Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu 705-717, Korea.
Kidney Blood Press Res. 2013;37(2-3):199-210. doi: 10.1159/000350145. Epub 2013 May 30.
Preservation of residual renal function (RRF) is a major issue for patients on peritoneal dialysis (PD). Whether proteinuria is associated with a decline in RRF in patients on PD remains unclear.
We reviewed the medical records at the Yeungnam University Hospital in Korea and identified patients who started PD between June 1995 and August 2011. A total of 147 non-diabetic patients were enrolled in the study. The patients were divided into 3 groups with respect to the tertile of initial proteinuria level: Low (n = 49; <320 mg/day), Middle (n = 49; 320-822 mg/day), and High groups (n = 49; >822 mg/day).
The mean patient age was 50.2 ± 15.0 years in the Low tertile, 50.2 ± 15.4 years in the Middle tertile, and 49.0 ± 15.1 years in the High tertile. Decline in RRF during follow-up period was greater in the High tertile than that in the other tertiles (P = 0.001). The proportion of patients with RRF >50% of baseline at 24 months after the initiation of PD was 83% in the Low tertile, 66% in the Middle tertile, and 40% in the High tertile (P < 0.001). The multivariate analysis after adjusting for initial RRF, age, gender, underlying disease of end-stage renal disease except diabetes mellitus, PD modality, use of icodextrin, PD-associated peritonitis, and tertile of the initial proteinuria level revealed that High tertile of the initial proteinuria level was associated with a decline in RRF (hazard ratios: 2.442 for the Middle tertile, P = 0.007 ; 3.713 for the Low tertile, P < 0.001).
The present study demonstrates that proteinuria may be is associated with a rapid decline in RRF in non-diabetic patients on PD, although the potential role of additional factors should be further investigated in prospective studies.
保留残余肾功能（RRF）是腹膜透析（PD）患者的主要问题。蛋白尿是否与 PD 患者的 RRF 下降有关尚不清楚。
我们回顾了韩国延世大学医院的病历记录，并确定了 1995 年 6 月至 2011 年 8 月期间开始 PD 的患者。共有 147 名非糖尿病患者入组本研究。根据初始蛋白尿水平的三分位值将患者分为 3 组：低（n = 49；<320mg/天）、中（n = 49；320-822mg/天）和高（n = 49；>822mg/天）组。
低三分位组患者的平均年龄为 50.2 ± 15.0 岁，中三分位组为 50.2 ± 15.4 岁，高三分位组为 49.0 ± 15.1 岁。在随访期间，高三分位组的 RRF 下降幅度大于其他三分位组（P = 0.001）。在 PD 开始后 24 个月时，RRF>50%基线的患者比例在低三分位组为 83%，在中三分位组为 66%，在高三分位组为 40%（P<0.001）。在调整初始 RRF、年龄、性别、除糖尿病以外的终末期肾病基础疾病、PD 方式、使用伊可定、PD 相关腹膜炎以及初始蛋白尿水平三分位值后进行的多变量分析显示，初始蛋白尿水平的高三分位值与 RRF 下降相关（中三分位值的危险比：2.442，P = 0.007；低三分位值的危险比：3.713，P<0.001）。
本研究表明，蛋白尿可能与 PD 非糖尿病患者的 RRF 快速下降有关，尽管需要在前瞻性研究中进一步探讨其他因素的潜在作用。
