Tzamaloukas A H, Oreopoulos D G, Murata G H, Servilla K, Rao P, Din S, Malhotra D
Medicine Service, New Mexico VA Health Care System and University of New Mexico School of Medicine, Albuquerque, USA.
Int Urol Nephrol. 2001;32(3):449-58. doi: 10.1023/a:1017579105158.
To analyze the effect of age on nutrition indices in subjects on the same continuous ambulatory peritoneal dialysis (CAPD) schedule.
We analyzed 613 sets of clearance values and nutrition indices in 302 CAPD patients. Small solute clearances included urea clearance (Kt/Vurea) and creatinine clearance (Ccr). Nutrition indices included body mass index (BMI), serum albumin, urea and creatinine, 24-h urea nitrogen and creatinine excretion in urine plus dialysate, protein nitrogen appearance (PNA), PNA normalized by standard weight (nPNA), lean body mass (LBM) computed by creatinine kinetics, and LBM/Weight. CAPD subjects were classified in 4 age quartiles (Q): Group Q1, age 33.7 +/- 7.6 years, N = 149; group Q2, age 49.5 +/- 3.8 years, N = 158; group Q3, age 61.5 +/- 2.6 years, N = 154; and group Q4, age 72.1 +/- 5.4 years, N = 152. Group comparison was done by one-way ANOVA or chi-square. Predictors of low nutritional parameters were identified by logistic regression. Selected variables were compared by linear regression.
Mean Kt/Vurea and Ccr were above the current adequacy standards and did not differ between the age quartiles. In contrast, older quartiles had, in general, lower nutrition indices than younger quartiles. However, the youngest quartile had the lowest BMI. By logistic regression, young age was a predictor of low BMI, while advanced age was a predictor of low creatinine and urea nitrogen excretion, low nPNA, and low LBM/Weight. The regressions of nPNA on Kt/Vurea differed between the age quartiles. By these regressions, the youngest quartile had higher nPNA values for the same Kt/Vurea than the oldest quartile in the clinically relevant range of Kt/Vurea and nPNA values.
Nutrition indices are worse in older than in younger CAPD patients with the same small solute clearances. Nutrition of CAPD patients is adversely affected by age and requires special attention in the older age group.
分析年龄对接受相同持续性非卧床腹膜透析（CAPD）方案的患者营养指标的影响。
我们分析了302例CAPD患者的613组清除率值和营养指标。小分子溶质清除率包括尿素清除率（Kt/Vurea）和肌酐清除率（Ccr）。营养指标包括体重指数（BMI）、血清白蛋白、尿素和肌酐、24小时尿加透析液中的尿素氮和肌酐排泄量、蛋白质氮呈现率（PNA）、按标准体重标准化的PNA（nPNA）、通过肌酐动力学计算的瘦体重（LBM）以及LBM/体重。CAPD患者被分为4个年龄四分位数组（Q）：Q1组，年龄33.7±7.6岁，N = 149；Q2组，年龄49.5±3.8岁，N = 158；Q3组，年龄61.5±2.6岁，N = 154；Q4组，年龄72.1±5.4岁，N = 152。组间比较采用单因素方差分析或卡方检验。通过逻辑回归确定低营养参数的预测因素。通过线性回归比较选定变量。
平均Kt/Vurea和Ccr高于当前的充分性标准，且在年龄四分位数组之间无差异。相比之下，一般来说，年龄较大的四分位数组的营养指标低于年龄较小的四分位数组。然而，最年轻的四分位数组的BMI最低。通过逻辑回归，年轻是低BMI的预测因素，而高龄是低肌酐和尿素氮排泄、低nPNA以及低LBM/体重的预测因素。年龄四分位数组之间nPNA对Kt/Vurea的回归不同。通过这些回归，在Kt/Vurea和nPNA值的临床相关范围内，相同Kt/Vurea时，最年轻的四分位数组的nPNA值高于最年长的四分位数组。
在小分子溶质清除率相同的情况下，老年CAPD患者的营养指标比年轻患者差。CAPD患者的营养受到年龄的不利影响，在老年人群中需要特别关注。
