Long-Term Clinical Experience with Pure Bicarbonate Peritoneal Dialysis Solutions
Long-Term Clinical Experience with Pure Bicarbonate Peritoneal Dialysis Solutions
复制标题
纯碳酸氢盐腹膜透析解决方案的长期临床经验
DOI：
10.1177/089686080602600114
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发表时间：
2006
影响因子：
2.8
通讯作者：
Evandro Valladares
中科院分区：
文献类型：
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作者：
J. Montenegro;R. Saracho;I. Martínez;R. Muñoz;J. Ocharan;Evandro Valladares
目的本前瞻性研究的目的是收集使用纯碳酸氢盐缓冲腹膜透析液治疗的偶发腹膜透析（PD）患者的长期经验。方法比较34 mmol/L碳酸氢盐缓冲液（BIC）和35 mmol/L乳酸盐缓冲液（LAC）治疗的PD患者的代谢指标酸中毒、酸碱平衡、充足性、液体平衡、营养指标、钙、磷、甲状旁腺激素（PTH）、一般实验室检查和药物治疗。观察期包括透析治疗开始后1个月（访视1）至12个月（访视5）的5次访视。对于描述性分析，计算平均值和标准差。使用Student t检验和线性混合模型比较两个治疗组。结果36例患者随访12个月，BIC组18例，LAC组18例。两组之间的统计学显著差异BIC组静脉血碳酸氢盐为27.4 ± 2.3mmol/L，碱过剩为0.8 ± 2.2mmol/L，pH为7.31 ± 0.05; LAC组静脉血碳酸氢盐为25.9 ± 2.4 mmol/L，碱过剩为-0.6 ± 2.1 mmol/L，pH为7.30 ± 0.04。BIC组无患者需要口服碳酸氢盐，而LAC组有4例患者需要。尽管两组间的腹膜尿素和肌酐清除率无差异，但BIC组的肾脏溶质清除率更好，12个月时的利尿功能更好（BIC组为1333 ± 935 mL，LAC组为839 ± 556 mL）。超滤的情况正好相反。结论纯碳酸氢盐缓冲PD溶液在纠正代谢性酸中毒方面具有上级优势，并且可以省略口服碳酸氢盐。碳酸氢盐缓冲PD溶液的轻微超滤被这些溶液更好地保留的残余肾功能所抵消。
Objectives The aim of this prospective study was to collect long-term experience in incident peritoneal dialysis (PD) patients treated with pure bicarbonate-buffered PD fluids. Methods The metabolic parameters acidosis, acid–base status, adequacy, fluid balance, nutritional markers, calcium, phosphorus, parathyroid hormone (PTH), and general laboratory work and medication were compared between incident PD patients in two groups: one treated with a 34 mmol/L bicarbonate-buffered PD fluid (BIC), the other with a 35 mmol/L lactate-buffered PD fluid (LAC). The observation period included 5 visits from 1 month (visit 1) until 12 months (visit 5) after the start of dialysis treatment. For the descriptive analysis, means and standard deviations were calculated. Student's t-test and linear mixed models were used to compare the two treatment groups. Results 36 patients were followed for 12 months, 18 in the BIC group and 18 in the LAC group. Statistically significant differences between the groups (at the end of study) were found. In BIC group, venous plasma bicarbonate was 27.4 ± 2.3 mmol/L, base excess 0.8 ± 2.2 mmol/L, and pH 7.31 ± 0.05; in LAC group, venous bicarbonate was 25.9 ± 2.4 mmol/L, base excess –0.6 ± 2.1 mmol/L, and pH 7.30 ± 0.04. No patient from the BIC group needed oral bicarbonate, in contrast to 4 patients in the LAC group. Whereas peritoneal urea and creatinine clearances did not differ between the groups, there was better renal solute clearance in the BIC group, accompanied by better-preserved diuresis at 12 months (1333 ± 935 mL with BIC vs 839 ± 556 mL with LAC). The reverse was true for ultrafiltration. Conclusions Pure bicarbonate-buffered PD solutions were superior in correcting metabolic acidosis and they allowed omission of oral bicarbonate. The minor ultrafiltration with bicarbonate-buffered PD solutions was counterbalanced by better-preserved residual renal function with these solutions.