腹膜透析患者腹膜转运率及透析充分性与炎症的关系。
Relationship of peritoneal transport rate and dialysis adequacy with inflammation in peritoneal dialysis patients.
作者信息
Fein Paul A, Fazil Irfan, Rafiq Muhammad A, Schloth Teresa, Matza Betty, Chattopadhyay Jyotiprakas, Avram Morrell M
机构信息
Avram Division of Nephrology, Long Island College Hospital, Brooklyn, New York 11201, USA.
出版信息
Adv Perit Dial. 2006;22:2-6.
Inflammation, dialysis adequacy, and peritoneal transport rate (PTR) influence clinical outcomes in peritoneal dialysis (PD) patients. The present study examined the relationship of C-reactive protein (CRP), a marker of inflammation, to PTR and residual renal function (RRF) in PD patients. We recorded the baseline dialysate-to-plasma creatinine (D/P Cr) of 210 PD patients starting in 1986. In a subgroup of 42 patients, we serially measured high-sensitivity CRP levels and.dialysis adequacy, including weekly Kt/V urea and creatinine clearance (CCr), starting in May 2003. The patients were followed to January 2006. Mean age was 53 +/- 16 (standard deviation) years, and 70% of the patients were African American. Enrollment mean and median CRP levels were 13.53 +/- 20.8 (range: 0.2-95.8) and 7.15 mg/L respectively. Mean weekly residual CCr and Kt/V during follow-up were 7.11 +/- 15.47 L/1.73 m2 and 0.14 +/- 0.30 respectively. The mean enrollment D/P Cr was 0.649 +/- 0.12 (range: 0.429-0.954). Patients with CRP > 10 mg/L had significantly lower weekly residual CCr (0.59 L/1.73 m2 vs. 10.1 L/1.73 m2, p = 0.01), residual Kt/V (0.01 vs. 0.20, p = 0.01), total CCr (56 L/1.73 m2 vs. 62 L/1.73 m2, p= 0.047), and total Kt/V (2.09 vs. 2.49, p = 0.001) than did those with CRP < or = 10 mg/L. Levels of CRP correlated negatively with weekly residual CCr (r = -0.42, p = 0.006), residual Kt/V (r = -0.43, p = 0.006), and total Kt/V (r = -0.44, p = 0.004). Enrollment D/P Cr was inversely correlated with serum albumin (r = -0.24, p = 0.001) and directly correlated with peritoneal protein loss (r = 0.34, p = 0.028). Higher enrollment D/P Cr was associated with lower observed cumulative survival (Kaplan-Meier) in PD patients. However D/P Cr was not an independent predictor of long-term survival in PD patients. Using multivariate Cox regression analysis, and including D/P Cr and residual Kt/V in the model, enrollment CRP was an independent predictor of mortality (relative risk = 1.036, p = 0.018). We conclude that elevated CRP is associated with lower RRF As a predictor of mortality, CRP may be better than RRF and D/P Cr.
炎症、透析充分性和腹膜转运率（PTR）会影响腹膜透析（PD）患者的临床结局。本研究探讨了炎症标志物C反应蛋白（CRP）与PD患者PTR及残余肾功能（RRF）之间的关系。我们记录了自1986年起开始治疗的210例PD患者的基线透析液与血浆肌酐比值（D/P Cr）。在一个42例患者的亚组中，自2003年5月起我们连续测量了高敏CRP水平以及透析充分性指标，包括每周的尿素Kt/V和肌酐清除率（CCr）。对患者随访至2006年1月。患者平均年龄为53±16（标准差）岁，70%为非裔美国人。入组时CRP的均值和中位数分别为13.53±20.8（范围：0.2 - 95.8）和7.15 mg/L。随访期间每周残余CCr和Kt/V的均值分别为7.11±15.47 L/1.73 m²和0.14±0.30。入组时D/P Cr的均值为0.649±0.12（范围：0.429 - 0.954）。CRP>10 mg/L的患者每周残余CCr（0.59 L/1.73 m² 对 10.1 L/1.73 m²，p = 0.01）、残余Kt/V（0.01对0.20，p = 0.01）、总CCr（56 L/1.73 m² 对 62 L/1.73 m²，p = 0.047）以及总Kt/V（2.09对2.49，p = 0.001）均显著低于CRP≤10 mg/L的患者。CRP水平与每周残余CCr（r = -0.42，p = 0.006）、残余Kt/V（r = -0.43，p = 0.006）以及总Kt/V（r = -0.44，p = 0.004）呈负相关。入组时D/P Cr与血清白蛋白呈负相关（r = -0.24，p = 0.001），与腹膜蛋白丢失呈正相关（r = 0.34，p = 0.028）。较高的入组D/P Cr与PD患者较低的观察到的累积生存率（Kaplan - Meier法）相关。然而，D/P Cr并非PD患者长期生存的独立预测因素。使用多因素Cox回归分析，并在模型中纳入D/P Cr和残余Kt/V，入组时的CRP是死亡率的独立预测因素（相对风险 = 1.036，p = 0.018）。我们得出结论，CRP升高与较低的RRF相关。作为死亡率的预测指标，CRP可能优于RRF和D/P Cr。
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