Analysis Of The Related Factors Of Ultrafiltration In Peritoneal Dialysis Patients

Objective:Peritoneal dialysis,as a common clinical renal replacement therapy,is one of the main treatments for patients with end-stage renal disease.Ultrafiltration refers to the process of water clearance in peritoneal dialysis treatment,which is a way to reduce the volume load of patients.Ultrafiltration can be affected by a variety of factors in peritoneal dialysis patients,such as the function of patients’peritoneal transport,the number of dialysate bags with different concentrations of glucose,and nutritional status,etc.The factors affecting the ultrafiltration of peritoneal dialysis were retrospectively studied in this article,aiming to provide reference for the maintenance of ultrafiltration function and the control of volume load in peritoneal dialysis patients,so as to improve the survival of peritoneal dialysis patients.Methods:A total of 150 patients who were followed up in the Peritoneal Dialysis Center of the Second Affiliated Hospital of Dalian Medical University and hospitalized in the Department of Nephrology from August 2014 to December 2020 were selected.The basic data of these 150 patients during this period and the examination results of indicators which related to peritoneal dialysis,residual renal function,metabolites,nutritional status,hypertension,diabetes,anemia,blood electrolytes were analyzed retrospectively.According to the median of the patients’ultrafiltration,the selected patients were divided into two groups:group 1:ultrafiltration<550ml,group 2:ultrafiltration≥550ml.To observe whether there were statistical differences in factors such as age,gender,and body mass index between the two groups.The correlation analysis between all the research variables and ultrafiltration was carried out one by one,and then the factors related to ultrafiltration in the single-factor correlation analysis were included as independent variables into the multiple linear regression analysis to explore the influencing factors of ultrafiltration in the treatment of peritoneal dialysis.Results:In terms of basic data,there were statistical differences in gender((?)~2=5.203,P=0.023)and dialysis duration(Z=-3.184,P=0.001)between the two groups of patients.There were statistical differences in weekly total urea clearance index(Z=-1.991,P=0.047),total creatinine clearance rate(Z=-3.637,P<0.001),4-hour corrected creatinine to 2-hour serum creatinine ratio(4h D/Pcr)(Z=-2.648,P=0.008),the number of high concentration glucose dialysate bags(including 2.5%and 4.25%glucose dialysate)(Z=4.741,P<0.001)and dialysis methods(continuous ambulatory peritoneal dialysis/day ambulatory peritoneal dialysis)((?)~2=4.168,P=0.041)in peritoneal dialysis related indicators between two groups.There were statistical differences in related indicators of residual renal function in the two groups such as the weekly residual renal urea clearance index(Z=-4.466,P<0.001),residual renal creatinine clearance(Z=-4.530,P<0.001)and urine output(Z=-4.706,P<0.001).There was statistical difference in serum creatinine(t=-3.918,P<0.001)in the related indexes of metabolites between two groups.The nutritional status related indicators showed statistical differences in albumin(Z=-2.010,P=0.044)between two groups.Hypertension related indicators showed statistical differences in systolic blood pressure(Z=-2.066,P=0.039),the use of angiotensin converting enzyme inhibitors or angiotensin II receptor blockers(with/without)((?)~2=9.793,P=0.002)between two groups.Blood electrolyte related indicators showed statistical differences in the use of active vitamin D(with/without)((?)~2=6.757,P=0.009)between two groups.The single factor correlation analysis found:body mass index(r=0.182,P=0.026),duration of dialysis(r=0.344,P<0.001),the number of dialysate bags with high concentration glucose(r=0.457,P<0.001)were positively correlated with ultrafiltration.Urine volume(r=-0.465,P<0.001),weekly residual renal urea clearance index(r=-0.484,P<0.001),weekly total urea clearance index(r=-0.249,P=0.002),residual renal creatinine clearance rate(r=-0.474,P<0.001),total creatinine clearance rate(r=-0.422,P<0.001),the ratio of 4-hour corrective creatinine in peritoneal dialysate to 2-hour serum creatinine(4h D/Pcr)(r=-0.167,P=0.041)were negatively correlated with ultrafiltration.The patients who were female(r=0.191,P=0.019),used daytime ambulatory peritoneal dialysis(r=0.177,P=0.030)or used angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers(r=0.225,P=0.006)had higher ultrafiltration.Multivariate linear regression analysis found that the ratio of 4-hour corrective creatinine in peritoneal dialysate to 2-hour serum creatinine(4h D/Pcr),the number of dialysate bags with high concentration glucose and the dialysis method were the main factors affecting the ultrafiltration in peritoneal dialysis patients.Conclusion:This study suggests that the ratio of 4-hour corrective creatinine in peritoneal dialysate to 2-hour serum creatinine(4h D/Pcr),the number of dialysate bags with high concentration glucose and the dialysis method are all factors that affect the ultrafiltration of peritoneal dialysis.Therefore,care should be taken to protect the peritoneal transport function in clinical work.According to the patient’s own condition and residual renal function,an appropriate amount of high-concentration glucose peritoneal dialysate should be used and the peritoneal dialysis method should be reasonably selected to protect the patient’s peritoneal ultrafiltration function.