透析时长及葡萄糖吸收对稳定的持续性非卧床腹膜透析患者营养指标的影响

Impact of dialysis duration and glucose absorption on nutritional indices in stable continuous ambulatory peritoneal dialysis patients.

作者信息

Pajek Jernej, Gucek Andrej, Kveder Radoslav, Bucar-Pajek Maja, Kaplan-Pavlovcic Stasa, Bren Andrej F

机构信息

Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.

出版信息

J Ren Nutr. 2008 Nov;18(6):503-8. doi: 10.1053/j.jrn.2008.06.002.

DOI:10.1053/j.jrn.2008.06.002

PMID:18940653

Abstract

OBJECTIVE

The presence of comorbidity is a risk factor for both poor nutrition and poor outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In CAPD specifically, peritoneal glucose load is associated with a possible suppression of appetite, contributing to protein malnutrition. This study sought to explore the factors associated with malnutrition indices in stable peritoneal dialysis patients without significant comorbidity, and to assess the impact of peritoneal glucose absorption on nutrition parameters.

DESIGN

This was a cross-sectional observational study.

SETTING

This study took place in the peritoneal dialysis department of a university hospital, and involved outpatients.

PATIENTS

There were 23 stable, comorbidity-free CAPD patients (9 women), aged 54 +/- 12 years, with a CAPD duration of 28 +/- 25 months (values are mean +/- SD unless otherwise noted).

METHODS

Nutritional status was evaluated by means of anthropometric and serum measurements. A peritoneal equilibration test was performed, and daily glucose absorption was measured. Lean body mass (LBM) was assessed through creatinine kinetics.

RESULTS

A significant impact of CAPD duration was found. Patients in the upper quartile of CAPD duration had worse nutritional parameters compared with the rest of the group: their mid-upper-arm surface area and fat surface area were lower (65 +/- 9 cm(2) vs. 78 +/- 6.2 cm(2) and 16 +/- 5.3 cm(2) vs. 26 +/- 9.5 cm(2), respectively, P < .05), their albumin concentration was lower (36 +/- 0.5 g/L vs. 42 +/- 4 g/L, P < .05), and their cholesterol and triglycerides were lower (3.5 +/- 0.5 vs. 5.2 +/- 1 mmol/L and 1.3 +/- 0.6 vs. 2.3 +/- 1.1 mmol/L, respectively, P < .05). No significant correlations between peritoneal glucose absorption and these indices were found.

CONCLUSION

The duration of dialysis treatment, but not peritoneal glucose absorption, is a predictor of malnutrition in stable, comorbidity-free CAPD patients.

摘要

目的

合并症的存在是持续性非卧床腹膜透析（CAPD）患者营养不良和预后不良的危险因素。在CAPD中，腹膜葡萄糖负荷可能与食欲抑制有关，进而导致蛋白质营养不良。本研究旨在探讨无明显合并症的稳定腹膜透析患者营养不良指标的相关因素，并评估腹膜葡萄糖吸收对营养参数的影响。

设计

这是一项横断面观察性研究。

地点

本研究在一所大学医院的腹膜透析科进行，纳入门诊患者。

患者

共有23例稳定、无合并症的CAPD患者（9名女性），年龄54±12岁，CAPD病程28±25个月（除非另有说明，数值均为平均值±标准差）。

方法

通过人体测量和血清检测评估营养状况。进行腹膜平衡试验，并测量每日葡萄糖吸收量。通过肌酐动力学评估瘦体重（LBM）。

结果

发现CAPD病程有显著影响。与组内其他患者相比，CAPD病程处于上四分位数的患者营养参数较差：他们的上臂中表面积和脂肪表面积较低（分别为65±9cm²对78±6.2cm²和16±5.3cm²对26±9.5cm²，P<.05），白蛋白浓度较低（36±0.5g/L对42±4g/L，P<.05），胆固醇和甘油三酯较低（分别为3.5±0.5对5.2±1mmol/L和1.3±0.6对2.3±1.1mmol/L，P<.05）。未发现腹膜葡萄糖吸收与这些指标之间存在显著相关性。