Dezfuli Arezu, Scholl Deborah, Lindenfeld Stanley M, Kovesdy Csaba P, Kalantar-Zadeh Kamyar
Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California at Los Angeles Medical Center, Torrance, CA 90502, USA.
J Ren Nutr. 2009 Jul;19(4):291-7. doi: 10.1053/j.jrn.2009.01.023. Epub 2009 May 23.
Intradialytic parenteral nutrition (IDPN) is used infrequently to correct hypoalbuminemia in maintenance hemodialysis (MHD) patients. We hypothesized that the severity of baseline hypoalbuminemia correlates with the success rate of IDPN therapy in MHD patients.
In a prospective and contemporary cohort of 196 hypoalbuminemic MHD patients who received IDPN through Pentec Health (Boothwyn, PA), predictors of IDPN response were examined using multivariate logistic regression.
Of 196 hypoalbuminemic MHD patients, 134 had severe hypoalbuminemia, defined as a baseline serum albumin level of less than 3.0 g/dL. The average period of IDPN therapy was 5.8 +/- 2.4 months, S.D. The baseline level of serum albumin was lower in MHD patients who responded to IDPN (2.68 +/- 0.47 g/dL, S.D.). A multivariate logistic regression analysis adjusted the associations for age, gender, diabetes, and IDPN time. The presence of severe hypoalbuminemia (serum albumin, <3.0 g/dL) at baseline was associated with a 2.5 times higher chance of responding to IDPN (95% confidence interval, 1.3 to 4.9; P = .006). The same severe hypoalbuminemia was associated with a 3.5 times increased likelihood of serum albumin correction by at least 0.5 g/dL (95% confidence interval, 1.8 to 6.8; P < .001).
Improvement of hypoalbuminemia occurs in most hypoalbuminemic MHD patients who receive IDPN therapy. The likelihood and magnitude of the response to IDPN are associated with the severity of baseline hypoalbuminemia. These associations need to be verified in controlled trials.
透析期间胃肠外营养（IDPN）在维持性血液透析（MHD）患者中较少用于纠正低白蛋白血症。我们推测基线低白蛋白血症的严重程度与MHD患者IDPN治疗的成功率相关。
在一个前瞻性当代队列中，196例低白蛋白血症MHD患者通过Pentec Health公司（宾夕法尼亚州布斯温）接受IDPN治疗，使用多因素逻辑回归分析IDPN反应的预测因素。
196例低白蛋白血症MHD患者中，134例患有严重低白蛋白血症，定义为基线血清白蛋白水平低于3.0 g/dL。IDPN治疗的平均时间为5.8±2.4个月，标准差。对IDPN有反应的MHD患者血清白蛋白基线水平较低（2.68±0.47 g/dL，标准差）。多因素逻辑回归分析对年龄、性别、糖尿病和IDPN治疗时间的关联进行了校正。基线时存在严重低白蛋白血症（血清白蛋白<3.0 g/dL）与对IDPN有反应的几率高2.5倍相关（95%置信区间，1.3至4.9；P = 0.006）。同样的严重低白蛋白血症与血清白蛋白至少校正0.5 g/dL的可能性增加3.5倍相关（95%置信区间，1.8至6.8；P < 0.001）。
大多数接受IDPN治疗的低白蛋白血症MHD患者的低白蛋白血症得到改善。对IDPN反应的可能性和程度与基线低白蛋白血症的严重程度相关。这些关联需要在对照试验中得到验证。
