目的  临床上观察到少量腹膜透析患者可实现足量起始，逐渐减量，并以小剂量(透析剂量≤4 L/d)维持透析，本研究分析该部分患者的临床特点，探讨渐进减量腹膜透析的可行性及安全性。 方法 筛选 2012年1月—2018年12月于西安交通大学医学院第一附属医院腹膜透析中心置管并符合渐进减量至小剂量透析(以≤4 L/d维持6月以上)的患者，排除急性肾损伤、狼疮性肾炎、血管炎、梗阻性肾病患者。收集其基线肾功、尿量，计算基线(定义为透析1月时)、减量前(指减量至4 L/d前)，小剂量维持6月后(指≤4 L/d维持6月时)残余肾功能、腹膜透析充分性。 结果 共19例患者纳入研究，平均年龄(49.87±20.53)岁，女性11例，男性8例，进入透析时的中位估算肾小球滤过率(estimating glomerular filtration rate,eGFR)为6.87(4.98,9.44)ml/(min·1.73m2)。慢性肾小球肾炎8例，糖尿病肾病、高血压肾损害、间质性肾炎各3例、IgA肾病/紫癜性肾炎2例。16例患者起始腹膜透析剂量为6 L/d，3例患者起始剂量为8 L/d。减为小剂量(≤4 L/d)的中位时间为5.33(4.57,14.20)透析月，小剂量维持的中位时间为22.17(13.13,45.80)月。基线时残余肾功能为(4.95±2.04)ml/min，减量前残余肾功能为(7.85±2.78)ml/min，较基线升高(F=10.284,P=0.005)。减量前尿量较基线增加(F=7.374,P =0.015)。小剂量透析维持6月后总尿素清除指数(tKt/V)、总肌酐清除率(total creatinine clearance,tCCr)较减量前无明显变化(F=3.436、0.015,P=0.082、0.904)。 结论  少量慢性肾衰竭患者经足量透析后残余肾功能较前改善，在该部分患者中小幅渐进减少透析剂量至小剂量维持的方法安全有效。

Objective We have observed that the volume of dialysate exchange for peritoneal dialysis (PD) can be started at a full dose, and then is gradually reduced and maintained at a lower dose (dialysate≤4 L/day) in a small group of PD patients. This study analyzes the clinical characteristics of these patients and discusses the feasibility and safety of decremented PD. Methods  Patients who initiated PD between January 2012 to December 2018 in our PD center and satisfied the criterion of decremented PD (maintained the PD at ≤4L/day for >6 months) were included in this study. Acute kidney injury, lupus nephritis, vasculitis, and obstructive nephropathy were excluded in these patients. Baseline renal function and urinary volume were collected. Residual renal function (RRF) and peritoneal permeability were calculated at baseline (within one month of PD), before the decrement (the time before decrement to 4 L/day), and after the decrement (maintenance of ≤4L/day for 6 months). Results A total of 19 patients were included, including 11 females and 8 males with a mean age of 49.87±20.53 years. The median estimating glomerular filtration rate (eGFR) before PD was 6.87 (4.98, 9.44) ml/min1.73m2. The primary renal diseases were chronic glomerulonephritis (8 case) diabetic nephropathy (3 cases), hypertensive renal impairment (3 cases), interstitial nephritis (3 cases), and IgA nephropathy/purpura nephritis (2 cases). The initial dialysate dose was 6L/day in 16 patients and 8L/day in 3 patients. The median period from the beginning to <4L/day was 5.33 (4.57, 14.20) months, and the median period to maintain the decremented PD was 22.17 (13.13, 45.80) months. RRF was 4.95±2.04 ml/min at baseline, and increased to 7.85±2.78 mL/min after PD but before decremented PD (F=10.284, P=0.005). Urinary volume also increased before decremented PD as compared with that at baseline (F=7.374, P=0.015). Total urea clearance (tKt/V) and total creatinine clearance (tCCr) had no differences between the values before decremented PD and after decremented PD for 6 months (F=3.436 and 0.015, P=0.082 and 0.904).  Conclusion  In a small group of PD patients, RRF can be slightly increased after adequate PD. In this group of patients, it is feasible and safe to gradually reduce the dialysate dose and maintain at a lower dose of PD.