Oh Kook-Hwan, Moon Ju-Young, Oh Jieun, Kim Seong Gyun, Hwang Young-Hwan, Kim Suhnggwon, Lee Jung Sang, Ahn Curie
Department of Internal Medicine, Seoul National University Hospital, Chongno Gu, 110-744, Seoul, Korea.
Nephrol Dial Transplant. 2008 Jul;23(7):2356-64. doi: 10.1093/ndt/gfm921. Epub 2008 Jan 4.
It is controversial whether comorbid status or systemic inflammation has an influence on the peritoneal solute transport rate (PSTR). Our aim is to elucidate whether baseline PSTR is associated with markers of systemic inflammation or degree of comorbidity in incident peritoneal dialysis (PD) patients.
One hundred and ninety-five incident PD patients were prospectively included. Results of their baseline peritoneal equilibration test (PET) using 3.86% glucose PD fluid were analysed. Clinical and laboratory parameters of inflammation, comorbidity, nutritional status, dialysis adequacy and residual renal function (RRF) were assessed at the time of PET.
Mean dialysate-to-plasma ratio for creatinine at 4 h (D/Pcr(4)) of our patients was 0.72 +/- 0.11. High-sensitivity C-reactive protein (hsCRP), serum interleukin-6 (IL-6) and serum albumin concentrations were closely interrelated to one another and these markers of systemic inflammation were also related to the Davies comorbidity score. No differences in age, sex ratio, body mass index, body surface area and presence of diabetes were found among four transport groups. RRF, total Kt/V, haemoglobin, nitrogen appearance and the Davies comorbidity score were not different either. High-sensitivity CRP, serum IL-6 and albumin concentrations were not associated with the baseline PSTR. By multiple linear regression analysis, only the serum albumin concentration measured at the time of PET (beta = -0.081 +/- 0.020, P < 0.001) remained significantly associated with D/Pcr(4).
In our study with incident Korean PD patients, the baseline PSTR was not influenced by markers of systemic inflammation or comorbidity. For a subgroup of PD patients without serious comorbidity, other mechanisms of high baseline PSTR need to be elucidated.
合并症状态或全身炎症是否会影响腹膜溶质转运率(PSTR)存在争议。我们的目的是阐明基线PSTR是否与新发腹膜透析(PD)患者的全身炎症标志物或合并症程度相关。
前瞻性纳入195例新发PD患者。分析他们使用3.86%葡萄糖腹膜透析液进行基线腹膜平衡试验(PET)的结果。在PET时评估炎症、合并症、营养状况、透析充分性和残余肾功能(RRF)的临床和实验室参数。
我们患者4小时时肌酐的平均透析液与血浆比值(D/Pcr(4))为0.72±0.11。高敏C反应蛋白(hsCRP)、血清白细胞介素-6(IL-6)和血清白蛋白浓度彼此密切相关,这些全身炎症标志物也与戴维斯合并症评分相关。四个转运组在年龄、性别比例、体重指数、体表面积和糖尿病患病率方面没有差异。RRF、总Kt/V、血红蛋白、氮清除率和戴维斯合并症评分也没有差异。高敏CRP、血清IL-6和白蛋白浓度与基线PSTR无关。通过多元线性回归分析,只有PET时测得的血清白蛋白浓度(β=-0.081±0.020,P<0.001)与D/Pcr(4)仍显著相关。
在我们对韩国新发PD患者的研究中,基线PSTR不受全身炎症标志物或合并症的影响。对于没有严重合并症的PD患者亚组,需要阐明高基线PSTR的其他机制。