水盐限制对腹膜透析患者血压的影响

目的研究水盐限制对腹膜透析患者血压的影响。方法选择我院肾内科门诊随访超过3个月的高血压腹膜透析患者42例，并对其进行限制水盐摄入治疗3个月，比较治疗前后体重、水肿状况、血压、血钠、白蛋白、血红蛋白水平、24小时尿钠定量、肾小球滤过率及降压药用量。结果水盐限制后，无浮肿的患者增加（P〈0．05），轻中度浮肿患者减少（P〈0．01），重度浮肿患者减少为0（P〈0．01）。患者体重明显减轻（P〈0．05），24小时尿钠排出量降低（P〈0．05），血压显著下降（P〈0．01）。透析液灌入量前后比较无显著性差异，总出量及超滤量减少，尿量增加（P〈0．05），高渗透析液用量减少（P〈0．05），白蛋白及血红蛋白明显升高（P〈0．05），肾小球滤过率前后比较有显著性差异。降压药用量明显减少（P〈0．05）。结论对高血压腹膜透析患者进行严格水盐限制可明显减轻水肿、降低血压，减少高渗透析液及降压药用量。饮食指导增加了患者的依从性，患者营养状况改善。治疗后未观察到残。肾功能减退的现象。

The effect of dietary salt and fluid restriction on blood Pressure control in maintain peritoneal dialysis patients

Objective To explore the effect of dietary salt and fluid restriction on blood pressure control in chronic peritoneal dialysis（PD） patients. Method 42 PD patients with hypertension, who had been treated for more than 3 months enrolled in this study. Strict dietary salt restriction was carried out in these patients for 3 months. The weight, edema, blood pressure, serum sodium concentration, excretion of sodium in urine,eGFR, dose of antihypertensive agent and other biochemical marker were collected and the initiate data were compared with that of after the intervention. Results After the intervention, the status of edema,blood pressure have been improved significantly（P 〈 0.01 ）. Although the dialysis dose was not changed,the total fluid removal and 24h sodium excretion was significantly decreased（P 〈 0.05 ） due to strict dietary salt and fluid restriction. Moreover, the usage of high concentrative glucose dialysate and antihypertensive agent were decreased （P 〈 0.05 ）. eGFR has not been changed after intervention. Conclusion Strict dietary salt and fluids restriction were beneficial to control of volume overload and hypertension and decreased the usage of high concentrative glucose dialysate and antihypertensive agent in peritoneal dialysis patients with hypertension. Compliance and nutrition status have been improved after dietary education. The decline of residual renal function has not been found after the intervention.