Korean Journal of Nephrology 2001;20(4):639-644.

논평 : 점증적 복막투석에서 저분자량 용질과 중분자량 용질의 복막 청소율의 비교 (Editorial : Dissociation between Clearances of Small and Middle Molecules in Incremental Peritoneal Dialysis)

도정호(Jung Ho Do),김대중(Dae Joong Kim),최성철(Sung Chul Choi),한혁준(Hyeok Jun Han),정시정(Shi Jung Chung),박진아(Jin Ah Park),오동진(Dong Jin Oh),허우성(Woo Seong Huh),김윤구(Yoon Goo Kim),오하영(Ha Young Oh)

Abstract

Objective To evaluate the peritoneal clearance of the middle molecule compared with that of the small molecule in incremental peritoneal dialysis(PD). Methods: Peritoneal clearances of the creatinine and β2-microgloblulin were compared in 57 continuous ambulatory PD patients with full dose 4 times exchange and in 54 incremental PD patients with 2 or 3 times exchange over 24 hours. The clearances were also compared when there were changes in the peritoneal dialysis regimen such as in the number of exchanges and dwelling time. Results : Peritoneal creatinine clearance increased almost linearly along with the increase in the number of exchanges. In contrast, peritoneal clearance of β2-microglobulin was 9.1±3.6 L/week, 8.8±4.4 U week, and 7.9±2.5 L/week respectively with 2, 3 and 4 exchanges per day, not different from each other. Peritoneal clearance of 0z-microglobulin did not change when there was an increase in the number of exchange from 2 to 3 times and 3 to 4 times over a period of 24 hours, whereas the peritoneal clearance of creatinine increased. Peritoneal clearance of β2-microglobulin almost doubled from 5.4±2.7 L/ week with 2 times exchange over 12 hours per day, to 9.5±4.4 L/week with 2 times exchange over 24 hours, whereas the creatinine clearance did not change. Conclusion: In contrast to peritoneal clearance of small molecule which depends on the number of dialysate exchange, peritoneal clearance of middle molecule depends mainly on the total dwelling hours rather than the number of exchange per day in incremental PD. This can be another advantage of incremental PD since peritoneal clearance of middle molecules in incremental PD over 24 hours is com- parable to that in full dose PD.