透析初始月透析剂量对腹膜透析患者残肾功能下降率的影响  

Effect of dialysis dose in early stage on the rate of decline of residual renal function in peritoneal dialysis patients

作　　者：吕晶[1] 耿瀛洲[1] 薛武军[1] 靳引红[1] 毋欣桐[1] 李昭[1] 杨亚丽[1] 

机构地区：[1]西安交通大学医学院第一附属医院肾脏病医院肾内科,陕西西安710061

出　　处：《中国现代医学杂志》2014年第32期49-55,共7页China Journal of Modern Medicine

摘　　要：目的通过回顾性研究进行渐进性腹膜透析治疗患者的残肾功能的变化,探讨调整透析剂量的不同时机对腹膜透析残肾功能的影响。方法回顾性研究在西安交通大学医学院第一附属医院肾内科腹膜透析中心规律随访治疗达1年的腹膜透析患者,分别调查患者透析1、3、6和12个月的透析充分性、白蛋白、血红蛋白、血钙、血磷、甲状旁腺素(PTH)、套式聚合酶链反应(n PCR)、透析充分性、肾小球滤过率(GFR),用(GFR1-GFRn)/n-1公式计算出平均每月GFR下降率,根据透析剂量调整的时间分为两组,透析3个月调整剂量者为A组,透析1个月调整剂量者为B组。分别比较两组患者各月透析剂量、血压、透析充分性、各项生化指标,以及肾小球滤过率下降率的差异。结果共观察85例,其中男45例,女40例;A组38例,B组47例。开始透析时,两组患者的GFR、年龄、透析剂量、透析充分性、生化指标差异均无统计学意义(P>0.05)。透析1年时,两组患者透析充分,营养状况良好,血钙、血磷水平及PTH水平均较开始透析时好转(P<0.05)。A组及B组的每个月GFR的下降率分别为(0.05±0.03)和(0.21±0.24)m L/min(P<0.05)。透析1年时,虽然两组患者总Kt/V及血压差异无统计学意义,但与B组比较,A组的GFR较高(P=0.002),每个月GFR下降率慢(P=0.001),尿量较多(P=0.042),灌入量(P=0.037)和超滤量较少(P=0.008),n PCR更低(P=0.035)。B组的n PCR逐渐降低(P=0.023),但白蛋白逐渐升高(P=0.031)。透析3个月时,两组的透析充分性(P=0.003)、GFR(P=0.003)、血压(P=0.010)、血肌酐(P=0.021)出现明显差异。透析6个月时,虽然血压、腹膜Kt/V及腹膜Ccr差异无统计学意义,但GFR仍有明显差异(P=0.008),血钙(P=0.038)、血磷(P=0.034)及尿量(P=0.044)差异有统计学意义。结论 1透析早期透析剂量不足和血压控制不佳可能是引起腹膜透析患者残肾功能丢失的重要原因。2透析前3个月给予足够的透析剂[Objective] To study the effect of dialysis dose adjustment time on the rate of decline of residual renal function in peritoneal dialysis patients. [Methods] The outpatients treated by progressive peritoneal dialysis in one center for 1 year were included in this retrospective study. Dialysis adequacy, GFR, nPCR and clinical data were evaluated at the initiation of dialysis and at 3, 6, 12 months after PD. According to the dialysis dose adjustment time, the patients were divided into two groups, the patients whose dialysis dose changed after dialysis for 1 month were designated as group A, and those whose dialysis dose were adjusted in 3 month after start of dialysis were defined as group B. The rate of decline of GFR, dialysis dose, adequacy, all clinical mark in two groups were compared. [Results] Compare with the PD patients in group B, residual renal functional （RRF） were reduced compare with initial dialysis month, the groups A was improved achieved good results in the dialysis adequacy, nutrition status, calcium-phosphorus and PTH status with better GFR （P〈0.01）, lower dialysis dose （P〈0.05） at the end of the 12rd month. [Conclusion] Dialysis dose and high blood pressure in early stage of dialysis are the important reasons of loss of RRF. Adequate dialysis dose and well blood pressure control at start of dialysis would be benefit to decrease the decline of GFR in peritoneal dialysis patients. It is more important for adjustment of peritoneal dialysis prescription ac- cording to decline of GFR than a single point adequacy of dialysis.

关 键 词：腹膜透析 剂量 血压 残肾功能 

分 类 号：R692[医药卫生—泌尿科学]