Treatment of severe ultrafiltration failure with nonglucose dialysis solutions in patients with and without peritoneal sclerosis.
Treatment of severe ultrafiltration failure with nonglucose dialysis solutions in patients with and without peritoneal sclerosis.
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DOI：
10.1093/ndtplus/sfn127
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发表时间：
2008-10
期刊：
影响因子：
--
通讯作者：
Krediet RT
中科院分区：
文献类型：
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作者：
Smit W;Ho-Dac-Pannekeet MM;Krediet RT
导论.腹膜透析（PD）患者的超滤失败（UFF）反映了腹膜的变化，包括间皮损伤、新血管生成和偶尔的腹膜纤维化。这些结构变化可能是由使用生物不相容的透析溶液引起的。因此，我们研究了联合使用非葡萄糖透析液治疗重度UFF患者的效果。方法. 10例UFF患者（3.86%葡萄糖下净超滤<400 mL/4 h）接受甘油和艾考糊精联合治疗，伴或不伴氨基酸透析液，持续3个月。其中4人被诊断为包裹性腹膜硬化症（PS），腹膜活检证实。使用3.86%葡萄糖进行标准腹膜渗透性分析（SPA），并在开始时、6周后和12周后分析透析液CA 125出现率（AR-CA 125）。比较了PS和非PS患者。结果1例患者在6周后接受了移植，1例患者在3个月期结束前因包裹PS的临床体征而退出PD。PS患者接受PD治疗的持续时间长于非PS患者（102 vs 52个月，P = 0.05），但基线转运参数或AR-CA 125无差异。在研究期间，当将整个组在第6周和第12周的结果与基线进行比较时，未观察到转运特征的差异。非PS患者无糖治疗6周后，经毛细血管超滤率显著增加（从2.2 mL/min增加到2.6 mL/min，P < 0.05），MTAC肌酐显著降低（从14.3 mL/min减少到12.6 mL/min，P < 0.05）。游离水转运（测量为透析液与血浆钠比的最大下降和第一分钟通过超小孔的转运）趋于改善，但该差异未达到显著性。AR-CA 125显著升高（从2.8 U/min增加到16.1 U/min，P < 0.05）。即使在3个月后继续治疗也没有达到统计学差异。在PS患者中未观察到变化。结论.在本研究中，非PS患者的UFF改善是通过停用基于葡萄糖的透析液获得的。PS患者的异常可能是不可逆的。在UFF患者中，应考虑早期停用葡萄糖透析液或至少显著减少葡萄糖暴露，但确定最受益的患者需要进一步研究。
Introduction. Ultrafiltration failure (UFF) in peritoneal dialysis (PD) patients is a reflection of changes in the peritoneal membrane, which can include mesothelial damage, neoangiogenesis, and occasionally, peritoneal fibrosis. These structural changes are probably induced by the use of bioincompatible dialysis solutions. Therefore, we investigated the effects of the treatment with a combination of nonglucose dialysis solutions in patients with severe UFF. Methods. Ten patients with UFF (net ultrafiltration <400 mL/4 h on 3.86% glucose) were treated with a combination of glycerol and icodextrin with or without amino acid-based dialysis solutions for 3 months. Four of them were diagnosed with encapsulating peritoneal sclerosis (PS), proven by peritoneal biopsies. Standard peritoneal permeability analyses (SPA), using 3.86% glucose, were performed, and dialysate CA125 appearance rate (AR-CA125) was analysed at the start, after 6 weeks and after 12 weeks. PS and non-PS patients were compared. Results. One patient underwent transplant after 6 weeks, one was withdrawn from PD because of clinical signs of encapsulating PS before the 3-month period ended. PS patients had been treated with PD for a longer duration than the non-PS patients (102 versus 52 months, P = 0.05), but no differences in baseline transport parameters or AR-CA125 were present. During the study, no differences were observed for transport characteristics when the results of the whole group at 6 and 12 weeks were compared to baseline. For the non-PS patients, however, a significant increase in the transcapillary ultrafiltration rate (from 2.2 mL/min to 2.6 mL/min, P < 0.05) and a decrease in the MTAC creatinine (from 14.3 mL/min to 12.6 mL/min, P < 0.05) were found after 6 weeks of glucose-free treatment. Free-water transport, measured as the maximum dip in the dialysate-to-plasma ratio of sodium and as the transport through the ultrasmall pores in the first minute, tended to improve, but this difference did not reach significance. In addition, the AR-CA125 increased significantly (from 2.8 U/min to 16.1 U/min, P < 0.05). Continued treatment did not reach statistical difference even after 3 months. No changes were observed in the PS patients. Conclusions. In the present study, an improvement of UFF in the non-PS patients was obtained by withdrawal of glucose-based dialysis solutions. The abnormalities in PS patients are probably irreversible. Early withdrawal of glucose-based dialysis solutions or at least a marked reduction in glucose exposure should be considered in UFF patients, but the identification of the patients who would benefit most needs further studies.