Empirical aminoglycosides for peritonitis do not affect residual renal function
Empirical aminoglycosides for peritonitis do not affect residual renal function
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DOI：
10.1053/ajkd.2003.50129
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发表时间：
2003-03-01
影响因子：
13.2
通讯作者：
Brown, EA
中科院分区：
文献类型：
--
作者：
Baker, RJ;Senior, H;Brown, EA
背景多年来，氨基糖苷类药物已被证明是治疗腹膜透析患者腹膜炎的有效药物。因此，在以前的指南中推荐了腹膜炎的经验性治疗。然而，随着对保留残余肾功能（RRF）的日益重视，人们对这些化合物的肾毒性潜力表示担忧。2000年国际腹膜透析学会（ISPD）指南建议RRF患者不使用氨基糖苷类药物，而使用头孢他啶。1997年，为了响应1996年ISPD指南，我们将腹膜炎治疗方案从万古霉素和环丙沙星改为头孢唑林和庆大霉素。本研究的目的是比较腹膜炎治疗后，与庆大霉素和不发生肾功能的变化。研究方法：使用6个月的尿液和透析清除率测量，确定70例接受氨基糖苷类药物治疗的腹膜炎发作（A组）、61例未接受氨基糖苷类药物治疗的腹膜炎发作（B组）和74例未发生腹膜炎的对照患者（C组）的腹膜炎前和腹膜炎后RRF（24小时尿素和肌酐清除率的平均值）。结果A组估计肾小球滤过率和尿量平均下降为-0.08 +/- 0.50 mL/min/mo和-8.82 +/- 88.09 mL/24 h/mo，而B组为-0.17 +/- 0.27 mL/min/mo和-34.68 +/- 69.58 mL/24 h/mo，B组为-0.20 +/- 0.39 mL/min/mo。C组为-14.61 ± 77.33 mL/24 h/mo。两组间无显著差异。总结：在我们的患者中，当使用含氨基糖苷类的经验性方案治疗腹膜炎时，没有证据表明RRF加速下降。由于很少有数据与这一发现相矛盾，我们建议在腹膜炎治疗方案中继续使用这些药物，即使是在有显著RRF的患者中。
Background. Aminoglycosides have been proven to be an efficacious treatment for peritonitis in peritoneal dialysis patients for many years. Consequently, they have been recommended in previous guidelines for the empirical treatment of peritonitis. However, with the increasing emphasis on preserving residual renal function (RRF), there has been concern about the nephrotoxic potential of these compounds. The 2000 International Society of Peritoneal Dialysis (ISPD) guidelines recommended that aminoglycosides not be used in patients with RRF, and that ceftazidime be used instead. In 1997, in response to the 1996 ISPD guidelines, we changed our peritonitis regimen from vancomycin and ciprofloxacin to cefazolin and gentamicin. The aim of this study is to compare the change in renal function occurring after treatment of peritonitis with and without gentamicin. Methods: Using 6-monthly urine and dialysis clearance measurements, preperitonitis and postperitonitis RRF (mean of 24-hour urea and creatinine clearance) were determined for 70 peritonitis episodes treated with the aminoglycoside-based regimen (group A), 61 episodes treated without aminoglycosides (group B), and 74 control patients without peritonitis (group C). Results Group A had mean declines in estimated glomerular filtration rate and urine output of -0.08 +/- 0.50 mL/min/mon and -8.82 +/- 88.09 mL/24 h/mon compared with -0.17 +/- 0.27 mL/min/mon and -34.68 +/- 69.58 mL/24 h/mon in group B and -0.20 +/- 0.39 mL/min/mon and -14.61 +/- 77.33 mL/24 h/mon in group C, respectively. There were no significant differences between groups. Conclusion: In our patients, there was no evidence of an accelerated decline in RRF when using an empirical regimen containing aminoglycosides for peritonitis. Because there are few data to contradict this finding, we recommend the continued use of these drugs in peritonitis regimens, even in patients with significant RRF.