nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/1680-4422-2017-4-499-511nid-412Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДвойной короткий тест перитонеального равновесия (двойной мини-РЕТ) в оценке функции перитонеальной мембраны и влияющие на нее факторыDouble mini peritoneal equilibration test equilibration test (mini-PET) in evaluation of peritoneal membrane function and its determinantsСалиховаК. А.SalikhovaK. A.noemail@neicon.ruКостылеваТ. Г.KostylevaT. G.noemail@neicon.ruАндрусевА. М.AndrusevA. M.noemail@neicon.ruГерасимчукР. П.GerasimchukR. P.noemail@neicon.ruСабодашА. Б.SabodashA. B.noemail@neicon.ruЭйдельшейнВ. А.EidelshteinV. A.noemail@neicon.ruЗемченковА. Ю.ZemchenkovA. Yu.kletk@inbox.ruРумянцевА. Ш.RumyanstevA. Sh.noemail@neicon.ruББраун Авитум Руссланд КлиниксРоссияBBraun Avitum Russland ClinicsRussian FederationСПб ГБУЗ "Городская Мариинская больница" - Городской нефрологический центрРоссияCity Mariinsky hospital - City nephrology centerRussian FederationМосковский государственный медико-стоматологический университет им. А.И. Евдокимова; ГБУЗ "ГКБ №52 Департамента здравоохранения г. Москвы"РоссияA.I. Evdokimov Moscow State University of Medicine and Dentistry; Moscow City Hospital 52Russian FederationСПб ГБУЗ "Городская Мариинская больница" - Городской нефрологический центр; Северо-Западный ГМУ им. И.И. МечниковаРоссияCity Mariinsky hospital - City nephrology center; North-Western State medical university n.a.I.I.MechnikovRussian FederationББраун Авитум Руссланд Клиникс; Первый СПб ГМУ им. акад. И.П. ПавловаРоссияBBraun Avitum Russland Clinics; First St.-Petersburg State medical university n.a. I.P. PavlovRussian FederationСПб ГБУЗ "Городская Мариинская больница" - Городской нефрологический центр; Северо-Западный ГМУ им. И.И. Мечникова; Первый СПб ГМУ им. акад. И.П. ПавловаРоссияCity Mariinsky hospital - City nephrology center; North-Western State medical university n.a.I.I.Mechnikov; First St.-Petersburg State medical university n.a. I.P. PavlovRussian FederationПервый СПб ГМУ им. акад. И.П. Павлова; Санкт-Петербургский государственный университетРоссияFirst St.-Petersburg State medical university n.a. I.P. Pavlov; Saint-Petersburg state universityRussian Federation201716082024194499511Copyright © Салихова К.А., Костылева Т.Г., Андрусев А.М., Герасимчук Р.П., Сабодаш А.Б., Эйдельшейн В.А., Земченков А.Ю., Румянцев А.Ш., 20242024Салихова К.А., Костылева Т.Г., Андрусев А.М., Герасимчук Р.П., Сабодаш А.Б., Эйдельшейн В.А., Земченков А.Ю., Румянцев А.Ш.Salikhova K.A., Kostyleva T.G., Andrusev A.M., Gerasimchuk R.P., Sabodash A.B., Eidelshtein V.A., Zemchenkov A.Y., Rumyanstev A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/412

Введение: функция перитонеальной мембраны с течением времени изменяется, затрудняя достижение важнейшего компонента адекватности диализа - состояния эуволемии. Важными причинами этого могут быть перитониты и глюкозная нагрузка. Современные функциональные тесты позволяют оценить динамику транспорта воды через мембрану и предсказать прогрессирование субмезотелиального фиброза. Методы: срезовое обследование 46 неотобранных пациентов одного центра (возраст 59±16 лет, срок диализа 35±34 месяца) явилось стартом проспективного исследования. Функция мембраны оценена в двойном мини-PET (в двух одночасовых обменах с растворами 4,25% и 1,5% глюкозы). Нагрузка глюкозой оценена как масса глюкозы, введенной в перитонеальную полость за время лечения, по истории режимов диализа суммарно и в расчете на месяц. Результаты: общая ультрафильтрация составила 562±199 мл, в т.ч. транспорт свободной воды (ТСВ) - 171±68 мл, транспорт воды по малым порам - 391±161 мл. Осмотическая проводимость по глюкозе (ОПГ) составила 5,38±2,88 мкл/мин/ммHg. При большем сроке диализа меньшими были ТСВ (-16 мл/год) и ОПГ (-0,233 мкл/мин/ммHg/год), большим - коэффициент массо-переноса по креатинину (MTAC-Cr) (+1,2 мл/мин/год). По мере увеличения суммарной глюкозной нагрузки достоверно снижается ТСВ, но для среднемесячной глюкозной нагрузки связь сохранялась только в подгруппах без перитонитов и с нагрузкой выше медианы (2,72 кг/мес). В моделях множественной регрессии большая суммарная нагрузка (но не срок диализа) была связана с меньшим ТСВ (-4,9 мл/[10 кг]) для всей группы. В подгруппе со среднемесячной нагрузкой выше медианы, напротив, больший срок диализа (но не суммарная нагрузка) был связан с меньшим ТСВ (-24 мл/[1 год ПД]). Заключение: продемонстрирована связь транспорта свободной воды со сроком диализа, перенесенными перитонитами и глюкозной нагрузкой, но её характер требуется уточнять в продолжительных исследованиях.

Introduction: the function of the peritoneal membrane can deteriorate over time. Peritonitis and glucose overload may be the important reasons. Contemporary functional tests are able to evaluate the fluid transport characteristics. Its alteration can predict submesotelial fibrosis progression. Methods: the cross-sectional study in 46 unselected patients from one center (female - 54%, age 59±16) with PD vintage of 35±34 months is the start of prospective observational study. The peritoneal membrane function was assessed with double mini-PET (two 1-hour exchange with 4.25% and 1.5% glucose). The glucose load was evaluated as the total mass of glucose flooded in cavity according PD-regimen per month and totally. Results: the total ultrafiltration was 562±199 ml including free water transport (FWT) - 171±68 ml and water transport through small pores 391±161 ml. The osmotic conductance to glucose (OCG) was 5.38±2.88 μl/min/mmHg. The longer PD time was linked with lower FWT (-16 ml/year) and OCG (-0.233 μl/min/mmHg/year) and with higher MTAC-Cr (+1.2 ml/min/year). FWT was inversely linked with the total glucose load, but for monthly load such association was significant only for subgroups without history of peritonitis or with monthly load higher than median (2.72 kg/mo). In multivariate regression models FWT was predicted by total glucose load (-4.8 mL/[10 kg], p=0,002) (but not monthly load) for whole group. In the subgroup with monthly load higher than median the dialysis duration (but not total glucose load) was inversely linked with FWT (-24 ml/1 year). Conclusion: the discrepancy in fluid and solute transport parameters under impact of different factors require more longitudinal studies to improve the prognosis evaluation for UFF and submesothelial fibrosis.

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The authors declare that there are no conflicts of interest present.