Coronel Francisco, Cigarrán Secundino, Herrero Jose Antonio, Delgado Jesús, Ramos Fernanda, Gomis Antonio
Nephrology Department, Hospital Clínico San Carlos, Madrid, Spain.
Adv Perit Dial. 2009;25:115-8.
During peritoneal dialysis (PD), a significant amount of protein is lost through the peritoneal membrane, and these losses could influence the patient's nutrition status. It has been reported that peritoneal protein loss (PPL) is greater in diabetic (D) patients than in nondiabetic (ND) patients, but the topic is still controversial, and the factors involved are not totally defined. We studied 23 patients on continuous ambulatory PD (12 with diabetes) who had experienced no episodes of infection during the preceding months. We measured peritoneal transport, PPL, proteinuria, and parameters of inflammation and nutrition. Our study was carried out during the first months of PD (2 - 4 months), which coincided with the first evaluation of peritoneal transport. The PPL was higher in D patients than in ND patients (8.4 +/- 2.2 g vs. 5.7 +/- 1.7 g daily, p < 0.001), as was proteinuria (3.7 +/- 2.7 g vs. 0.9 +/- 0.7 g daily, p = 0.003). In 83% of D patients and 54% of ND patients, peritoneal transport (p = 0.002) was high or high-average. Dialysate-to-plasma creatinine in D patients was 0.77 +/- 0.12 as compared with 0.66 +/- 0.09 in ND patients (p = 0.031). Parameters of nutrition and inflammation were normal in both groups of patients and showed no significant differences, except for serum total protein, which was significantly lower in D patients. Ultrafiltration, Kt/V, and weekly creatinine clearance were similar in both groups. The D patients with a higher PPL had the highest proteinuria values. We conclude that the higher PPL seen in D patients starting PD seems to be related to high membrane transport in these patients. The condition of high transport in D patients could be a result of diabetic microvascular lesions that cause a similar pattern of permeability in the peritoneal and glomerular membranes.
在腹膜透析（PD）过程中，大量蛋白质通过腹膜丢失，这些丢失可能会影响患者的营养状况。据报道，糖尿病（D）患者的腹膜蛋白丢失（PPL）比非糖尿病（ND）患者更大，但该话题仍存在争议，且相关因素尚未完全明确。我们研究了23例接受持续性非卧床腹膜透析的患者（12例患有糖尿病），这些患者在前几个月未发生感染。我们测量了腹膜转运、PPL、蛋白尿以及炎症和营养参数。我们的研究在腹膜透析的最初几个月（2 - 4个月）进行，这与腹膜转运的首次评估时间一致。D组患者的PPL高于ND组患者（每日8.4±2.2克对5.7±1.7克，p<***），蛋白尿情况也是如此（每日3.7±2.7克对0.9±0.7克，p = 0.003）。83%的D组患者和54%的ND组患者腹膜转运为高或高平均水平（p = 0.002）。D组患者透析液与血浆肌酐比值为0.77±0.12，而ND组患者为0.66±0.09（p = 0.031）。两组患者的营养和炎症参数均正常，除血清总蛋白外无显著差异，D组患者的血清总蛋白显著更低。两组患者的超滤量、Kt/V和每周肌酐清除率相似。PPL较高的D组患者蛋白尿值最高。我们得出结论，开始腹膜透析的D组患者中较高的PPL似乎与这些患者的高腹膜转运有关。D组患者的高转运情况可能是糖尿病微血管病变导致腹膜和肾小球膜通透性出现相似模式的结果。
