残余肾功能状态对腹膜透析效能的影响

目的:前瞻性观察终末期肾衰(ESRF)患者在腹膜透析(PD)治疗后残余肾功能(RRF)对透析效能及相关临床指标之间的影响。方法:所有患者按残余肾小球滤过率(rGFR)水平将其分为A组(GFR0~2ml/min)、B组(GFR2·1~4ml/min)和C组(GFR>4ml/min)。每3个月进行一次临床随访,全面评估患者的全身情况及透析状态,包括血压、身高、体重、体重指数(BMI)、尿量(UV)、残余肾肌酐清除率(Ccr)、每周总尿素氮表现率(Kt/Vtotal)、每周肌酐总清除率(WCcrtotal)、蛋白氮呈现率(nPNA)、残余肾尿素及Ccr。对比观察不同RRF状态患者透析状况和部分临床及生化指标变化。尿量<100ml/d或Ccr<1·0ml/min视为无尿。结果:三组不同残肾状态患者Kt/vtotal和Ccr分别为1·75±0·35、2·07±0·54、2·46±0·50和53·4±11·2、66·6±11·2、97·6±22·1(L/Wks),各组之间差异非常显著(P<0·001)。三组不同残余肾Kt/v和Ccr分别占总体kt/v的12·4%、27%、45·7%及总体Ccr的18·3%、47·3%和65·3%,三组间相比差异亦显著(P<0·01)。此外,三组间高血压发生率、心胸比例及左心室肥厚(LVH)亦存在一定差异,C组心脏增大的病例明显低于A、B两组。RRF状态与透析效能呈正相关。本组患者除2例在透析治疗时即无尿,128例患者中有31例(24·2%)发生无尿,其中原发病为血管炎综合征及糖尿病肾病各占4例和7例,其无尿发生率分别占本病种的66·7%及25·9%;另20例无尿患者为肾小球肾炎或其它疾病,占此类疾病的20·6%。此外,发生无尿患者中有5例(16·1%)透析时尿量<300ml/d。结论:PD患者的残余肾仍然是清除体内代谢产物的重要途径,同时也影响血压及心血管系统并发症。     

Autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients as measured by sympathetic skin response

ObjectivesThe purpose of this study was to evaluate the prevalence of autonomic dysfunction in non-diabetic continuous ambulatory peritoneal dialysis patients and to investigate its risk factors using the sympathetic skin response.MethodsWe performed a cross-sectional study on 113 non-diabetic continuous ambulatory peritoneal dialysis patients using the sympathetic skin response, a non-invasive test to detect sympathetic sudomotor deficit.ResultsSixty-six patients (58.4%) showed an abnormal sympathetic skin response suggesting a sympathetic sudomotor deficit. Patients were then categorized into two groups according to their sympathetic skin response result. The baseline clinical data, nutritional and dialysis adequacy indices of the two groups were compared. Patients with an abnormal sympathetic skin response are significantly older (54.9 ± 12.52 vs 61.79 ± 12.16 years, p=0.004), more malnourished with a lower albumin (35.79 ± 2.41 vs 33.98 ± 4.92 g/L, p=0.012) and normalized protein nitrogen appearance values (0.99 ± 0.17 vs 0.93 ± 0.16 g/kg/day, p=0.046). Further, they have a lower residual renal function as calculated by weekly renal Kt/V (0.63 ± 0.61 vs 0.29 ± 0.35, p=0.001) or renal creatinine clearance (41.35 ± 40.2 vs 21.96 ± 27.22 L/wk/1.73 m², p=0.006). Patients with an abnormal sympathetic skin response are also receiving a smaller dialysis dose as calculated by the total weekly Kt/V (2.13 ± 0.6 vs 1.83 ± 0.41, p=0.004) or the total creatinine clearance (82. 42 ± 37.34 vs 66.81 ± 25.38 L/wk/1.73 m², p=0.017).ConclusionBased on sympathetic skin response, autonomic dysfunction is common among non-diabetic continuous ambulatory peritoneal dialysis patients. Patients with autonomic dysfunction are significantly older, more malnourished, have low residual renal function and are receiving a smaller dialysis dose. A prospective study is warranted to investigate the reversibility of autonomic dysfunction after an increment in dialysis dose.     

Cystatin C Levels in Functionally Anephric Patients Undergoing Dialysis: The Effect of Different Methods and Intensities

Background and objectives: Cystatin C, a low molecular weight protein, is produced by nucleated cells, filtered by glomeruli, and degraded by tubules at a constant rate. Its serum concentration has been proposed as a marker of GFR. Its size should make it dialyzable. It is hypothesized that serum cystatin C levels are influenced by the method and intensity of dialysis received.Design: This is a cross-sectional pilot study of cystatin C in functionally anephric dialysis patients. It was measured predialysis in 14 patients on conventional (3 to 5 h, 3 × wk) hemodialysis; eight on nocturnal hemodialysis (three to seven nights, 6 to 8 h); three on daily hemodialysis (6 d, 1½ to 2½ h); and 10 on automated peritoneal dialysis. All had urea kinetic studies and values for single pool Kt/V (Sp Kt/V), standard weekly Kt/V (Std Kt/V), and protein equivalent of nitrogen appearance (nPNA; g/kg/d). C reactive protein (CRP; mg/L) and thyroid stimulating hormone (TSH; mIU/L) were measured as factors known to influence cystatin C.Results: There was no correlation between cystatin C and Sp Kt/V, but there was a significant inverse linear correlation with Std Kt/V and there were significant differences between treatment modalities in cystatin C levels and in Std Kt/V. The estimation of cystatin C was reliable and stable over 3 to 6 wk and its levels uninfluenced by nPNA, CRP, or TSH.Conclusion: Serum cystatin C levels are influenced by the method and intensity of dialysis and may have a role in treatment adequacy monitoring.Serum creatinine is a widely used yet crude marker of GFR (GFR). The limitations of serum creatinine and creatinine clearance for estimation of GFR are well known (1). Creatinine concentration is affected by several factors that are independent of GFR, such as age, race, muscle mass, gender, medication use, and catabolic state (2). Serum cystatin C, a cystine protease inhibitor, is a low molecular weight protein (13.2 KD) produced at a constant rate by all nucleated cells (3). In the kidney, it is freely filtered and catabolized in the proximal tubule without being secreted (3). Studies suggest that cystatin C is a better marker of GFR than serum creatinine because of its independence from age and gender (4). Prediction equations have been derived from pediatric and adult patients to give an estimate of GFR from the serum cystatin C (5,6). Surprisingly there are few studies of serum cystatin C levels in dialysis patients. Its size (13.2 kDaltons) should make it dialyzable and a marker for “middle molecule” toxin removal. We, therefore, conducted a pilot study of serum cystatin C levels in such patients. A recent study by Delaney and colleagues suggested that serum cystatin C reflected predominantly renal not dialytic clearance in chronic renal failure patients on peritoneal dialysis (7). For this reason, we studied functionally anephric patients. We hypothesized that serum cystatin C levels would be related to markers of dialysis adequacy such as the standard weekly Kt/V urea (Std Kt/V) (8). To test this hypothesis, we studied patients treated by a variety of dialytic modalities that provided a range of values for Std Kt/V. Significant differences in Std Kt/V exist between conventional three times per week hemodialysis and daily or nightly hemodialysis (9). Std Kt/V can also be used to compare different treatment modalities (peritoneal versus hemodialysis) as well as different frequencies and treatment times (8). We studied patients encompassing all these treatment modalities.     

The 2006 K/DOQI guidelines for peritoneal dialysis adequacy are not adequate

The 2006 National Kidney Foundation K/DOQI guidelines have lowered the peritoneal dialysis adequacy standard of Kt/V(urea) from 2.1 to 1.7 in anuric patients, largely based on the patient survival results of 2 clinical trials in Mexico and Hong Kong. It is our contention that the guidelines may be misleading since they have chosen to ignore the bias in these trials and have ignored the adverse outcomes in control groups in the trials on which the guidelines are based, as well as the body size of the subjects in these trials. Body size has changed in the US and Canada over the last few decades and there are similar changes worldwide. We suggest that the minimum targets for peritoneal dialysis be reinstituted at the previous standard Kt/V(urea) of 2.0.     

Patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) with a basic three 2-liter daily exchanges: a 12- year single center experience in the pre-urea kinetics era

Continuous ambulatory peritoneal dialysis (CAPD) is the prevailing mode of renal replacement therapy in Hong Kong and the routine practice is three 2 L daily exchanges with four exchanges reserved for patients with ultrafiltration problems or clinically inadequate dialysis. In our hospital, Tung Wah Hospital, adequacy of dialysis assessment by urea kinetics was conducted after 1993 and adjustment of dialysis regime according to Kt/V was made only after 1995. This study represented the survival data of CAPD patients in our center before the urea kinetics era. From 1983 to 1994, we have accepted 569 patients into our CAPD program with a mean age ±SD of 47.8 ±15.4 and incidence of diabetes of 17.9%. The overall patient survival rates were 92%, 56% and 26% at 1, 5 and 10 years respectively. The corresponding technique survival rates were 97%, 86% and 60%. A cross-sectional analysis of the CAPD population from 1993 to 1994 showed that only 5% of patients were on four 2 L exchanges and the mean Kt/V was 1.76 ±0.35 and creatinine clearance 58.1 ±23.2 L/week/1.73 m². The patient and technique survival rates were comparable to western centers with a higher mean Kt/V and creatinine clearance. Our data showed that favorable clinical outcome can be achieved with three 2 L daily exchange regime in Chinese patients. This indicates different Kt/V standards may exist for different racial populations.     

Evaluation of methods to calculate dialysis dose in daily hemodialysis

Daily dialysis has shown excellent clinical results because a higher frequency of dialysis is more physiological. Different methods have been described to calculate dialysis dose which take into consideration change in frequency. The aim of this study was to calculate all dialysis dose possibilities and evaluate the better and practical options. Eight patients, 6 males and 2 females, on standard 4 to 5 hours thrice weekly on-line hemodiafiltration (S-OL-HDF) were switched to daily on-line hemodiafiltration (D-OL-HDF) 2 to 2.5 hours six times per week. Dialysis parameters were identical during both periods and only frequency and dialysis time of each session were changed. Time average concentration (TAC), time average deviation (TAD), normalized protein catabolic rate (nPCR), Kt/V, equilibrated Kt/V (eKt/V), equivalent renal urea clearance (EKR), standard Kt/V (stdKt/V), urea reduction ratio (URR), hemodialysis product and time off dialysis were measured. Daily on-line hemodiafiltration was well accepted and tolerated. Patients maintained the same TAC although TAD decreased from 9.7 +/- 2 in baseline to a 6.2 +/- 2 mg/dl after six months, p < 0.01. No significant changes were observed in weekly Kt/V and eKt/V throughout the study. However EKR, stdKt/V and weekly URR were increased during D-OL-HDF in 24-34%, 46% and 50%, respectively. Hemodialysis product was raised in a 95% and time off dialysis was reduced to half. CONCLUSION: Dialysis frequency is an important urea kinetic parameter which there are to take in consideration. It's necessary to use EKR, stdKt/V or weekly URR to calculate dialysis dose for an adequate comparison between different frequency dialysis schedules.     

Role of soluble intercellular adhesion molecule-1 in the process of peritonitis in peritoneal dialysis

ObjectiveTo investigate the role and clinical significance of changes of levels of soluble intercellular adhesion molecule-1 in the process of peritonitis in peritoneal dialysis patients.MethodsA total of 50 patients on continuous ambulatory peritoneal dialysis in the Shanghai Changhai Hospital between May 1999 and July 2000 were enrolled into this study. They were assigned to two groups according to diagnostic standard of peritonitis-Group A, with episodes of peritonitis; Group B, in the absence of peritonitis. The serum and peritoneal effluent levels of soluble intercellular adhesion molecule-1 during and after peritonitis were assessed by using sandwiched enzyme-linked immunosorbent assay.ResultsThe serum levels of soluble intercellular adhesion molecule-1 in Group A were significantly lower compared with Group B (214.5 ± 90.7 vs 511.2 ± 124.7 ng/mL; p<0.01). The peritoneal effluent levels of soluble intercellular adhesion molecule-1 in Group A were significantly higher than those in Group B (5.8 ± 1.6 vs 2.1 ± 0.9 ng/mL; p<0.01). For Group A, after treatment of peritonitis, the serum levels of soluble intercellular adhesion molecule-1 profoundly increased to 506.1 ± 107.8 ng/mL and the peritoneal effluent levels of soluble intercellular adhesion molecule-1 markedly decreased to 3.9 ± 1.1 ng/mL, compared with those during peritonitis, respectively (p<0.01).ConclusionThe study showed that increased peritoneal effluent levels of soluble intercellular adhesion molecule-1 during peritonitis possibly activate or damage peritoneal mesothelial cells. Monitoring changes of levels of soluble intercellular adhesion molecule-1 in peritoneal dialysis fluid may be useful for analyzing the process of peritonitis.     

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

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 ,尤其当水平衡难以维持时可行血液透析     

An Overview of Regular Dialysis Treatment in Japan (As of 31 December 2010)

A nationwide statistical survey of 4226 dialysis facilities was conducted at the end of 2010, and 4166 facilities (98.6%) responded. The number of new patients introduced into dialysis was 37 512 in 2010. This number has decreased for two consecutive years since it peaked in 2008. The number of patients who died in 2010 was 28 882, which has been increasing every year. The number of patients undergoing dialysis at the end of 2010 was 298 252, which is an increase of 7591 (2.6%) compared with that at the end of 2009. The number of dialysis patients per million at the end of 2010 was 2329.1. The crude death rate of dialysis patients in 2010 was 9.8%, and has been gradually increasing. The mean age of the new patients introduced into dialysis was 67.8 years and the mean age of the entire dialysis patient population was 66.2 years. Regarding the primary disease of the new patients introduced into dialysis, the percentage of patients with diabetic nephropathy was 43.6%, which is a slight decrease from that in the previous year (44.5%). Patients with diabetic nephropathy as the primary disease accounted for 35.9% of the entire dialysis patient population, which approaches the percentage of patients with chronic glomerulonephritis as the primary disease (36.2%). The percentage of patients who had undergone carpal tunnel release surgery (CTx) was 4.3%, which is a slight decrease from that at the end of 1999 (5.5%). The decrease in the percentage of patients who had undergone CTx was significant among the patients with dialysis durations of 20–24 years (1999, 48.0%; 2010, 23.2%). A total weekly Kt/V attributable to peritoneal dialysis and their residual functional kidney was 1.7 or higher for 59.4% of patients who underwent peritoneal dialysis.     

Ionic dialysance to control the dose of dialysis. One year experience

The Diascan equipment (Hospal) measures ionic dialysane which it derives the K and the Kt. If we divide the Kt obtained with Diascan between the Kt/V obtained by a simplified formula, it result a value of V for every patient. Entering this V in the Diascan software we can obtain a Kt/V (Diascan Kt/V), similar in theory to the simplified Kt/V. In the year 2002 we have controlled the delivered dialysis in our unit with the Diascan Kt/V. The aim of the present study was to study the agreement between de Diascan Kt/V and the Lowrie Kt/V. During the year 2002, 63 patients have been dialyzed in monitors with Diascan equipment. We calculated the V of each patient by dividing the Kt Diascan between the Lowrie Kt/V in the same dialysis session. The mea of the two consecutive measurements was considered the V value. Throughout the year 2002, 7 agreement studies were realized. The inter-method variability was assessed by the relative difference (absolute difference Diascan Kt/V-Lowrie Kt/V, divided by the average of both tests). A good agreement was considered when the relative difference was equal or lower than 10%. In the 7 agreement studies realized, the mean of the relative difference oscilled between 5.2 and 6.6%, and the percentage of patients with a relative difference equal or lower than 10% oscilled between 83 and 91%. During a month, the Diascan Kt/V was controlled in all dialysis sessions in 41 patients (554 sessions in total). Failure in the lecture of Kt/V Diascan was observed in 41 sessions (7%). A Diascan Kt/V greater than 1 (the minimum delivered dialysis considered in our unit) was obtained in 93% of the valid sessions. 38 of 41 patients had a mean monthly Diascan Kt/V greater than 1. The coefficient of variability of any patient oscilled between 2.1 and 12.4% (mean 5.1%). Diascan Kt/V is good procedure for the monitoring the delivered dialysis without blood sampling or any additional costs.     

Bedeutung von PET und Kt/V für die Peritonealdialyse

PET should be monitored 4 weeks after the start of peritoneal dialysis (PD) and then yearly, and Kt/V every 3 months. PET makes it possible to determine different velocities of glucose absorption (from the dialysate) and of the transport of such low-molecular-weight substances as creatinine and urea (from blood to dialysate), and in particular to calculate the prognosis of the long-term ultrafiltration capacity of the peritoneum in each PD patient. Kt/V is a measure of the urea clearance both of the peritoneum and of the actual kidneys; it seems that preservation of any residual renal function has a more significant positive influence on patient survival and on the technical course than does an increase of the dialysis dose. It is accepted that PD is working efficiently when Kt/V is over 1.7. Besides PET and Kt/V clinical (well-being, eating behaviour, whether body weight is steady, functional capacity) and other (blood pressure, neurological status, degree of anaemia, calcium/phosphate ratio) criteria are also important in the evaluation of whether PD treatment is adequate.     

ADEMEX and HEMO trials: where are we going?

Doubt has remained as to whether or not the K/DOQI recommended targets for adequacy of dialysis for peritoneal dialysis patients is appropriate (weekly Kt/V 2 + creatinine clearance 50-60 l/1.73 m(2)). The ADEMEX trial can be interpreted as indicating that lower targets might be acceptable. The HEMO trial, not yet published but presented in April 2002, casts doubts on the advantages of achieving higher than recommended small solute clearance targets. Taken together, these trials require that we broaden our concept of adequacy. There is also a risk of complacency with respect to dialysis adequacy because of these trials and this would be unwise.     

Incremental peritoneal dialysis - yes

The incremental modality at the start of peritoneal dialysis (Incr-DP) is implicit in the definition of adequacy, which is expressed as the sum of dialysis clearance and renal clearance.Theoretically, it is possible to demonstrate that with a glomerular filtration rate at the start of dialysis of 6 mL/min, the minimum Kt/V target of 1.70 indicated by the current guidelines is easily exceeded with both 2-exchange of CAPD (incremental CAPD) and APD of 3 or 4 weekly sessions (Incr-APD), with a daytime icodextrin dwell. The GSDP (Peritoneal Dialysis Study Group) census data suggest that Incr-DP favors the choice of peritoneal dialysis. Although limited to a few studies with a relatively small number of patients, data show that Incr- CAPD is associated with a better quality of life, the achievement of Kt/V targets, and satisfactory ultrafiltration. The clearance of medium molecules is equivalent in Incr-DP and full-dose PD as it depends on the duration of the dwell and not on the number of exchanges. The maintenance of body weight, protein intake and peritoneal permeability may be explained by the lower glucose load with Incr-DP. The preservation of residual renal function is similar to that recorded with full-dose PD, while the peritonitis rate seems to be lower. The favorable results reported in the literature and the indications of the most recent guidelines about the importance of reducing the exposure to glucose to a minimum and safeguarding the patient's quality of life in our opinion further justify the use of Incr-DP.     

Does dialysis therapy improve autonomic and peripheral nervous system abnormalities in chronic uraemia?

OBJECTIVES: Autonomic nervous system (ANS) dysfunction and peripheral neuropathy occur in patients with chronic renal insufficiency. Adequate renal replacement therapy should prevent development or correct these abnormalities. DESIGN AND SUBJECTS: We studied retrospectively ANS and peripheral neuropathy in 32 patients with chronic uraemia who received either haemodialysis (16) or peritoneal dialysis (16) therapy, and compared the observed dialysis efficiency with changes in neurological function. METHODS: Heart rate variability (HRV) time domain indices and peripheral sensory nerve conduction studies were followed for a mean of 2.9 years. The adequacy of haemodialysis (HD) efficiency was estimated by Kt/V, an index of fractional urea clearance. Adequacy of continuous ambulatory peritoneal dialysis (CAPD) was estimated on the basis of the patient's wellbeing and nutritional status as excellent, satisfactory or poor. Based on observed changes in HRV time domain measures, the observations were divided in three subgroups: improved, unchanged or deteriorated. RESULTS: The peripheral sensory nerve conduction studies were abnormal in 38% of the patients and did not change significantly during the study. Improvement in HRV time domain measures occurred in HD patients with mean Kt/V > 1.20 or in CAPD patients with satisfactory or excellent response to dialysis treatment. Values of Kt/V < 0.85 in HD patients were associated with progressive deterioration of autonomic neuropathy. Diabetic patients (n = 4) differed from others as their HRV was grossly abnormal and did not improve. CONCLUSIONS: The adequacy of haemodialysis is a predictor of improvement of cardiac autonomic nervous function in chronic uraemia. The same trend of improvement was seen also in CAPD patients.     

残余肾功能对腹膜透析患者心血管系统的影响

目的:观察不同残余肾功能(RRF)对腹膜透析(PD)患者心血管系统的影响. 方法:根据PD患者随访过程中残余肾小球滤过率(rGFR)水平将其分为A组(GFR 0～2 ml/min)、B组GFR(2.1～4 ml/min)、C组GFR(4.1～6.0 ml/min)和D组(>6.0 ml/min).每3个月对患者进行一次临床随访,全面评估患者的伞身情况及透析状态,包括血浆白蛋白(AIb)、收缩压(SBP)、舒张压(DBP)、体重指数(BMI)、尿量(UV)、残余肾肌酐清除率(Ccr)、每周总尿素氮清除率(Kt/V total)、每周肌酐总清除率(WCcr total)、蛋白氮呈现率(nPNA)、心脏超声和胸部平片. 结果:四组不同RRF患者Kt/v total分别为1.66±0.42、1.85±0.40、2.11±0.45、2.60±0.69(P<0.01);四组间心胸比分别为0.54±0.08、0.51±0.07、0.51±0.06、0.50±0.06(P<0.05);左室后壁厚度分别为(10.4±1.79)、(9.96±1.35)、(9.51±1.33)、(9.65±1.40)mm(P<0.05);室间隔厚度分别为(10.9±1.88)、(10.4±1.59)、(10.2±1.59)、(10.1±1.47)mm(P<0.05);此外四组间AIb、SBP、DBP均存在统计学差异(P<0.05). 结论:RRF每下降2 ml/min患者室间隔厚度、左室后壁厚度均增加,且室间隔厚度与RRF呈负相关.RRF对腹膜透析患者心血管并发症有重要影响.     

腹膜透析治疗充分性评估与影响因素干预

腹膜透析(PD)充分性是PD患者预后的关键因素,目前国内外常用的小分子溶质清除指标为每周尿素清除指数(Kt/V)。Kt/V已经由既往指南的＞2.0,降低到≥1.7即可。除了小分子溶质清除外,容量平衡、营养状态、临床症状等也是透析充分性的评估指标。因此,PD充分性评估既有小分子溶质的清除,也包括其他综合性因素。影响透析充分性的因素中,残余肾功能、腹膜转运特性为主要因素,应予以足够重视并定期监测。     

Conventional blood sampling versus On-Line Clearance Monitoring

On-line Clearance Monitoring (OCM) calculates the Kt/V during a dialysis session using a module incorporated into the Fresenius 4008 H/S haemodialysis machine (1). The method is based on repeated increments in dialysate sodium concentrations followed by measuring the change of dialysate sodium concentration after the dialysate has passed through the kidney. OCM is a patient friendly, non-invasive and easy method for measuring Kt/V. Kt/V calculated on single-pool urea kinetics according to Daugirdas was compared to Kt/V measured by OCM in thirty stable patients on chronic haemodialysis. Patients were dialysed using a dialyser with either a high-flux polysulfone or a haemophane membrane. In four patients OCM was measured in ten consecutive sessions to assess the intra-individual variation in OCM. The calculated Kt/V was compared to Kt/Vocm in three patients at five consecutive dialysis sessions to measure the intra-individual correlation. A linear correlation was present between Kt/Vocal and Kt/Vac for both the polysulfone and haemophane membrane. Intra-individual Kt/Vocm showed very stable values with an average variation of less than 5%. Intra-individual correlation between calculated Kt/V and Kt/Vocm was high.     

老年腹膜透析患者生存率和临床特点的研究

目的研究本中心老年维持性腹膜透析患者生存率和临床特点。方法回顾性分析2004年1月至2008年9月新进入我院腹膜透析中心行正规随访的维持性腹膜透析患者。根据进入腹膜透析治疗时的年龄分为A组（年龄〉165岁）和B组（年龄〈65岁）。比较两组患者生存率以及贫血、钙磷代谢、脂代谢、炎症等方面的实验室指标。初步分析残肾功能和各组生存率的关系。用Kaplan—Meier检验进行生存分析。结果本研究共包括180例维持性腹膜透析患者。A组累积生存率低于B组（P〈0．05）。A组中无残肾功能患者死亡率高于有残肾功能者。A组的血磷、钾、白蛋白、前白蛋白水平均低于B组;而A组血CRP水平高于B组。结论老年腹膜透析患者的生存率低于年轻患者,有无残肾功能与老年患者的生存率高低有关。老年患者营养水平较年轻患者差,炎症反应较年轻患者高。