Korean Journal of Nephrology 2002;21(1):74-85.

원저 : 장기 지속성 외래 복막투석 환자에서 복막기능 변화에 영향을 미치는 인자 (Original articles : Clinical Factors Affecting Peritoneal Membrane Function in Long - Term Continuous Ambulatory Peritoneal Dialysis Patients)

한승혁(Seung Hyeok Han), 이상철(Sang Cheol Lee), 구영석(Youn g Seok Goo), 강이화(Ehw a Kang), 박형천(Hyung Chun Park), 노현정(Hyun Jeong Roh), 윤수영(Soo Young Yoon), 죄소래(So Rye Choi), 윤도식(Do Sik Yun), 강신욱(Shin Wook Kang), 최규헌(Kyu Hun Choi), 한대석(Dae Suk Han), 이호영(Ho Yun g Lee)

Abstract

Background
: According to previous studies on peritoneal membrane function, solute transport significantly increased 3 years after the begining of peritoneal dialysis. However, there were only few reports regarding the change of peritoneal membrane function in long-term CAPD patients in Korea.
Methods
: Clinical factors affecting peritoneal membrane function were analyzed, in patients who maintained CAPD more than 5 years. 124 patients performed peritoneal equilibration test(PET) 5 years after CAPD were included. Cross sectional study was performed to know the differences of clinical characteristics among 4 types of peritoneal membrane transport characteristics based on PET. Also, clinical factors affecting peritoneal memebrane function were analyzed in 31 patients who had undertaken PET initially and 5 years after the beginning of CAPD. Results : D/P Cr was the highest(p<0.001) and ultrafiltration was the lowest(p=0.011) in high transport group. Also, the number of hypertonic glucose exchanges(more than 2.5%) per day was the highest (p=0.02), and serum albumin was the lowest(p<0.001) in this group. 17 patients were included in ultrafiltraion failure group. D/P Cr and the number of hypertonic glucose exchanges was significantly higher (p<0.001, p<0.001, respectively) and the duration of peritoneal dialysis was significantly longer(p=0.033) in ultrafiltration failure group compared with the others. D/P Cr of 124 patients was well correlated with the number of peritonitis(γ=0.246, p=0.006), and the number of hypertonic glucose exchanges(γ=0.33, p<0.001), but inversely correlated with serum albumin(γ=-0.452, p<0.001) with the statistical significance. In 31 patients who undertook PET within 1 year after the begining of CAPD, although not significant, D/P Cr increased and ultrafiltration decreased after 5 years. A significant increase in D/P Cr(p=0.014) was seen in patients who experienced more than 2 episodes of peritonitis(n=14), compared with patients who experienced either peritonitis free or single episode of peritonitis(n=17). The linear regression analysis showed that the number of peritonitis and the number of hypertonic glucose exchanges per day were significantly correlated with the increased D/P Cr after 5 years(p=0.001, p=0.003, respectively). Conclusion : Clinical factors affecting peritoneal membrane function were the number of peritonitis, the use of hypertonic glucose exchanges and the duration of peritoneal dialysis. To preserve peritoneal membrane function, it is recommended to avoid hypertonic glucose exchanges and to reduce the number of peritonitis. (Korean J Nephrol 2002;21(1): 74-85)