequacy, residual renal function, body mass index

王萍，周婷婷，钱凯，等. 基于残余肾功能的腹膜透析剂量评估[J]. 肾脏病与透析肾移植杂志, 2018, 27(1): 35-40.

WANG Ping,ZHOU Tingting,QIAN Kai,et al. Evaluation significance of peritoneal dialysis volume calculation based on residual renal function[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2018, 27(1): 35-40.

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ISSN 1006-298X CN 32-1425/R

基于残余肾功能的腹膜透析剂量评估

Evaluation significance of peritoneal dialysis volume calculation based on residual renal function

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