References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

nid-432

Research Article

ОРИГИНАЛЬНЫЕ СТАТЬИ

ORIGINAL ARTICLES

Новый адаптированный режим перитонеального диализа

New adapted modality of peritoneal dialysis

Шутов

Е. В.

Shutov

E. V.

shutov_e_v@mail.ru

Исачкина

А. Н.

Isachkina

A. N.

noemail@neicon.ru

Зайцев

В. В.

Zaytsev

V. V.

noemail@neicon.ru

Лобов

Г. И.

Lobov

G. I.

noemail@neicon.ru

Горелова

Е. А.

Gorelova

E. A.

noemail@neicon.ru

Российская Медицинская Академия последипломного ОбразованияРоссияRussian Medical Academy of Postgraduate EducationRussian Federation

Северо-Западный государственный медицинский университет им. И.И. МечниковаРоссияI.I. Mechnikov North-Western State Medical UniversityRussian Federation

Институт физиологии им. И.П. Павлова РАНРоссияPavlov Institute of Physiology, Russian Academy of SciencesRussian Federation

ГКБ им. С.П. БоткинаРоссияS.P. Botkin City Clinical Hospital of Healthcare Department of MoscowRussian Federation

2016

19082024

182178185

2024

Шутов Е.В., Исачкина А.Н., Зайцев В.В., Лобов Г.И., Горелова Е.А.

Shutov E.V., Isachkina A.N., Zaytsev V.V., Lobov G.I., Gorelova E.A.

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/432

Стандартным режимом перитонеального диализа (СРПД) является 4-5-разовый обмен диализного раствора (ДР) с короткими временными интервалами между обменами (4-5 часов) и 1 обменом ночью (8-9 часов) с применением глюкозо-содержащих растворов. Цель исследования: изучить влияние нового адаптированного режима перитонеального диализа (АРПД): двух обменов (через 3 часа) и двух (через 9 часов) на транспортные свойства брюшины и адекватность. Материал и методы: данное исследование было рандомизированным, открытым, проспективным, локальным и сравнительным. В исследование было включено 90 пациентов: 45 пациентов получали АРПД и 45 пациентов получали СРПД в течение 6 месяцев. У больных определяли недельный KT/V, объем ультрафильтрации (УФ), перитонеальный клиренс электролитов каждые 3 месяца. Исследование завершило 80 человек. Результаты: KT/V в группах больных на АРПД и на СРПД значимо не изменился. УФ в группе больных на АРПД осталась без изменений, в то время как у больных на СРПД обьем УФ к 6мес достоверно снизился с 1,37±0,5 до 1,21±0,4 л (р<0,05). Отношение концентрации креатинина в диализате к концентрации в крови (D/Pкреат) у больных на СРПД увеличилось с 0,74±0,04 до 0,78±0,04 (р<0,05), у больных на АРПД изменений не произошло. Удаление Na у больных на АРПД оказалось достоверно выше (151,9±53,0 ммоль/24ч), чем в группе на СРПД (88,48±42 ммоль/24 ч). У больных на АРПД к концу исследования АД не изменилось, тогда как у больных на СРПД систолическое и диастолическое АД достоверно увеличились (со 129,1±15,5 до 132,14±14,5 мм рт.ст.; с 75,5±9,7 до 79,6±8,0 мм рт.ст., соответственно). Заключение: применение АРПД позволяет уменьшить негативное влияние ДР на брюшину. При АРПД удаляется больше натрия с диализатом, АД сохраняется неизменным в динамике, в то время как при СРПД отмечается увеличение АД. Использование АРПД позволяет пациенту использовать большой дневной период без обмена для лучшей социальной реабилитации.

Aim of the study: we investigated the influence of the new (adaptive) regime of peritoneal dialysis (ARPD): two short dwell times (3 hours) and two long dwell times (9 hours) on the transport properties of the peritoneum and adequacy treatment. Material and methods: this study was a randomized, open, prospective, comparative and local. Ninety patients were studied: 45 patients had their treatment with ARPD and 45 patients received a standard treatment with SRPD for 6 months. We measured peritoneal KT/V urea, volume ultrafiltration (UF), D/Pcreat, and removal of sodium through the peritoneum. Those parameters were monitored every 3 months. Eighty patients out of 90 randomized completed the study. Results. KT/Vurea in patients on both regimens did not change significantly. UF in the group on ARPD remained unchanged, while UF in patients on SRPD substantially reduced from 1.37±0.5 to 1.21±0.4l (p<0.05). D/Pcreat increased from 0.74±0.04 to 0.78±0.4 (p<0.05) in patients on SRPD after 6 months, but did not change in patients on ARPD. Sodium removal in patients on ARPD was much higher (151.9 ±53.0 mmol/24h) than in the group on SRPD 88.48±42 mmol/24h (p<0.05). After 6 months BP did not change greatly in patients on ARPD, whereas systolic and diastolic BP increased substantially in patients on SRPD (from 129.1±15.5 to 132.14±14.5 mmHg; from 75.57±9.7 to 79.6±8.0 mmHg, respectively). Conclusion: the application of ARPD reduces the negative effects of dialysis solution on peritoneum. The highest removal of sodium in patients on ARPD rather than on SRPD can explain the changes in BP, ARPD allows patients to use daytime (without changes) for their better rehabilitation.

перитонеальный диализобъем ультрафильтрацииадекватностьнатрийperitoneal dialysissodiumvolume of ultrafiltrationadequacy

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