维持性腹膜透析患者尿素清除指数达标现状及其与残余肾功能、临床状况的关系被引量：27

The status on achieving Kt/Vureas target and its relation with residual renal function and clinical characteristics of peritoneal dialysis patients

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摘要目的探讨目前中国部分地区腹膜透析患者尿素清除指数（Kt／Vureas）的达标情况及其与患者残余肾功能（RRF）和临床状况的关系。方法在中国不同城市的5家腹透中心进行横断面调查，入选2011年4月1日至2011年8月31日临床稳定在透3个月以上的完成透析充分性及生化评估结果的腹膜透析患者共681例，按照Kt／Vureas。是否达标及其中达标者按RRF的高低分组，比较人口学资料和临床指标。结果（1）所有患者的总Kt／Vureas为1．95±0．59，总Ccr为（63．80±30．84）L·周^-1·（1．73m^2）^-1，Kt／Vureas达标率为67．4％。（2）达标组女性居多，体格较小，RRF及尿量较好，血清钙磷水平、血清胆固醇及低密度脂蛋白、C反应蛋白及全身并发症方面均优于未达标患者（均P〈0．05）。（3）Kt／Vureas≥1．7且RRF≥2ml／min的患者（亚组1），血清白蛋白好于而炎性反应和并发症少于Kt／Vureas≥1．7但RRF〈2ml／min（亚组2）及Kt／Vureas〈1．7（亚组3）的患者（P〈0．05），而后两者临床指标比较发现，钙磷水平亚组2优于亚组3[血清钙：（2．22±0．21）mmol／L比（2．14±0．24）mmol／L，P〈0．01；血清磷：（1．43±0．47）mmol／L比（1．66±0．52）mmol／L，P〈0．01]，亚组3的胆固醇、低密度脂蛋白水平低于而高密度脂蛋白高于亚组2[胆固醇：（4．62±0．99）mmol／L比（4．91±1．29）mmol／L，P〈0．05；低密度脂蛋白：（1．13±0．61）mmol／L比（2．86±0．96）mmol／L，P〈0．01；高密度脂蛋白：（2．20±0．72）mmol／L比（1．08±0．33）mmol／L，P〈0．01]。（4）总Kt／Vureas与RRF呈正相关（R^2=0．317），RRF每下降1ml／min，Kt／Vureas不达标的风险增加40．3％。结论中国部分地区维持性腹膜透析患者的Kt／Vureas达标率约为67．4％；Kt／Vureas未达标者，及虽达标但残余肾功能较差的患者临床状况较差。RRF与Kt／Vureas呈正相关，是Kt／Vureas达标的保护因素。 Objective To explore the present status on achieving Kt/Vureas target in Chinese peritoneal dialysis （PD） patients and its relation with residual renal function （RRF） and clinical characteristics. Methods This was a cross-sectional study carried out in 5 PD centers in different area of China. Totally 681 clinical stable PD patients with durations〉3 months who completed dialysis adequacy and biochemical test during April 1^st, 2011 and August 31^st, 2011 were enrolled in this study. The demographic data and clinical characteristics were compared according to varied Kt/Vureas and RRF levels. Results （1）The total Kt/Vureas was 1.95±0.59, and total Ccr was （63.80±30.84） L·week^-1· （1.73 m^2）^-1 for the whole group, there were 67.4% subjects achieving the Kt/Vureas target. （2） Patients achieving Kt/Vureas target were prone to be female and had smaller size with higher RRF and urine volume （P 〈 0.05）. The serum calcium and phosphorus were controlled well in these patients （P 〈 0.05）. They also had better higher cholesterol and low-density lipoprotein, and lower CRP level and less complications （P 〈 0.05）. （3）Serum albumin was higher but inflammation and complications were less in patients with Kt/Vureas value≥ 1.7 and RRF≥2 ml·min-1· （1.73 m^2）^-1（subgroup 1）, as compared to those with Kt/Vureas〉1.7 but RRF〈2 ml·min-1· （1.73 m^2）^-1（subgroup 2） and those with Kt/Vureas〈 1.7 （subgroup 3）（P 〈 0.05）. The subgroup 2 and 3 were statistically different in these clinical indices, serum calcium [（2.22±0.21） mmol/L vs （2.14±0.24） mmol/L, P 〈 0.01], serum phosphorous [（1.43±0.47） mmol/L vs （1.66±0.52） mmol/L, P 〈 0.01], cholesterol [（4.91±1.29） mmol/L vs （4.62±0.99） mmol/L, P 〈 0.05], low-density lipoprotein [（2.86±0.96） mmol/L vs （1.13±0.61） mmol/L, P 〈 0.01], high-density lipoprotein [（1.08 ± 0.33） mmol/L vs （2.20 ± 0.72） mmol/L, P 〈 0.01]. （4）The Kt/Vureas. was positively correlated with RRF （R^2= 0.317）; if RRF decreased 1 ml/min, the hazard of Kt/Vureas： un- targeting increased 40.3%. Conclusions About 67.4% of PD patients can reach the Kt/V target recommended by K/DOQI. RRF makes a great contribution to Kt/Vureas target. The clinical characteristics are poorer in patients who can not achieve the Kt/Vureas,o, target, or with worse RRF.

作者田娜陈孟华董捷许戎赵慧萍朱彤莹任野平王梅郝传明王琴王海燕

机构地区宁夏医科大学总医院肾内科北京大学第一医院肾内科北京大学肾病研究所卫生部肾病重点实验室教育部慢性肾脏病防治重点实验室北京大学人民医院肾内科复旦大学华山医院肾内科哈尔滨医科大学附属第二医院肾内科

出处《中华肾脏病杂志》 CAS CSCD 北大核心 2014年第2期92-98,共7页 Chinese Journal of Nephrology

基金志谢感谢ISNGOR＆P委员会及Renal Baxter Grant（中国百特）的基金支持

关键词腹膜透析残余肾功能临床状况尿素清除指数 Peritoneal dialysis Residual renal function Clinical status Kt/V

分类号 R459.5 [医药卫生—治疗学]

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1Lo W K, Bargman J M, Burkart J, et al. Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis[J]. Perit Dial Int, 2006, 26: 520-522.
2Nakamoto H, Kawaguchi Y, Suzuki H. Is technique survival on peritoneal dialysis better in Japan?[J]. Petit Dial Int, 2006, 26: 136-143.
3Carvalho MJ, Rodrigues A. Importance of residual renal function and peritoneal dialysis in anuric patients[J]. Contrib Nephrol, 2009, 163: 155-160.
4Fried L, Hebah N, Finkelstein F, et al. Association of Kt/V and creatinine clearance with outcomes in anuric peritoneal dialysis patients[J]. Am J Kidney Dis, 2008, 52:1122-1130.
5Wang AY, Sea MM, Ip R, et al. Independent effects of residual renal function and dialysis adequacy on actual dietary protein, calorie, and other nutrient intake in patients on continuous ambulatory peritoneal dialysis[J]. J Am Soc Nephrol, 2001, 12: 2450-2457.
6Dittrich E, Puttinger H, Schillinger M, et al. Effect of radio contrast media on residual renal function in peritoneal dialysis patients- a prospective study[J]. Nephrol Dial Transplant, 2006, 21: 1334-1339.
7Enia G, Sicuso C, Alati G, et al. Subjective global assessment of nutrition in dialysis patients[J]. Nephrol Dial Transplant, 1993, 8: 1094-1095.
8Jang SH, Chea JW, Lee KB. Charlson comorbidity index using administrative database in incident PD patients[J]. Clin Nephrol, 2010, 73: 204-209.
9Rocco MY, Frankenfield DL, Prowant B, et al. Response to inadequate dialysis in chronic peritoneal dialysis patients. Results from the 2000.Centers for Medicare and Medicaid (CMS) ESRD Peritoneal Dialysis Clinical Performance Measures (PD- CPM) Project[J]. Am J Kidney Dis, 2003, 41: 840-848.
10Bargman JM, Thorpe KE, Churchill DN. Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study[J]. J Am Soe Nephrol, 2001, 12: 2158-2162.