Gulati S, Stephens D, Balfe J A, Secker D, Harvey E, Balfe J W
Department of Pediatrics, Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Kidney Int. 2001 Jun;59(6):2361-7. doi: 10.1046/j.1523-1755.2001.00754.x.
Few data are available on the clinical significance of hypoalbuminemia [serum albumin (SA) <35 g/L] in children with end-stage renal disease (ESRD) on continuous peritoneal dialysis (CPD). This study was conducted to analyze the prevalence of hypoalbuminemia, its predictive factors, and its clinical impact in these children.
A retrospective analysis was done of 180 patients on CPD over the last 22 years. Patients were excluded from the study if they were on CPD for less than four months or had nephrotic syndrome. Demographic, clinical, and biochemical variables were studied. Children continued on CPD until they received a transplant or were transferred to an adult unit or to hemodialysis as a result of technique failure. The subjects were divided into two groups based on SA levels at last follow-up.
A total of 135 children was included. After a mean duration of CPD of 573 +/- 437 (120 to 2960) days, 54 children (40%) were observed to have hypoalbuminemia. Four patients (2.9%) died, 7 (5.2%) continued on continuous cyclic peritoneal dialysis, and 13 (9.6%) were transferred to an adult unit for continuation of CPD. Ninety-five (70.3%) were transplanted, and 16 (11.8%) were transferred to hemodialysis because of technique failure. Children in group I (N = 54, SA <35 g/L), compared with group II (N = 81, SA > or =35 g/L), were younger at initiation of PD, more likely to have hypoalbuminemia at one month and six months after initiation of PD, and have more episodes of peritonitis. No differences were seen between the groups in gender, modality of CPD, body surface area, initial body mass index, and presence of hypertension or acidosis. The only factors predictive of hypoalbuminemia on follow-up were low SA at one month after PD and recurrent peritonitis using multiple logistic regression analysis. Evaluating the clinical impact of hypoalbuminemia, we observed a higher incidence of failed PD in children who had hypoalbuminemia.
Low SA at one month after PD and recurrent peritonitis are predictive of hypoalbuminemia in children on CPD, which is associated with an increased incidence of CPD failure.
关于终末期肾病（ESRD）儿童持续腹膜透析（CPD）期间低白蛋白血症[血清白蛋白（SA）<35 g/L]的临床意义，相关数据较少。本研究旨在分析这些儿童低白蛋白血症的患病率、预测因素及其临床影响。
对过去22年中180例接受CPD治疗的患者进行回顾性分析。如果患者接受CPD治疗时间少于4个月或患有肾病综合征，则被排除在研究之外。对人口统计学、临床和生化变量进行研究。儿童继续接受CPD治疗，直到他们接受移植，或因技术失败而转至成人科室或改为血液透析。根据最后一次随访时的SA水平将受试者分为两组。
共纳入135名儿童。CPD平均持续时间为573±437（120至2960）天，54名儿童（40%）出现低白蛋白血症。4例患者（2.9%）死亡，7例（5.2%）继续接受持续循环腹膜透析，13例（9.6%）转至成人科室继续接受CPD治疗。95例（70.3%）接受了移植，16例（11.8%）因技术失败转至血液透析。与第二组（N = 81，SA≥35 g/L）相比，第一组（N = 54，SA <35 g/L）的儿童开始腹膜透析时年龄更小，开始腹膜透析后1个月和6个月时更易出现低白蛋白血症，且腹膜炎发作次数更多。两组在性别、CPD方式、体表面积、初始体重指数以及是否存在高血压或酸中毒方面无差异。采用多因素logistic回归分析，随访时预测低白蛋白血症的唯一因素是腹膜透析后1个月时SA水平低和反复发生腹膜炎。评估低白蛋白血症的临床影响时，我们观察到低白蛋白血症儿童腹膜透析失败的发生率更高。
腹膜透析后1个月时SA水平低和反复发生腹膜炎可预测接受CPD治疗儿童的低白蛋白血症，这与CPD失败发生率增加有关。
