장기 지속성 외래 복막투석 환자에서 복막기능 변화에 영향을 미치는 인자

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 w as 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 w as significantly higher (p<0.001, p<0.001, respectively ) and the duration of peritoneal dialysis w as 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) w as 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). T he 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.