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紧急起始腹膜透析患者实行递增式腹透的临床疗效观察

Effects of incremental peritoneal dialysis in patients with urgent-start peritoneal dialysis

中文摘要英文摘要

目的:观察紧急起始腹膜透析(Urgent-start Peritoneal Dialysis, USPD)患者实行递增式腹膜透析(Incremental Peritoneal Dialysis)方案的可行性以及临床疗效。 方法:本研究为单中心回顾性研究,纳入2018-8-1至2021-7-31在西安交通大学第一附属医院肾内科住院行紧急起始腹膜透析的终末期肾病患者,所有患者透析前肾小球滤过率介于4~6ml/min/1.73m2。根据起始透析剂量不同,分为递增剂量组(透析剂量≤6000mL/日)和标准剂量组(透析剂量≥8000mL/日),其中递增剂量组依据患者的残余肾功能和透析充分性调整透析方案。每位患者随访时间1年,于透析1个月、3个月、6个月及1年时分别评估两组患者临床生化指标、透析剂量、透析充分性、尿量、腹透超滤量、残余肾功能以及腹膜透析相关并发症等指标。 结果:1.本研究共纳入169位患者,其中递增剂量组111人,平均年龄45.01±12.84岁;标准剂量组58人,平均年龄43.5±15.62岁。透析前两组的人口学特征、临床生化指标(血压、白蛋白、尿素氮、血肌酐、血钾、血磷、甲状旁腺素、血红蛋白)以及残余肾功能均相似,差异无统计学意义(P>0.05)。2.在整个随访期内,虽然递增剂量组的透析剂量始终低于标准剂量组,差异均有统计学意义(P<0.05),但两组的透析充分性均达标。并且在透析治疗1个月和6个月时,递增剂量组的UKt/V明显高于标准剂量组(1月:0.75±0.43 VS. 0.61±0.32,P=0.027;6月:0.68±0.53 VS. 0.50±0.29,P=0.018),差异有统计学意义。3.在随访期内,两组患者血压的控制、贫血及低钙血症纠正的情况相似,差异无统计学意义(P>0.05)。两组高磷血症的纠正情况均达标,但在透析1个月时,递增剂量组的血磷明显高于标准剂量组(1.48±0.43mmol/L VS. 1.34±0.31mmol/L,P=0.039);当透析1年时,递增剂量组的血磷明显低于标准剂量组(1.39±0.36mmol/L VS. 1.53±0.35mmol/L,P=0.030),差异均有统计学意义。4.随访期内,两组的残余肾功能相似,标准剂量组的超滤量高于递增剂量组,但差异均无统计学意义(P>0.05)。而递增剂量组的尿量均明显高于标准剂量组,尤其在透析1个月和透析6个月时差异有统计学意义(P0.05)。 结论:对于USPD患者,递增式腹膜透析的治疗效果以及并发症情况与标准剂量组相似,并且递增式腹膜透析不会导致USPD患者残余肾功能的快速下降。因此,递增性腹膜透析方式可以作为USPD患者的起始透析方式。

Objective: To observe the feasibility and effects of the incremental peritoneal dialysis in patients receiving urgent-start peritoneal dialysis. Methods: This is a single-center retrospective study. ESRD patients who received urgent-start peritoneal dialysis from August 1st2018 through July 31st2021 at the first affiliated hospital of Xi'an Jiaotong University were enrolled to this study. The estimated glomerular filtration rate (eGFR) of all patients was between 4 ~ 6ml/min/1.73m2.According to the difference in the initial dialysis dose, recruited patients were divided into an incremental PD group: initial dialysis dose less than or equal to 6000mlper day, with the dialysis dose being adjusted according to the RRF and dialysis adequacy, and a full-dose PD group: dialysis dose more than or equal to 8000ml per day. Patients were followed-up for 1 year. Clinical biochemical indices, dialysis dose, dialysis adequacy, urine volume, dialysis ultra-filtration volume, residual renal function and peritoneal dialysis-related complications were recorded when peritoneal dialysis was performed at 1,3, and 6-months and 1year. Results: 1. This study examined 169 patients, of which, 111 patients with a mean age of 45.01±12.84 years were in the incremental PD group and 58 patients with a mean age of 43.5±15.62 years were in the full-dose PD group. The demographics, the clinical biochemical indices and residual renal function of both groups before peritoneal dialysis were similar(P0.05). 2. During follow-up, the dialysis dose in the full-dose PD group exceeded that of the incremental PD group (P<0.05). However, the total Kt/V for both groups exceeded 1.7, and the total Ccr was greater than 50L. At 1 and 6 months, the urine Kt/V in the incremental PD group was higher than that found in the full-dose PD group (P0.05).The correction of hyperphosphatemia in both groups reached the standard.4. During the follow-up period, the residual renal function in both group were similar (P>0.05). The dialysis ultra-filtration volume in the full-dose PD group exceeded that of the incremental PD group, but the differences were not statistically significant (P>0.05).The urine volume of the incremental PD group were significantly higher than that of the full-dose PD group, especially at 1 month and 6 months of dialysis(P0.05). Conclusions: The dialysis effect and complications from incremental PD, were similar to full-dose peritoneal dialysis. Incremental PD did not cause a rapid decline of residual renal function in USPD patients. Therefore, USPD patients can be treated by incremental peritoneal dialysis.

吕佳、韩静、李燕、梁彧、张文静

10.12074/202401.00018V1

临床医学内科学

关键词:递增式腹膜透析紧急起始腹膜透析残余肾功能透析剂量尿量

Key words: Incremental Peritoneal DialysisUrgent-start Peritoneal DialysisResidual Renal Functionialysis doseUrine volume

吕佳,韩静,李燕,梁彧,张文静.紧急起始腹膜透析患者实行递增式腹透的临床疗效观察[EB/OL].(2023-12-30)[2025-08-23].https://chinaxiv.org/abs/202401.00018.点此复制

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