残余肾功能对慢性血液透析患者整体营养状况的影响。

The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients.

作者信息

Suda T, Hiroshige K, Ohta T, Watanabe Y, Iwamoto M, Kanegae K, Ohtani A, Nakashima Y

机构信息

Second Department of Internal Medicine, School of Medicine, University of Environmental and Occupational Health, Fukuoka, Japan.

出版信息

Nephrol Dial Transplant. 2000 Mar;15(3):396-401. doi: 10.1093/ndt/15.3.396.

DOI:10.1093/ndt/15.3.396

PMID:10692527

Abstract

BACKGROUND

The benefits of residual renal function (RRF) in peritoneal dialysis patients have been described frequently. However, previous reports have shown that RRF diminished faster in haemodialysis (HD) patients than in peritoneal dialysis patients, and in most of the studies in HD patients, RRF was ignored. In this study, the RRF in chronic HD patients was studied to assess its impact on patients' nutritional status.

METHODS

In 41 chronic HD patients with at least a 2-year history of HD treatment, RRF was determined by a urine collection for 7 consecutive days. Nutritional parameters, such as percentage body fat, fat-free mass index, serum albumin concentration and normalized protein catabolic rate, were also measured.

RESULTS

In all 41 patients, mean weekly total Kt/V urea was 4.88 and renal Kt/V urea was 0.65. RRF was well correlated with serum albumin concentration, but dialysis Kt/V urea was not. One year after the start of this study, RRF and nutritional indices were re-examined and patients were classified into two groups: with RRF, preserved residual renal diuresis over 200 ml/day (mean, 720 ml; range, 230-1640 ml), N=23; and without RRF, persistent anuria (mean, 51 ml; range, 0-190 ml), N=18. At the start of this study, the mean serum albumin concentration and mean normalized protein catabolic rate in patients with RRF were 3.84 g/dl and 1.16 g/kg/day, respectively, which were significantly higher than those in patients without RRF (P=0.02 and P=0.0002, respectively), despite total (renal+dialysis) Kt/V urea being equal in both groups. During the 1-year study period, there was no significant change in total Kt/V urea in either group. Mean serum albumin concentration increased to 4.05 g/dl in patients with RRF, but did not change significantly (from 3.66 to 3.62 g/dl) in patients without RRF. The same trend was observed in all other parameters.

CONCLUSION

Over half of our HD patients had sufficient RRF. RRF itself may have a beneficial effect on nutritional parameters, and it is important to determine RRF over time, even in chronic HD patients.

摘要

背景

腹膜透析患者残余肾功能（RRF）的益处已被频繁描述。然而，既往报道显示，血液透析（HD）患者的RRF下降速度比腹膜透析患者更快，并且在大多数针对HD患者的研究中，RRF被忽视了。在本研究中，对慢性HD患者的RRF进行了研究，以评估其对患者营养状况的影响。

方法

在41例具有至少2年HD治疗史的慢性HD患者中，通过连续7天收集尿液来测定RRF。还测量了营养参数，如体脂百分比、去脂体重指数、血清白蛋白浓度和标准化蛋白分解代谢率。

结果

在所有41例患者中，平均每周总Kt/V尿素为4.88，肾脏Kt/V尿素为0.65。RRF与血清白蛋白浓度密切相关，但透析Kt/V尿素与血清白蛋白浓度无关。在本研究开始1年后，对RRF和营养指标进行重新检查，并将患者分为两组：有RRF组，残余肾利尿超过200 ml/天（平均720 ml；范围230 - 1640 ml），N = 23；无RRF组，持续无尿（平均51 ml；范围0 - 190 ml），N = 18。在本研究开始时，有RRF患者的平均血清白蛋白浓度和平均标准化蛋白分解代谢率分别为3.84 g/dl和1.16 g/kg/天，显著高于无RRF患者（分别为P = 0.02和P = 0.0002），尽管两组的总（肾脏 + 透析）Kt/V尿素相等。在1年的研究期间，两组的总Kt/V尿素均无显著变化。有RRF患者的平均血清白蛋白浓度升至4.05 g/dl，但无RRF患者的平均血清白蛋白浓度无显著变化（从3.66 g/dl降至3.62 g/dl）。所有其他参数也观察到相同趋势。