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目的:回顾性分析了腹膜透析(PD)患者不同透析效能状态下所使用透析液剂量(PDV)与残余肾功能(RRF)及体表面积(BSA)之间的相关性,探讨符合国人生理及病情特点的透析液剂量计算方法。方法:414例患者中位透析时间为14.8个月(6～161个月)共进行1 650例次测定。按2006 NKF-K/DOQI标准分为充分、临界及不充分三组,观察各组患者之间尿素Kt/V、肌酐清除率(CCr)、蛋白质表现率(nPNA)和血浆白蛋白(Alb)、残余肾小球滤过率(rGFR)、PDV及单位BSA透析剂量(PDV/BSA)改变及彼此间相互关系。结果:1 650检测中,透析不充分391例次,占23.7%。分析三组患者除尿素Kt/V、Ccr及nPNA有明显差异外,透析充分组无论是尿量(UV)及rGFR均明显高于其它两组,各组间亦有明显差异(P<0.01);以PDV/BSA为单位计算透析剂量,并以此判断与Kt/V、Ccr及nPNA之间相关性,较PDV更具有统计学意义(P<0.01);透析充分组患者rGFR明显高于其它组(P<0.01),而PDV/BSA明显少于其它各组(P<0.01);按rGFR分组观察同样显示不同RRF所需透析剂量差异有显著统计学意义(F=189.3,P<0.01);探讨rGFR与PV/BSA的相关性发现,两者间的相关系数可以用以下公式表达:PV/BSA=4277.0-123.7×rGFR(r=-0.58,P<0.01)。由此得到PD患者个体化透析剂量的计算公式:PDV(L/d)=(4.4-0.15×rGFR)×BSA。结论:所有PD患者应根据RRF及BSA状态来计算透析剂量。这种个体化透析方案不仅可以最大程度地发挥RRF在PD中的优势,还可以节约透析液用量,减少患者的经济开支。
OBJECTIVE: To retrospectively analyze the correlation between dialysate dosage (PDV) and residual renal function (RRF) and body surface area (BSA) in patients undergoing peritoneal dialysis (PD) Characteristics of the dialysate dose calculation method. Methods: One hundred and forty-four patients underwent a median of 1650 dialysis sessions of 14.8 months (6 to 161 months). According to the 2006 NKF-K / DOQI criteria, the patients were divided into three groups: full, critical and inadequate. Urea Kt / V, creatinine clearance rate (CCr), protein performance (nPNA) and plasma albumin (Alb) , Residual glomerular filtration rate (rGFR), changes in PDV and unit BSA dialysis dose (PDV / BSA) and their relationship to each other. Results: Of the 1 650 tests, dialysis was inadequate for 391 episodes, accounting for 23.7%. Analysis of three groups of patients with significant differences in urine Kt / V, Ccr and nPNA, the dialysis group, both urine volume (urine) and rGFR were significantly higher than the other two groups, there were significant differences (P <0.01) ; Calculated dialysis dose in PDV / BSA, and in order to determine the correlation with Kt / V, Ccr and nPNA, more statistically significant than PDV (P <0.01); rGFR was significantly higher in patients with dialysis adequacy group than the other (P <0.01), and PDV / BSA was significantly less than other groups (P <0.01). According to the rGFR group, the differences in the dialysis doses required by different RRFs were also statistically significant (F = 189.3, P <0.01) ; The correlation between rGFR and PV / BSA was explored. The correlation coefficient between the two can be expressed as follows: PV / BSA = 4277.0-123.7 × rGFR (r = -0.58, P <0.01). The calculation of the individual dialysis dose for PD patients is thus obtained: PDV (L / d) = (4.4-0.15 × rGFR) × BSA. Conclusion: All PD patients should calculate the dialysis dose based on the RRF and BSA status. This personalized dialysis program not only maximizes the advantages of RRF in PD, but also saves dialysate usage and reduces patient financial costs.