Shemin D, Bostom A G, Lambert C, Hill C, Kitsen J, Kliger A S
Division of Renal Diseases, Rhode Island/Brown University School of Medicine, Providence, USA.
Perit Dial Int. 2000 Jul-Aug;20(4):439-44.
Residual renal function contributes importantly to total solute clearance in peritoneal dialysis (PD) patients. This study was designed to examine the progression of residual renal function over time and its impact on nutrition and mortality in PD patients in the six New England states (ME, NH, VT, CT, MA, RI) comprising End Stage Renal Disease (ESRD) Network 1.
As part of the ESRD Clinical Indicators Project, data on 990 PD patients in Network 1 were abstracted from data supplied by dialysis units in the fourth quarter of 1997. This included demographic information; dose of PD in L/day; weekly renal, dialysis, and total Kt/V urea; weekly renal, dialysis, and total creatinine clearance (CCr); serum albumin level; and mortality and transplantation information. Data collection was repeated in the second and fourth quarters of 1998 and in the second quarter of 1999.
990 PD patients in Network 1.
The change in total and renal solute clearances over time, the relationship between renal clearance and mortality, and the relationship between renal clearance and nutritional status, as represented by serum albumin.
Over the 2-year period, mean weekly renal Kt/V urea and weekly renal CCr dropped significantly. To examine the effect of residual renal function on mortality, patients were divided into high and low (above and below the median) weekly renal Kt/V urea and weekly renal CCr groups. Patients above the median levels of both weekly renal Kt/V urea and weekly renal CCr had a significantly decreased risk of dying during the observation period, after controlling for age, gender, serum albumin level, and diabetic status [OR for high vs low renal Kt/V urea 0.54 (CI 0.34 - 0.84), OR for high vs low renal CCr 0.61 (CI 0.40 - 0.94)]. The mean weekly renal Kt/V urea was significantly and directly correlated with the mean serum albumin level by Spearman rank correlation (R = 0.133, p < 0.001), as was the mean weekly renal CCr (R = 0.115, p < 0.001).
Residual renal function is an important contributor to total solute clearance in PD patients. Even at low levels it is linked to decreased mortality and better nutritional status.
残余肾功能对腹膜透析（PD）患者的总溶质清除率有重要贡献。本研究旨在考察残余肾功能随时间的变化及其对新英格兰六个州（缅因州、新罕布什尔州、佛蒙特州、康涅狄格州、马萨诸塞州、罗德岛州）终末期肾病（ESRD）网络1中PD患者营养状况和死亡率的影响。
作为ESRD临床指标项目的一部分，从1997年第四季度透析单位提供的数据中提取了网络1中990例PD患者的数据。这包括人口统计学信息；以升/天为单位的PD剂量；每周的肾脏、透析及总尿素Kt/V；每周的肾脏、透析及总肌酐清除率（CCr）；血清白蛋白水平；以及死亡率和移植信息。1998年第二和第四季度以及1999年第二季度重复进行数据收集。
网络1中的990例PD患者。
总溶质清除率和肾脏溶质清除率随时间的变化、肾脏清除率与死亡率之间的关系以及肾脏清除率与以血清白蛋白表示的营养状况之间的关系。
在两年期间，平均每周肾脏尿素Kt/V和每周肾脏CCr显著下降。为了考察残余肾功能对死亡率的影响，将患者分为每周肾脏尿素Kt/V和每周肾脏CCr高（高于中位数）、低（低于中位数）两组。在控制年龄、性别、血清白蛋白水平和糖尿病状态后，每周肾脏尿素Kt/V和每周肾脏CCr均高于中位数水平的患者在观察期内死亡风险显著降低[高肾脏尿素Kt/V与低肾脏尿素Kt/V相比的OR为0.54（95%CI 0.34 - 0.84），高肾脏CCr与低肾脏CCr相比的OR为0.61（95%CI 0.40 - 0.94）]。通过Spearman等级相关分析，平均每周肾脏尿素Kt/V与平均血清白蛋白水平显著正相关（R = 0.133，p < 0.001），平均每周肾脏CCr与平均血清白蛋白水平也显著正相关（R = 0.115，p < 0.001）。
残余肾功能是PD患者总溶质清除率的重要贡献因素。即使处于较低水平，它也与死亡率降低和更好的营养状况相关。
