Johnson David W, Mudge David W, Sturtevant Joanna M, Hawley Carmel M, Campbell Scott B, Isbel Nicole M, Hollett Peter
Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Perit Dial Int. 2003 May-Jun;23(3):276-83.
The aim of this study was to prospectively evaluate the risk factors for decline of residual renal function (RRF) in an incident peritoneal dialysis (PD) population.
Prospective observational study of an incident PD cohort at a single center.
Tertiary-care institutional dialysis center.
The study included 146 consecutive patients commencing PD at the Princess Alexandra Hospital between 1 August 1995 and 1 July 2001 (mean age 54.8 +/- 1.4 years, 42% male, 34% diabetic). Patients with failed renal transplants (n = 26) were excluded.
Timed urine collections (n = 642) were performed initially and at 6-month intervals thereafter to measure RRF. The development of anuria was also prospectively recorded.
The mean (+/- SD) follow-up period was 20.5 +/- 14.8 months. The median slope of RRF decline was -0.05 mL/minute/month/1.73 m2. Using binary logistic regression, it was shown that the 50% of patients with more rapid RRF loss (< -0.05 mL/min/month/1.73 m2) were more likely to have had a higher initial RRF at commencement of PD [adjusted odds ratio (AOR) 1.83, 95% confidence interval (CI) 1.39-2.40] and a higher baseline dialysate/ plasma creatinine ratio at 4 hours (D/P creat; AOR 44.6, 95% CI 1.05-1900). On multivariate Cox proportional hazards model analysis, time from commencement of PD to development of anuria was independently predicted by baseline RRF [adjusted hazard ratio (HR) 0.81, 95% CI 0.60-0.81], D/P creat (HR 2.87, 95% CI 2.06-82.3), body surface area (HR 6.23, 95% CI 1.53-25.5), dietary protein intake (HR 2.87, 95% CI 1.06-7.78), and diabetes mellitus (HR 1.65, 95% CI 1.00-2.72). Decline of RRF was independent of age, gender, dialysis modality, urgency of initiation of dialysis, smoking, vascular disease, blood pressure, medications (including angiotensin-converting enzyme inhibitors), duration of follow-up, and peritonitis rate.
The results of this study suggest that high baseline RRF and high D/P creat ratio are risk factors for rapid loss of RRF. Moreover, a shorter time to the onset of anuria is independently predicted by low baseline RRF, increased body surface area, high dietary protein intake, and diabetes mellitus. Such at-risk patients should be closely monitored for early signs of inadequate dialysis.
本研究旨在前瞻性评估新发腹膜透析（PD）人群残余肾功能（RRF）下降的危险因素。
对单一中心的新发PD队列进行前瞻性观察研究。
三级医疗机构透析中心。
本研究纳入了1995年8月1日至2001年7月1日期间在亚历山德拉公主医院开始进行PD的146例连续患者（平均年龄54.8±1.4岁，42%为男性，34%患有糖尿病）。排除肾移植失败的患者（n = 26）。
最初及之后每6个月进行一次定时尿液收集（n = 642）以测量RRF。还前瞻性记录了无尿的发生情况。
平均（±标准差）随访期为20.5±14.8个月。RRF下降的中位数斜率为-0.05 mL/分钟/月/1.73 m²。使用二元逻辑回归分析显示，RRF损失较快（<-0.05 mL/分钟/月/1.73 m²）的50%患者在开始PD时更可能具有较高的初始RRF[调整后的优势比（AOR）1.83，95%置信区间（CI）1.39 - 2.40]以及4小时时较高的基线透析液/血浆肌酐比值（D/P肌酐；AOR 44.6，95%CI 1.05 - 1900）。在多变量Cox比例风险模型分析中，从开始PD到出现无尿的时间由基线RRF[调整后的风险比（HR）0.81，95%CI 0.60 - 0.81]、D/P肌酐（HR 2.87，95%CI 2.06 - 82.3）、体表面积（HR 6.23，95%CI 1.53 - 25.5）、饮食蛋白质摄入量（HR 2.87，95%CI 1.06 - 7.78）和糖尿病（HR 1.65，95%CI 1.00 - 2.72）独立预测。RRF的下降与年龄、性别、透析方式、开始透析的紧迫性、吸烟、血管疾病、血压、药物（包括血管紧张素转换酶抑制剂）、随访时间和腹膜炎发生率无关。
本研究结果表明，高基线RRF和高D/P肌酐比值是RRF快速丧失的危险因素。此外，低基线RRF、增加的体表面积、高饮食蛋白质摄入量和糖尿病独立预测无尿发生时间较短。此类高危患者应密切监测透析不充分的早期迹象。
