Clinical Experience of One-Year Icodextrin Treatment in Peritoneal Dialysis Patients

使用ICODEXTRIN腹膜透析液的一年臨床經驗

許君碩(Chun-Shuo Hsu) ； 蘇鍵育(Chien-Yu Su) ； 張智鴻(Chih-Hung Chang) ； 許國泰(Kao-Tai Hsu) ； 林景坤(King-Kwan Lam) ； 廖上智(Shang-Chih Liao) ； 陳德全(Te-Chuan Chen) ； 李志雄(Chih-Hsiung Lee) ； 陳靖博(Jin-Bor Chen) ； 鄭本忠(Ben-Chung Cheng) ； 李建德(Chien-Te Lee)

《Acta Nephrologica》 24卷3期 (2010/07) Pp. 133-137

摘要

背景：Icodextrin是一種高分子量糖聚合物，特別適用於透析液需要長時間滯留的腹膜透析。為了研究它對於透析的足量及分子的動力學的影響，我們研究這一年來的觀察成果。
方法：我們評估使用平均使用icodextrin達16個月的腹膜透析病人。Icodextrin使用的基礎值，使用後6個月及12個月的血壓，體重，血清中的白蛋白，脂肪狀態，電解質，脫水量，腹膜平衡測試(PET)，腹膜透析適量的指標（包括weekly Kt/V, CCR, nPCR），殘餘功能的變化情形，給予記錄並比較。對於使用時所產生的不良反應也加以記錄。
結果：每袋icodextrin透析液的平均脫水量為621±286mL；統計學分析顯示icodextrin不會影響體重及血壓（包括：收縮壓和舒張壓）。腹膜透析治療的每日脫水量在icodextrin使用後並無顯著改變，這一年的期間，殘餘腎絲球過濾率與整體的肌酸酐清除率逐漸下降但是Kt/V沒有顯著改變。nPCR在6個月及12個月期間顯著增加。血清中白蛋白保持一定並沒有受到icodextrin使用而有所影響。空腹血糖值在6個月及12個月持續下降。三酸甘油脂在使用icodextrin後6個月下降最顯著。血清鈉離子沒有顯著改變；但是鉀離子有微幅增加。大部份病人的腹膜功能PET在使用icodexrtin後仍保持一樣。本研究沒有發現嚴重的不良反應。
結論：Icodextrin能有效增加腹膜透析的脫水量。含有icodextrin的透析液能夠降低血糖及三酸甘油脂。腹膜功能在一年icodextrin的治療中並無顯著改變。Icodextrin的使用能夠改善蛋白質的攝取量且會增加血清鉀離子的濃度。

關鍵字

Icodextrin ； 腹膜透析 ； 代謝反應 ； 脫水量

並列摘要

Background: icodextrin is a glucose polymer dialysate of high molecular weight indicated specifically for use as an alternative during the long-dwell exchange in peritoneal dialysis (PD). To investigate its influence on PD therapy, a one-year observational study was conducted.
Methods: We evaluated the effects of icodextrin PD solution in 34 stable PD patients after a mean treatment period of 16 months. Their blood pressure, body weight, serum albumin, lipid profile, electrolyte, amount of ultrafiltration (UF), peritoneal equilibration test (PET), total dialysis clearance (weekly Kt/V and creatinine clearance), residual renal function at baseline, and after 6 and 12 months of icodextrin treatment were recorded and compared. Adverse treatment-related reactions were also collected.
Results: Icodextrin indwell achieved an average UF amount of 621±286 mL per bag. The body weight, blood pressure, and daily UF amount did nor change significantly after usage of icodextrin. Within a one-year period, there was a significant reduction in weekly creatinine clearance and amount of urine. nPCR was increased significantly at 6-and 12-month intervals. The fasting serum glucose and triglyceride levels decreased at 6-month interval but only glucose level continued to decline at 12-month interval. Mild elevation of serum potassium level was noted after icodextrin treatment. Most patients' PET remained essentially the same after icodextrin use. No major adverse reaction was reported.
Conclusion: Icodextrin-based peritoneal solution could lower plasma sugar and triglyceride levels. It also improved protein intake and increased serum potassium level. There was no significant change in peritoneal transport function during one-year icodextrin treatment.

並列關鍵字

Icodextrin ； periloneal dialysis ； metabolic effects ； ultrafiltration