Ultrafiltration and dialysis adequacy with various daily schedules of dialysis fluids

Dialysis regimens for continuous ambulatory peritoneal dialysis (CAPD) patients vary with the need for fluid removal, but also because of concerns about the local and systemic consequences of high glucose exposure. The implications of various regimens for dialysis adequacy-that is, fluid and small-solute removal-are not always clear. We therefore analyzed ultrafiltration (UF) and adequacy indices for 4 different combinations of dialysis fluid. Collections of 24-hour dialysate and urine were carried out in 99 patients on CAPD. On 4 separate occasions, each patient performed 4 exchanges in 24 hours, including 3 daily exchanges with 1.36% glucose and 1 night exchange with either 1.36% glucose (G1 schedule), 2.27% glucose (G2 schedule), 3.86% glucose (G3 schedule), or icodextrin (Ico schedule). Weekly, total, and dialysis Kt/V and KT were calculated for both urea and creatinine. The mean values of urea Kt/V and KT were significantly lower for the G1 schedule than for the G3 and Ico schedules. The adequacy indices for overnight application of 3.86% glucose and icodextrin were similar. Using dialysis fluids with 1.36% and 2.27% glucose overnight reduces glucose exposure, but those schedules may provide inadequate UF and small-solute removal in some patients (UF < 1 L daily, Kt/V < 1.7).     

Culture-negative peritonitis associated with the use of icodextrin-containing dialysate in twelve patients treated with peritoneal dialysis.

BACKGROUND: In the first half of the year 2001, an unusually large number of culture-negative peritonitis episodes occurred in Center A. One patient noticed that his culture-negative antibiotic-resistant peritonitis promptly cleared after inadvertently stopping the use of icodextrin-containing dialysate, but recurred immediately after using icodextrin again. This observation led to the recognition of eight contemporaneous cases of icodextrin-induced culture-negative peritonitis in Center A, and identification of three additional cases in Center B. DESIGN: Case studies in 12 patients. SETTING: Peritoneal dialysis unit of a university hospital and an affiliated unit (Center A), and a second university hospital (Center B). PATIENTS: 12 patients on peritoneal dialysis presenting with culture-negative peritonitis. RESULTS: At presentation, abdominal pain was absent or mild and dialysate leukocyte counts were moderately elevated (approximately 100-1,500 cells/mm3). Differentiation of the dialysate leukocytes showed a low fraction of neutrophils (approximately 35%). In eight cases, the evidence that the peritonitis was caused by icodextrin was very strong (the clinical picture and laboratory results mentioned above, unresponsiveness to antibiotic therapy, cure after withdrawal of icodextrin, relapse after rechallenge); in 3 patients, the evidence was strong (as in the cases mentioned above, but no rechallenge was performed). Stopping icodextrin promptly relieved the symptoms and normalized the dialysate leukocyte counts. After rechallenge, a relapse invariably occurred, usually within a few days. In one case, the evidence was circumstantial. CONCLUSION: Our findings are compatible with icodextrin-induced peritonitis. This entity is characterized by mild abdominal pain at presentation, a moderate dialysate leukocytosis with a low fraction of neutrophils in the differential count, and resistance to antibiotic treatment. Speculations about the pathogenesis of this type of peritonitis include chemical peritonitis due to a contaminating substance or hypersensitivity to icodextrin.     

The relationship between Kt/V(urea) and nPNA in anuric peritoneal dialysis patients: a comparison with predialysis patients.

OBJECTIVE: It is unknown whether a given level of urea clearance by the native kidneys provides better or similar control of uremia than the same level of urea clearance by continuous peritoneal dialysis (PD). More insight into possible differences between renal and peritoneal urea clearances is warranted. Therefore, we investigated the relationship between Kt/V(urea) and protein equivalent of total nitrogen appearance normalized to body weight (nPNA), the relationship between urea clearance and creatinine appearance, and other nutritional parameters in PD patients without residual renal function, and in predialysis end-stage renal disease patients. PATIENTS: All patients participated in the Netherlands Cooperative Study on the Adequacy of Dialysis. This is a prospective cohort study of incident dialysis patients, in whom regular assessments of renal function are done. A group of 75 PD patients was identified at the first follow-up assessment in which their urine production was less than 100 mL/day. These patients were considered the anuric group. This group was compared with a control group of 97 predialysis patients studied 0-4 weeks before the start of dialysis treatment. RESULTS: Linear relationships were present between Kt/V(urea) and nPNA, in both the predialysis patients and the anuric PD patients. A significant difference was present between the slopes of the two regression lines (0.40 vs 0.18, p = 0.007). When Kt/V(urea) exceeded 1.3/week, a given level of Kt/V(urea) was associated with a higher nPNA in predialysis than in anuric PD patients. Similar relationships were found between Kt(urea) and PNA. Kt(urea) was also significantly related to urine or dialysate creatinine appearance. A significant difference existed between the slopes of the regression lines in the two groups of patients (p < 0.001). A weekly Kt(urea) of 70 L was associated with a urine creatinine appearance of 11.0 mmol/day and a dialysate creatinine appearance of 8.4 mmol/day. Nutritional status measured with creatinine appearance and Subjective Global Assessment was better in the predialysis population, despite much lower values for Kt/V(urea) in these patients. CONCLUSIONS: The relationship between Kt/V(urea) and nPNA in anuric PD patients is different from that in a predialysis population. It follows from our results that, when Kt/V(urea) is above 1.3/week, a given level of Kt/V(urea) is associated with a higher nPNA in predialysis than in anuric PD patients.This challenges the concept of equivalency between renal and peritoneal Kt/V(urea) with respect to control of uremic morbidity.     

Correlation of intraperitoneal antibiotic pharmacokinetics and peritoneal membrane transport characteristics.

OBJECTIVE: To identify correlations between the pharmacokinetic variables that describe drug disposition in peritoneal dialysis (PD) patients and the measures used to assess dialysis adequacy. DESIGN AND METHODS: This retrospective study re-evaluated data collected during previous pharmacokinetic studies for intraperitoneally administered cefazolin, ceftazidime, and gentamicin in continuous ambulatory peritoneal dialysis (CAPD) patients, and intravenous cefazolin and tobramycin in automated PD patients. Pharmacokinetic variables were compared to creatinine clearance (CCr), Kt/V, and peritoneal equilibration test data using the Pearson product correlation coefficient (r). RESULTS: Prominent correlations were found between renal CCr and renal Kt/V, with renal clearances of CAPD cefazolin and ceftazidime, and automated PD tobramycin and cefazolin (r values ranged from 0.698 to 0.986; p < 0.05). CONCLUSION: These findings support current peritonitis treatment recommendations that patients with residual renal function may require higher doses or more frequent drug administration.     

Enhanced ultrafiltration using 7.5% icodextrin/1.36% glucose combination dialysate: a pilot study.

OBJECTIVE: A pilot study to compare the use of a combination dialysate (7.5% icodextrin/1.36% glucose) versus icodextrin 7.5% alone for the long dwell in patients on peritoneal dialysis (PD). DESIGN: A 4-week, prospective, randomized crossover study. SETTING: A large regional renal unit providing treatment for a population of 1.7 million. PATIENTS: Five patients on continuous ambulatory PD (CAPD) and 3 patients on automated PD. MAIN OUTCOME MEASUREMENTS: Long-dwell and 24-hour ultrafiltration volumes, body weight, 24-hour ambulatory blood pressure, and antihypertensive/diuretic tablet count. RESULTS: The use of the combination dialysate resulted in an increase in the median (interquartile range) long-dwell ultrafiltration, from 750 (650-828) mL to 1000 (889-1100) mL (p < 0.001), and 24-hour ultrafiltration, from 739 (400-1623) mL to 956 (700-1750) mL (p < 0.001). Weight, blood pressure, and tablet count remained unchanged. CONCLUSIONS: The use of the novel combination dialysate resulted in a 33% increase in long-dwell ultrafiltration and a 29% increase in 24-hour ultrafiltration.     

Frequency and causes of discrepancy between Kt/V and creatinine clearance.

This study examines the frequency of discrepancy between Kt/V urea and creatinine clearance (Ccr) measurements in patients on peritoneal dialysis (PD) and the reasons for this discrepancy. DESIGN: Nonrandomized, retrospective data analysis. SETTING: Single PD unit of a university teaching hospital. PATIENTS: All adult patients receiving PD at our center from January 1995 to December 1996. METHODS: Actual (a) and desired (d) body weight (BW) were used to calculate urea volume of distribution (V) and body surface area (BSA). Patients were divided into four groups based upon their total small solute clearances (Kt/V and Ccr, normalized by actual weight) and three additional groups based upon actual/desired (a/d) body weight ratio. An additional analysis was performed for the subset of anuric patients. Data collected for all patients included the following: total Kt, total Ccr, 4-hour dialysate/ plasma (D/P) creatinine, serum albumin concentration, duration of PD, actual body weight, age, and height. RESULTS: Twenty-three percent of the clearance measurements in our study were discrepant, defined as having values for either Kt/V or Ccr (but not both) above the accepted targets of Kt/V > or = 2.0/wk and Ccr > or = 60 L/wk/ 1.73 m2. Patients with both values above target are more likely to have higher residual renal function. Patients who are significantly less than BWd and patients on PD for a longer time are more likely to have adequate Kt/V but not Ccr. Furthermore, patients who are less than 90% or greater than 110% of BWd have markedly different values for Kt/V and Ccr when BWa versus BWd values are used. CONCLUSIONS: Kt/V and Ccr values are frequently discrepant; a number of factors affect these two measurements to varying degrees, including weight, degree of residual renal function, and duration of PD.     

Determination of high and low molecular weight molecules of icodextrin in plasma and dialysate, using gel filtration chromatography, in peritoneal dialysis patients.

OBJECTIVE: The aim of this study was to apply high performance liquid chromatography (HPLC) with modern gel filtration media to determine high molecular weight (HMW) icodextrin fractions and low molecular weight (LMW) icodextrin metabolites in dialysate and plasma in peritoneal dialysis (PD) patients on treatment with icodextrin, and to explore the potential relationships between these compounds, alpha-amylase activity, and glomerular filtration rate. DESIGN: Retrospective study of dialysate and plasma samples from PD patients. SETTING: Samples were collected at one PD center. PATIENTS: Blood and dialysate samples were obtained from PD patients who were subdivided into three groups: patients using only glucose-based peritoneal dialysis fluid (GPDF; GLU group, n = 23), patients studied after the first long dwell with icodextrin-based peritoneal dialysis fluid (IPDF; 1st ICO group, n = 24), and patients who were regular users of IPDF for the long dwells (ICO group, n = 9). METHODS: LMW icodextrin metabolites [i.e., maltose (G2), maltotriose (G3), maltotetraose (G4), maltopentaose (G5), maltohexaose (G6), and maltoheptaose (G7)] and HMW fractions were determined in plasma and dialysate using two different gel filtration HPLC methods. Enzymatic hydrolysis with amyloglucosidase to glucose yielded the total carbohydrate content and this was used to validate the HPLC results. alpha-Amylase activity was determined using a routine method. RESULTS: The results obtained by gel filtration HPLC yielded values of LMW metabolites and HMW fractions in plasma and dialysate in agreement with results obtained with enzymatic hydrolysis. HMW fractions were not detectable in plasma. Absorption of icodextrin from the peritoneal cavity during the long dwell (10 - 16 hours) was, on average, 39% of the amount instilled. During the long dwell, there was a relative decrease in the dialysate concentration of the largest HMW fractions (>21.4 kDa). Plasma concentration of the LMW icodextrin metabolites G2-G7 was highest in the ICO group (2.65+/-0.54 mg/mL) but also higher in the 1st ICO group (1.97+/-0.57 mg/mL) compared with the GLU group (0.52+/-0.23 mg/mL). Plasma alpha-amylase activity was significantly lower in the 1st ICO group and in the ICO group compared with the GLU group. CONCLUSIONS: Accurate analysis of HMW icodextrin fractions in dialysate and LMW icodextrin metabolites in plasma and dialysate in PD patients can be achieved by gel filtration HPLC with two different columns. This method can be used to study the complex pattern of changes in icodextrin and its metabolites in plasma and dialysate. The finding that HMW icodextrin fractions were not detected in plasma was unexpected, and differs from results of previous studies by other researchers.     

The effect of depressive symptoms on survival in peritoneal dialysis patients.

OBJECTIVE: There is little information on the relationship between depressive symptoms and survival in peritoneal dialysis (PD) patients. We examined whether a single measurement of depressive symptoms using a simple self-administered tool predicts survival. DESIGN: Screening test of depressive symptoms as a predictor of outcome. SETTING: Three dialysis centers in Southwestern Pennsylvania. PARTICIPANTS: 66 adult PD subjects were screened in 1997-1998 for depression using the Zung scale. MAIN OUTCOME MEASURES: Baseline data collection included assessments of comorbidity, residual renal function, total Kt/V, nPNA, previous renal transplant, and serum albumin. Outcomes were collected prospectively after completion of the depression survey to 12/01. Cox regression analysis of patient survival was performed using all cofactors with p < 0.05 on univariate analysis. RESULTS: One third of patients had depressive symptoms. Compared to nondepressed patients, depressive symptom patients were older (62.5 vs 52.5 years, p = 0.012), had borderline lower serum albumin levels (3.47 vs 3.70 g/dL, p = 0.058), and were more disabled (Karnofsky score 70 vs 90, p< 0.001), but had similar Kt/V, residual renal function, and previous time on PD at the point of the testing. Using multivariate analysis and controlling for comorbidity (using a measurement that includes diabetes mellitus and age) and serum albumin, the survival of patients with depressive symptoms was significantly reduced compared to nondepressed patients. CONCLUSION: A single measurement of depressive symptoms using a simple self-administered test was an independent predictor of death in a cohort of PD patients, which extends observations in hemodialysis patients. Screening for depressive symptoms should be routine for dialysis patients, and those depressed should have thorough assessment and treatment. Whether treating depression will have an impact on survival is unclear and needs to be studied.     

Preliminary evaluation of incremental peritoneal dialysis in 25 patients.

BACKGROUND: Incremental dialysis has been suggested for patients with some residual renal function. However, very little published clinical data exist on the feasibility of this schedule. OBJECTIVES: To assess feasibility of incremental dialysis, with regard to its effect, complications, and impact on quality of life. DESIGN: Pilot prospective study, not controlled. SETTING: Nephrology division, public clinical research hospital. PATIENTS: Twenty-five patients (19 men, mean age 61+/-13 years, body weight 63+/-11 kg) began peritoneal dialysis (the first treatment of uremia) with a single nightly exchange lasting 10 hours or 2 daily exchanges over 12 hours according to creatinine clearance and Kt/N. Patients gave informed consent and reported their work activity, degree of rehabilitation, and their quality of life by answering a questionnaire prepared for this purpose. OUTCOME MEASURES: Survival rate, complications related to peritoneal dialysis, and residual renal and peritoneal clearances. RESULTS: During the study period no patient died. Complications related to dialysis were peritonitis (0.41 episodes/year) and exit-site infection (0.32 episodes/year). All patients continued to work with full rehabilitation and considered 1 or 2 exchanges per day less troublesome than 3 or 4. CONCLUSIONS: Incremental dialysis is well accepted by patients and staff. This technique does not involve a high risk of complications and is economical. Therefore incremental dialysis is feasible.     

氯沙坦对CAPD患者胰岛素抵抗和血脂联素水平的影响

目的探讨氯沙坦对持续不卧床腹膜透析（CAPD）患者胰岛素抵抗和透析充分性的影响以及血脂联素与胰岛素抵抗和透析充分性的相关性。方法选择上海交通大学医学院附属第三人民医院肾脏内科腹膜透析患者25例随机分为腹膜透析组（N=12）、腹膜透析-氯沙坦组（N=13）。13例非透析慢性肾脏疾病患者作为对照组。治疗组给予氯沙坦100mg/d,观察时间6月。分别在0、3、6月测定胰岛素抵抗指数（HOMA-IR）、血脂、残余肾功能和透析充分性。结果腹膜透析-氯沙坦治疗组较对照组和腹膜透析组HOMA-IR水平下降,三酰甘油、血清胆固醇、低密度脂蛋白下降;总Ccr、腹膜Ccr、总Kt/V、腹膜Kt/V提高。CAPD患者脂联素水平与HOMA-IR、三酰甘油、低密度脂蛋白呈正相关;而与腹膜Ccr和腹膜Kt/V呈负相关。结论氯沙坦具有改善CAPD患者胰岛素抵抗和提高透析充分性的作用,能降低CAPD患者增高的血脂联素水平。     

维持血透患者血红蛋白水平对尿素清除指数的影响

目的探讨维持性血液透析患者血红蛋白(Hb)水平与单次血透尿素清除指数(Kt/V)的关系,为增加透析充分性提供帮助。方法选取进行维持性血液透析的终末期肾病患者57例,透前抽血检验,计算该次血透的Kt/V,然后按照血红蛋白水平分成Hb达标组(Hb≥110g.L-1)与Hb不达标组(Hb<110g.L-1)2组,统计分析Hb与Kt/V的关系。结果 Hb达标组的Kt/V为(1.18±0.09),Hb不达标组的Kt/V为(1.31±0.11),2组相比,差异有统计学意义(P<0.05)。结论 Hb水平是影响维持性血液透析患者尿素Kt/V的重要因素。     

狼疮性肾炎在终末期肾衰竭时肾脏替代治疗的特点

目的 探讨狼疮性肾炎（lupus nephritis，LN）患者在尿毒症阶段行肾脏替代治疗的特点。方法 收集上海交通大学医学院附属仁济医院肾脏科近年LN患者尿毒症阶段的临床资料，包括完整的病史、病情演变、临床症状、实验室检查等随访资料，总结分析LN患者行肾脏替代治疗（renal replacement therapy，RRT）的特点。结果 入选规律性肾脏替代治疗的LN患者共23例，8例男性（35％），15例女性（65％）。其中10例（43．5％）首选血液透析（HD），13例（56．5％）首选腹膜透析（PD）。随访时间为6～211个月。随访中有4例患者死亡，2例（50％）死于心血管疾病（cardiovasculardisease，CVD），5年生存率为85．0％。皿患者中有4例（40％）在开始透析治疗后一年内肾功能部分恢复。PD患者中有2例（15．0％）在透析第一年后残肾Kt／V有上升。HD患者中有2例（20．0％）因心房纤颤、腕管综合征和瘘管功能不良改为PD。PD患者中有5例（38．5％）因腹水感染而改为HD。透析后第一年有14例（60．996）发生感染，有6例（21．6％）发生肾外狼疮活动。结论 进入肾脏替代治疗的LN患者的预后较好。部分患者在开始透析一年内肾功能可有不同程度恢复，CVD是LN终末期肾衰竭患者的主要死因。     

Residual renal function in a large cohort of peritoneal dialysis patients: change over time, impact on mortality and nutrition.

OBJECTIVE: Residual renal function contributes importantly to total solute clearance in peritoneal dialysis (PD) patients. This study was designed to examine the progression of residual renal function over time and its impact on nutrition and mortality in PD patients in the six New England states (ME, NH, VT, CT, MA, RI) comprising End Stage Renal Disease (ESRD) Network 1. DESIGN: As part of the ESRD Clinical Indicators Project, data on 990 PD patients in Network 1 were abstracted from data supplied by dialysis units in the fourth quarter of 1997. This included demographic information; dose of PD in L/day; weekly renal, dialysis, and total Kt/V urea; weekly renal, dialysis, and total creatinine clearance (CCr); serum albumin level; and mortality and transplantation information. Data collection was repeated in the second and fourth quarters of 1998 and in the second quarter of 1999. PATIENTS: 990 PD patients in Network 1. OUTCOME MEASURES: The change in total and renal solute clearances over time, the relationship between renal clearance and mortality, and the relationship between renal clearance and nutritional status, as represented by serum albumin. RESULTS: Over the 2-year period, mean weekly renal Kt/V urea and weekly renal CCr dropped significantly. To examine the effect of residual renal function on mortality, patients were divided into high and low (above and below the median) weekly renal Kt/V urea and weekly renal CCr groups. Patients above the median levels of both weekly renal Kt/V urea and weekly renal CCr had a significantly decreased risk of dying during the observation period, after controlling for age, gender, serum albumin level, and diabetic status [OR for high vs low renal Kt/V urea 0.54 (CI 0.34 - 0.84), OR for high vs low renal CCr 0.61 (CI 0.40 - 0.94)]. The mean weekly renal Kt/V urea was significantly and directly correlated with the mean serum albumin level by Spearman rank correlation (R = 0.133, p < 0.001), as was the mean weekly renal CCr (R = 0.115, p < 0.001). CONCLUSIONS: Residual renal function is an important contributor to total solute clearance in PD patients. Even at low levels it is linked to decreased mortality and better nutritional status.     

Patient and technique survival and factors affecting mortality on peritoneal dialysis in Turkey: 12 years' experience in a single center.

BACKGROUND: We investigated patient and technique survival and factors affecting mortality in Turkish peritoneal dialysis (PD) patients. Patients and METHODS: This was a retrospective study. 423 PD patients were included. The demographic, clinical, and biochemical data were collected from the medical records. Clinical outcomes were mortality and technique failure. RESULTS: Mean age at the start of PD was 46.0 +/- 14.3 years and mean PD duration was 37.1 +/- 28.3 (median: 30, range: 4-137) months. Diabetes mellitus was the most common cause of end-stage renal disease (35.2%), followed by hypertension (14.7%). There were 89 (21.0%) deaths. 25 (5.9%) patients received a kidney transplant, 74 (17.4%) patients were transferred to hemodialysis. Estimation of technique survival by Kaplan-Meier was 96.1%, 83.2%, 67.6%, 45.8%, and 33.6% at 1, 3, 5, 8, and 10 years. Technique failure was associated with peritonitis rate [relative risk (RR): 3.22, p < 0.001] and peritoneal Kt/V urea (RR: 0.38, p = 0.001) in the Cox proportional hazards model analysis. Estimation of patient survival by Kaplan-Meier was 96.9%, 83.8%, 68.8%, 50.2%, and 40.7% at 1, 3, 5, 8, and 10 years, respectively. In the Cox proportional hazards model analysis, age (RR: 1.01, p = 0.05), transfer to PD from hemodialysis (RR: 1.84, p = 0.03), comorbid cardiovascular disease (RR: 1.90, p = 0.004), serum creatinine level (RR: 0.75, p < 0.001), total Kt/V urea (RR: 0.34, p < 0.001), peritonitis rate (RR: 1.87, p < 0.001), and dialysate-to-plasma creatinine ratio (RR: 6.49, p = 0.04) predicted mortality. CONCLUSIONS: Even though we cannot conclude with certainty that survival rates in Turkish patients are better than those in the United States and Europe, our results seem to suggest this and warrant further studies adjusted for more extensive demographic features and comorbidities. The factors affecting mortality in Turkish PD patients are similar to other populations.     

Icodextrin effluent leads to a greater proliferation than glucose effluent of human mesothelial cells studied ex vivo.

OBJECTIVE: To compare the effect of glucose (Glu) and icodextrin (Ico) dialysate on in vitro culture of mesothelial cells (MC) from peritoneal dialysis (PD) patients. DESIGN: Prospective, controlled comparative study on the effects of two PD solutions. SETTING: A tertiary-care public university hospital. PATIENTS: Sixteen PD patients regularly using Glu dialysate were asked to collect an 8-hour dwell peritoneal effluent on 2 different days, with an interval shorter than 7 days. In the first collection, 2.27% Glu solution and in the last, 7.5% Ico solution was infused. Human MC were isolated from the nocturnal peritoneal effluent bags and grown ex vivo. MAIN OUTCOME MEASURES: Mesothelial cell proliferative capacity ex vivo. RESULTS: Mesothelial cells were present in all patient dialysates except that of a single patient's Glu dialysate. The number of MC drained was similar with both solutions. After the initial culture reached confluence, MC were identified in 14 and 12 patients receiving Ico and Glu, respectively. However, in 1 patient using Ico and in 2 using Glu, the MC count at this stage was so low that further subculture could not be performed. Cells from Ico-derived solutions exhibited a higher degree of proliferation than cells from Glu-derived solutions. The morphology of MC was also different. Cells from drained effluent were typical in 11 patients using Glu solution in contrast with 14 patients using Ico. At confluence, the percentages of typical appearance were 50% and 92.9% (p < 0.05) in Glu and Ico respectively. CONCLUSIONS: Mesothelial cells taken from icodextrin effluent show a greater proliferation ex vivo than those taken from glucose effluent.     

在线尿素清除率监测对血液透析充分性评价的研究

目的 探讨在线尿素清除率监测对血液透析充分性的评估价值.方法 选取规律血液透析患者65例,其中男38例,女27例,平均透析时间(41±29)个月.透析中血流量200～300ml/min,透析液流量500ml/min,利用在线尿素清除率监测(on-line clearance monitoring,OCM)Kt/V值;同时透析前后取全血检测尿素氮浓度等,根据单室尿素动力模型DaugirdasⅡ公式计算K t/V值,比较2种方法的相关性及不同体质量,超滤量,血流量,血红蛋白,红细胞压积对两者的影响.结果 本组65例患者利用OCM法测得的Kt/V值与采血计算法所得的K t/V值分别为(1.42±0.25)与(1.45±0.25),直线回归分析相关指数 r=0.979,P＜ 0.001.不同体质量≤60kg和＞60kg的2组患者,OCM监测的K t/V值分别为(1.50±0.27)与(1.37±0.22),t =2.09p=0.04采血计算Kt/V值(1.54±0.27)与(1.40±0.22),t=2.23,P=0.03 2者有显著差别.不同超滤量<3kg和≥3kg的2组患者,K t/V值无显著差别OCM法比较t=-1.34,P =0.19采血计算法比较t=-1.52,P=0.13.不同血流量200～250ml/min和260～300ml/min的2组患者,Kt/V值有显著差别OCM法比较t=-9.11p=0.01采血计算法比较 t=-9.13,P=0.01.不同血红蛋白水平Hgb≤110g及Hgb＞110g的2组患者,K t/V值无显著差异OCM法比较t=0.33,P =0.74采血计算法比较t=-0.15,P =0.88.不同红细胞压积水平HCT≤33%及HCT＞33%的2组患者,Kt/V值无显著差异OCM法比较t=-0.50,P =0.62采血计算法比较t=-0.81,P =0.43.结论 采用OCM监测可以很好的反映患者单次透析的尿素清除,有利于短期内调整透析处方,并结合其结果制定个体化的透析方案,以保证患者的透析充分性.     

家庭隔离衣的应用对腹膜透析患者感染的影响

目的探讨应用家庭隔离衣对降低腹膜透析（peritoneal dialysis,PD）患者感染发生率的作用。方法便利选取2005年7月至2011年6月在南京军区南京总医院行PD置管的终末期。肾功能衰竭患者,于2009年7月起统一应用家庭隔离衣行PD换液治疗,对患者的腹膜炎发生情况及家庭隔离衣使用情况进行监测。结果应用家庭隔离衣后,PD患者的腹膜炎发生率明显降低（P〈O．01）;但复发性腹膜炎发生率及腹膜炎后转归情况差异无统计学意义（均P〉0．05）。结论在PD中心一体化管理的基础上应用家庭隔离衣,有效降低了腹膜透析感染发生率,提高了PD患者的生活质量。