Flanigan M J, Frankenfield D L, Prowant B F, Bailie G R, Frederick P R, Rocco M V
University of Iowa College of Medicine, Iowa City, USA.
Perit Dial Int. 2001 Jul-Aug;21(4):345-54.
This analysis explores the nutritional status of adult U.S. peritoneal dialysis (PD) patients.
The Peritoneal Dialysis Core Indicators Study is a prospective cross-sectional prevalence survey describing the care provided to a random sample of adult U.S. PD patients.
Prevalence data were collected from a national random sample of 1381 adult PD patients participating in the United States End Stage Renal Disease (ESRD) program.
The median age of these patients was 55 years, 61% were Caucasian; the leading cause of ESRD was diabetes mellitus. Age, sex, size, peritoneal permeability, dialysis adequacy, and nutritional indices did not differ between patients on continuous ambulatory PD and patients on automated PD. The dialysis prescriptions employed achieved mean weekly Kt/V urea (wKt/V) and creatinine clearance (wCCr) values of 2.22 +/- 0.57 and 67.8 +/- 22.5 L/1.73 m2/week, respectively. The PD patients were large, with a mean body weight of 77 +/- 21 kg and body mass index (BMI) of 27 +/- 8.6 kg/m2. The mean serum albumin of these patients was 3.5 +/- 0.51 g/dL, and 43% of values fell below the National Kidney Foundation Dialysis Outcomes Quality Initiative's desired range. The PD patients had a normalized protein equivalent of nitrogen appearance (nPNA) of 1.0 +/- 0.57 g/kg/day, a normalized creatinine appearance rate (nCAR) of 17 +/- 7.3 mg/kg/day, and an estimated lean body mass (%LBM) of 62% +/- 18% of body weight. Serum albumin correlated positively with patient size, nCAR, and nPNA, but negatively with age, the presence of diabetes mellitus, female gender, erythropoietin dose, the creatinine dialysate-to-plasma ratio results of peritoneal equilibration testing, and the dialysis portion of the wCCr. The duration of ESRD experience correlated negatively with both serum albumin and patient size, although these relationships were complex.
Peritoneal dialysis patients generally have marginal serum albumin levels, a finding incongruent with alternative measures of nutritional status, such as weight, BMI, and creatinine generation. Serum albumin is reduced in patients with high peritoneal permeability (i.e., rapid transporters) and, because these patients generally have higher than average wCCr values, serum albumin is inversely correlated with the dialysis component of the wCCr. The presumptive nutritional indicators (BMI, %LBM, nPNA, and serum albumin) provide disparate estimates, varying from 10% to 50% for the prevalence of nutritionally stressed PD patients.
本分析探讨美国成年腹膜透析（PD）患者的营养状况。
腹膜透析核心指标研究是一项前瞻性横断面患病率调查，描述了为美国成年PD患者随机样本提供的护理情况。
患病率数据来自参与美国终末期肾病（ESRD）项目的1381名成年PD患者的全国随机样本。
这些患者的中位年龄为55岁，61%为白种人；ESRD的主要病因是糖尿病。持续非卧床腹膜透析患者和自动化腹膜透析患者在年龄、性别、体型、腹膜通透性、透析充分性和营养指标方面无差异。所采用的透析处方使每周尿素Kt/V（wKt/V）和肌酐清除率（wCCr）的平均数值分别达到2.22±0.57和67.8±22.5L/1.73m²/周。PD患者体型较大，平均体重为77±21kg，体重指数（BMI）为27±8.6kg/m²。这些患者的平均血清白蛋白为3.5±0.51g/dL，43%的值低于美国国家肾脏基金会透析预后质量倡议的理想范围。PD患者的标准化蛋白质氮出现率（nPNA）为1.0±0.57g/kg/天，标准化肌酐出现率（nCAR）为17±7.3mg/kg/天，估计瘦体重（%LBM）占体重的62%±18%。血清白蛋白与患者体型、nCAR和nPNA呈正相关，但与年龄、糖尿病的存在、女性性别、促红细胞生成素剂量、腹膜平衡试验的肌酐透析液与血浆比值结果以及wCCr的透析部分呈负相关。ESRD病程与血清白蛋白和患者体型均呈负相关，尽管这些关系较为复杂。
腹膜透析患者的血清白蛋白水平普遍处于边缘状态，这一发现与体重、BMI和肌酐生成等营养状况的其他衡量指标不一致。腹膜通透性高（即快速转运者）的患者血清白蛋白降低，并且由于这些患者的wCCr值通常高于平均水平，血清白蛋白与wCCr的透析部分呈负相关。推定的营养指标（BMI、%LBM、nPNA和血清白蛋白）提供了不同的估计值，营养状况不佳的PD患者患病率从10%到50%不等。
