Wang Angela Yee-Moon, Sea Mandy Man-Mei, Ip Ricky, Law Man-Ching, Chow Kai-Ming, Lui Siu-Fai, Li Philip Kam-Tao, Woo Jean
Department of Medicine and Therapeutics, Center for Nutritional Studies, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
J Am Soc Nephrol. 2001 Nov;12(11):2450-2457. doi: 10.1681/ASN.V12112450.
Previous studies have suggested that the cross-sectional relationship observed between total solute clearance (Kt/V) and dietary protein intake (DPI) in patients undergoing dialysis is possibly mathematical in origin. A cross-sectional study on 242 patients undergoing continuous ambulatory peritoneal dialysis (CAPD) was performed to determine the differential effects of dialysis adequacy and residual renal function (RRF) on actual dietary intake. All patients underwent a 7-d food frequency questionnaire to quantify daily dietary protein, calorie (DCI), and other nutrient intake, subjective global assessment (SGA), and collection of 24-h dialysate and urine for total (PD and renal) Kt/V and RRF. Patients were categorized into three groups: I (n = 94), total Kt/V >/=1.7 and GFR >0.5 ml/min per 1.73 m(2); II (n = 58), total Kt/V >/=1.7 but GFR <0.5 ml/min per 1.73 m(2); and III (n = 90), total Kt/V <1.7. Sixty-nine percent versus 62% versus 42% of group I versus II versus III patients were well nourished according to SGA (P = 0.004). DPI (1.23 [0.47] versus 1.12 [0.49] versus 0.99 [0.40] g/kg per d; P = 0.002) and DCI (27.3 [8.9] versus 23.8 [8.6] versus 23.0 [8.2] kcal/kg per d; P = 0.002) showed significant decline across the three groups. Intake of other nutrients, including carbohydrate, fat, fatty acids, and cholesterol was higher for group I compared with groups II and III. Adjusting for age, gender, weight, and diabetes, every 1 ml/min per 1.73 m(2) increase in GFR was associated with a 0.838-fold increase in DCI (95% confidence interval to interval, 0.279 to 1.397; P = 0.003) and a 0.041-fold increase in DPI (95% confidence interval, 0.009 to 0.072; P = 0.012), whereas every 0.25-unit increase in total (PD and renal) Kt/V was associated with a 0.570-fold increase in DCI (95% confidence interval, 0.049 to 1.092; P = 0.032) and a 0.052-fold increase in DPI (95% confidence interval, 0.023 to 0.081; P = 0.001). Greater small-solute clearances are associated with better dietary intake and better nutrition. The study confirmed significant and independent effect of RRF, but not PD solute clearance, on actual DPI, DCI, and other nutrient intake in patients on CAPD.
以往研究表明，在接受透析的患者中观察到的总溶质清除率（Kt/V）与饮食蛋白质摄入量（DPI）之间的横断面关系可能源于数学关系。对242例接受持续性非卧床腹膜透析（CAPD）的患者进行了一项横断面研究，以确定透析充分性和残余肾功能（RRF）对实际饮食摄入量的不同影响。所有患者均接受了为期7天的食物频率问卷调查，以量化每日饮食蛋白质、热量（DCI）和其他营养素摄入量、主观全面评定（SGA），并收集24小时透析液和尿液以测定总（腹膜透析和肾脏）Kt/V和RRF。患者被分为三组：I组（n = 94），总Kt/V≥1.7且肾小球滤过率（GFR）>0.5 ml/min per 1.73 m²；II组（n = 58），总Kt/V≥1.7但GFR<0.5 ml/min per 1.73 m²；III组（n = 90），总Kt/V<1.7。根据SGA，I组、II组和III组患者营养良好的比例分别为69%、62%和42%（P = 0.004）。DPI（分别为1.23 [0.47]、1.12 [0.49]、0.99 [0.40] g/kg per d；P = 0.002）和DCI（分别为27.3 [8.9]、23.8 [8.6]、23.0 [8.2] kcal/kg per d；P = 0.002）在三组中均呈显著下降。与II组和III组相比，I组碳水化合物、脂肪、脂肪酸和胆固醇等其他营养素的摄入量更高。在校正年龄、性别、体重和糖尿病因素后，GFR每增加1 ml/min per 1.73 m²，DCI增加0.838倍（95%置信区间为0.279至1.397；P = 0.003），DPI增加0.041倍（95%置信区间为0.009至0.072；P = 0.012）；而总（腹膜透析和肾脏）Kt/V每增加0.25单位，DCI增加0.570倍（95%置信区间为0.049至1.092；P = 0.032），DPI增加0.052倍（95%置信区间为0.023至0.081；P = 0.001）。更高的小分子溶质清除率与更好的饮食摄入和营养状况相关。该研究证实了RRF而非腹膜透析溶质清除率对CAPD患者实际DPI、DCI和其他营养素摄入量具有显著且独立的影响。
