Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis
Role of diuretics in the preservation of residual renal function in patients on continuous ambulatory peritoneal dialysis
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DOI：
10.1046/j.1523-1755.2001.0590031128.x
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发表时间：
2001-03-01
影响因子：
19.6
通讯作者：
Walls, J
中科院分区：
文献类型：
--
作者：
Medcalf, JF;Harris, KPG;Walls, J
背景 连续不卧床腹膜透析 (CAPD) 患者的溶质和水清除依赖于残余肾功能，并且这种情况随着透析时间的推移而下降。袢利尿剂被认为可以减缓这种下降。方法。 61 名刚开始透析的患者在 CAPD 训练时被随机分配到每天 250 mg 速尿组或不使用速尿组，并进行前瞻性随访。在六个月和一年时随机测量尿量 (UV)、尿素清除率 (C-Urea) 和西咪替丁肌酐清除率 (C-Cr)。患者接受标准的四小时腹膜平衡测试，并通过生物电阻抗测量体内水分总量。结果以意向治疗为基础表达。结果。 UV、C-Cr 和 C-尿素在随机分组中相似（1020 +/- 104 与 1040 +/- 130 mL/24 小时、4.95 +/- 0.51 与 4.07 +/- 0.40 mL/min/1.73 m(2)、0.91 +/- 0.09 与 0.84 +/- 0.08、利尿剂与 0.84 +/- 0.08）。控制）。利尿剂治疗组的 UV 增加，而对照组则下降（6 个月时+176 vs.-200 mL/24 小时，1 年时+48.8 vs.-305 mL/24 小时，P < 0.05）。 C-Cr 和 C-尿素以恒定速率下降，并且不受利尿剂给药的影响（0.12 +/- 0.05 与 0.071 +/- 0.04 mL/min/1.73 m(2)/月，0.020 +/- 0.01 与 0.019 +/- 0.01 每月）。利尿剂组的尿钠排泄量增加，而对照组则下降（+0.72 +/- 0.85 vs. -2.56 +/- 1.31 mmol/24 小时/月，P = 0.04）。两组体重均有所增加（4.3 vs. 3.0 kg），但对照组总体重百分比有所增加，而利尿剂组则保持不变（52 +/- 2.4 vs. 64 +/- 6.6%，P = 0.10）。结论。接受 CAPD 治疗后 12 个月内，长期使用呋塞米可显着增加 UV，并可能导致临床上体液平衡的显着改善。然而，速尿对保留残余肾功能没有作用。
Background Patients on continuous ambulatory peritoneal dialysis (CAPD) are dependent on residual renal function for solute and water clearances, and this declines with time on dialysis. Loop diuretics have been postulated to slow this decline.Methods. Sixty-one patients new to dialysis were randomly assigned to either furosemide 250 mg every day or no furosemide at the time of CAPD training and were followed prospectively. Urine volume (UV), urea clearance (C-Urea), and creatinine clearance on cimetidine (C-Cr) were measured at randomization at six months and at one year. Patients underwent a standard four-hour peritoneum equilibrium test, and total body water was measured by bioelectrical impedance. Results were expressed on an intention-to-treat basis.Results. UV, C-Cr, and C-Urea were similar at randomization (1020 +/- 104 vs. 1040 +/- 130 mL/24 hours, 4.95 +/- 0.51 vs. 4.07 +/- 0.40 mL/min/1.73 m(2), 0.91 +/- 0.09 vs. 0.84 +/- 0.08, diuretic vs. control). UV in the diuretic-treated group increased, whereas in the control group, it declined (+176 vs. -200 mL/24 hours at 6 months and +48.8 vs. -305 mL/24 hours at 1 year, P < 0.05). C-Cr and C-Urea declined at a constant rate and were unaffected by diuretic administration (0.12 +/- 0.05 vs. 0.071 +/- 0.04 mL/min/1.73 m(2)/month, 0.020 +/- 0.01 vs. 0.019 +/- 0.01 per month). Urinary sodium excretion increased in the diuretic group and declined in the control group (+0.72 +/- 0.85 vs. -2.56 +/- 1.31 mmol/24 hours/month, P = 0.04). Body weight rose in both groups (4.3 vs. 3.0 kg), but the percentage of total body weight rose in the control group and remained constant in the diuretic group (52 +/- 2.4 vs. 64 +/- 6.6%, P = 0.10).Conclusions. Long-term furosemide produces a significant increase in UV over 12 months when on CAPD and may result in clinically significant improvement in fluid balance. However, furosemide has no effect on preserving residual renal function.