炎症和细胞外液容量扩张与腹膜透析患者的钠和水清除有关。

Inflammation and extracellular volume expansion are related to sodium and water removal in patients on peritoneal dialysis.

作者信息

Avila-Díaz Marcela, Ventura María-de-Jesús, Valle Delfilia, Vicenté-Martínez Marlén, García-González Zuzel, Cisneros Alejandra, Furlong María-Del-Carmen, Gómez Ana María, Prado-Uribe María-Del-Carmen, Amato Dante, Paniagua Ramón

机构信息

Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México.

出版信息

Perit Dial Int. 2006 Sep-Oct;26(5):574-80.

PMID:16973513

Abstract

BACKGROUND

Inflammation is an important risk for mortality in dialysis patients. Extracellular fluid volume (ECFv) expansion, a condition commonly seen in peritoneal dialysis (PD) patients, may be associated with inflammation. However, published support for this relationship is scarce.

OBJECTIVES

To quantify the proportion of patients on PD with inflammation and to analyze the role of ECFv expansion and the factors related to these conditions.

DESIGN

A prospective, multicenter cross-sectional study in six hospitals with a PD program.

PATIENTS AND METHODS

Adult patients on PD were studied. Clinical data, body composition, and sodium and fluid intake were recorded. Biochemical analysis, C-reactive protein (CRP), and peritoneal and urinary fluid and sodium removal were also measured.

RESULTS

CRP values positive (>or=3.0 mg/L) for inflammation were found in 147 (80.3%) and negative in 36 patients. Patients with positive CRP had higher ECFv/total body water (TBW) ratio (women 47.69 +/- 0.69 vs 47.36 +/- 0.65, men 43.15 +/- 1.14 vs 42.84 +/- 0.65; p < 0.05), higher serum glucose (125.09 +/- 81.90 vs 103.28 +/- 43.30 mg/dL, p < 0.03), and lower serum albumin (2.86 +/- 0.54 vs 3.17 +/- 0.38 g/dL, p < 0.001) levels. They also had lower ultrafiltration (1003 +/- 645 vs 1323 +/- 413 mL/day, p < 0.005) and total fluid removal (1260 +/- 648 vs 1648 +/- 496 mL/day, p < 0.001), and less peritoneal (15.59 +/- 162.14 vs 78.11 +/- 110.70 mEq/day, p < 0.01) and total sodium removal (42.06 +/- 142.49 vs 118.60 +/- 69.73 mEq/day, p < 0.001). In the multivariate analysis, only ECFv/TBW was significantly (p < 0.04) and independently associated with inflammation. ECFv/TBW was correlated with fluid removal (r = 0.16, p < 0.03) and renal sodium removal (r = 0.2, p < 0.01).

CONCLUSION

The data suggest that ECFv expansion may have a significant role as an inflammatory stimulus. The results disclose a relationship between the two variables, ECFv expansion and inflammation, identified as independent risk factors for mortality in PD patients.

摘要

背景

炎症是透析患者死亡的重要风险因素。细胞外液量（ECFv）扩张是腹膜透析（PD）患者常见的一种情况，可能与炎症相关。然而，关于这种关系的公开支持证据很少。

目的

量化接受PD治疗且伴有炎症的患者比例，并分析ECFv扩张的作用以及与这些情况相关的因素。

设计

在六个设有PD项目的医院进行的一项前瞻性、多中心横断面研究。

患者和方法

对接受PD治疗的成年患者进行研究。记录临床数据、身体成分以及钠和液体摄入量。还测量生化分析、C反应蛋白（CRP）以及腹膜和尿液中的液体及钠清除情况。

结果

147例（80.3%）患者的CRP值呈阳性（≥3.0 mg/L）表明存在炎症，36例患者的CRP值为阴性。CRP阳性的患者具有更高的ECFv/总体水（TBW）比值（女性为47.69±0.69 vs 47.36±0.65，男性为43.15±1.14 vs 42.84±0.65；p<0.05）、更高的血清葡萄糖水平（125.09±81.90 vs 103.28±43.30 mg/dL，p<0.03）以及更低的血清白蛋白水平（2.86±0.54 vs 3.17±0.38 g/dL，p<0.001）。他们的超滤量（1003±645 vs 1323±413 mL/天，p<0.005）和总液体清除量（1260±648 vs 1648±496 mL/天，p<0.001）也更低，腹膜钠清除量（15.59±162.14 vs 78.11±110.70 mEq/天，p<0.01）和总钠清除量（42.06±142.49 vs 118.60±69.73 mEq/天，p<0.001）也更少。在多变量分析中，只有ECFv/TBW与炎症显著相关（p<0.04）且具有独立相关性。ECFv/TBW与液体清除量（r = 0.16，p<0.03）和肾脏钠清除量（r = 0.2，p<0.01）相关。