基于 Kt/V 尿素的透析充分性与营养状况之间的关系及其对新进入腹膜透析患者生活质量各组分的影响。
Relationship between Kt/V urea-based dialysis adequacy and nutritional status and their effect on the components of the quality of life in incident peritoneal dialysis patients.
机构信息
Division of Nephrology, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
出版信息
BMC Nephrol. 2012 Jun 14;13:39. doi: 10.1186/1471-2369-13-39.
BACKGROUND
It is well known that the quality of life of patients with chronic kidney disease can be improved by dialysis. While previous studies have used retrospective designs and adhered to a standard target prescribed by clinical guidelines, our study prospectively investigates the association between the adequacy of peritoneal dialysis (PD) and measures of nutritional status on quality-of-life domains in a cohort of incident PD patients.
METHODS
It was a prospective 6-month observational study. Eighty incident PD participants who were treated in a hospital-based PD center were enrolled. The period of enrollment was January 2009-June 2010; follow-up continued until December 2010. PD adequacy indices, including Kt/V urea, weekly Ccr (WCcr), measures of nutritional status (albumin, BMI), and nPCR were measured at 1 month and 6 months after PD initiation. SF-36 health survey questionnaires were used to measure the quality of life. The outcomes were used to measure the changes in the domains of the SF-36 after 6 months of PD therapy.
RESULTS
Seventy-seven incident patients who underwent PD for 6 months were included in the study. The mean age was 47.3 years, and the male-to-female ratio was 38:39. A peritoneal Kt/V urea value of 1.2, which was also the baseline cutoff value, was found to have the highest influence on SF-36 domains. Patients with baseline peritoneal Kt/V urea value of <1.2 showed improvement in the physical functioning and role limitation of physical functioning components after 6 months of PD. In contrast, patients with baseline peritoneal Kt/V urea values of ≥1.2 showed remarkable improvement in the general health, physical functioning, role limitation caused by physical problems, and bodily pain components. However, the trend of improvement decreased in patients with baseline nPCR of <1.2. Baseline renal WCcr did not influence the improvement in the SF-36 domains.
LIMITATIONS
A small cohort and a short observation period.
CONCLUSIONS
The baseline level of peritoneal Kt/V urea affected the components of the quality of life after PD initiation. In contrast, a lower baseline nPCR level was associated with deterioration in the quality of life after PD therapy.
背景
众所周知，透析可以提高慢性肾脏病患者的生活质量。虽然以前的研究使用回顾性设计，并遵循临床指南规定的标准目标，但我们的研究前瞻性地调查了腹膜透析（PD）的充分性与一系列新开始 PD 患者的营养状况衡量标准与生活质量领域之间的关联。
方法
这是一项前瞻性的 6 个月观察性研究。共纳入 80 名在医院 PD 中心接受治疗的新发病例 PD 患者。入组时间为 2009 年 1 月至 2010 年 6 月，随访持续至 2010 年 12 月。在开始 PD 后 1 个月和 6 个月时，测量 PD 充分性指数，包括 Kt/V 尿素、每周 Ccr（WCcr）、营养状况衡量标准（白蛋白、BMI）和 nPCR。采用 SF-36 健康调查问卷调查生活质量。结果用于测量 PD 治疗 6 个月后 SF-36 各领域的变化。
结果
纳入 77 名接受 PD 治疗 6 个月的新发病例患者。患者平均年龄为 47.3 岁，男女比例为 38:39。腹膜 Kt/V 尿素值 1.2，也是基线截止值，对 SF-36 各领域的影响最大。腹膜 Kt/V 尿素值＜1.2 的患者在 PD 治疗 6 个月后，生理功能和身体受限成分方面的功能得到改善。相比之下，腹膜 Kt/V 尿素值≥1.2 的患者在总体健康、生理功能、因身体问题引起的身体受限和身体疼痛方面的改善更为显著。然而，在基线 nPCR＜1.2 的患者中，改善趋势下降。基线肾 WCcr 并不影响 SF-36 各领域的改善。
局限性
队列较小且观察期较短。
结论
基线腹膜 Kt/V 尿素水平影响 PD 起始后生活质量的组成部分。相比之下，较低的基线 nPCR 水平与 PD 治疗后生活质量恶化相关。
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