지속성 외래 복막투석 환자에서 한외여과부전의 위험인자 및 임상양상; 투석 도관을 제거한 환자를 대상으로 시행한 환자-대조군 연구

Abstract

Purpose : Ultrafiltration (UF) failure is one of the most important causes of CAPD withdrawal accounting for up to 20% of CAPD catheter removal. Factors contributing to RF failure are; severe and multiple peritonitis, continuous exposure to nonphysiologic dialysis solution, and use of β-blockers. We evaluated clinical features of patients with UF failure and assessed the risk factors for UF failure in CAPD patients. Methods : CAPD data of our institution from Jan 1990 to Dec 2000 were anlayzed and a subgroup of 191 patients whose CAPD catheters were removed were collected. Nineteen patients, whose CAPD catheters were removed due to UF failure, were selected from the subgroup as the case group. Seventy six hospital controls without ultrafiltration failure matched for age, sex, and time of CAPD initiation who were currently maintained on CAPD were selected as the control group. Peritoneal equilibration test (PET) was done within 3 months of initiation of CAPD and at the diagnosis of UF failure, respectively. Peritoneal glucose load was estimated for the first twp years. Incidence of peritonitis, accumulated days of peritoneal inflammation (APID), causative organisms of peritonitis, and history of β-blocker use were evaluated. Peritoneal function was determined by daily net ulr\trafiltration and mass transfer area coefficient (MTAC) for creatinine. Serum albumin, normalized protein catabolic rate (nPCR) and Kt/V_urea were also evaluated. Results : There was no difference between cases and controls in etiology of ESRD, peritonitis incidence, APID and causative organisms of peritonitis. The case group included more high transporters at the time of the diagnosis of UF failure. The patients with UF failure showed lower nPCR and higher CRP than controls. Serum albumin level was similar at start of CAPD, but decreased faster in UF failure group. Use of β-blockers and decline in RRF were not different between the two groups. UF failure group had higher MTAC for creatinine and more peritioneal glucose load compared to conrtol group. By logistic regression analysis, peritoneal glucose load and incrernent in glucose load were independent factors associated with UF failure. Conclusion : Peritoneal glucose load and increment of glucose load were found to be important risk factors for UF failure in our study. Therefore, various efforts to reduce peritoneal glucose load in CAPD patients are needed for prevention of UF failure.