Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Nephrology (Carlton). 2013 Oct;18(10):657-64. doi: 10.1111/nep.12124.
Metabolic syndrome (MS) is associated with higher mortality and morbidity in the general population. However, the effect of MS and its individual components on clinical outcomes in non-diabetic peritoneal dialysis (PD) patients has not been widely studied in India. Our aim was to study the prevalence of MS in non-diabetic PD patients who were on PD for at least 3 months and to analyze the influence of MS and its individual components on clinical outcomes of these patients on subsequent follow up.
We prospectively included 163 non-diabetic PD patients (mean age 45.1 ± 16.2 years, 104 male). MS was defined using the modified National Cholesterol Education Programme (ATP III) criteria. Outcomes of patients with and without MS were compared.
Of the 163 non-diabetic PD patients, 84 (51.5%) patients had MS. The mean follow up duration was 24.0 ± 14.0 patient months. Patients with MS had significantly greater body mass index (P = 0.007), Systolic BP (P = 0.001), diastolic BP (P = 0.001), Triglycerides (P = 0.002), total cholesterol (P = 0.001) level; and significantly lower high density lipoprotein (P = 0.013) values. Mean survival (patient-months) of patients with MS (30.7 (95%CI 27.1-34.3)) was significantly inferior to that of patients without MS (55.6 (95% CI 50.8-60.4), P = 0.001). Mean technique survival of patients with MS was also significantly lower (38.9 (95% CI 35.9-41.9)) compared to that of patients without MS (61.5 (95% CI 58.3-64.7), P = 0.039). On univariate Cox regression analysis diastolic BP (P = 0.003), Systolic BP (P = 0.026), hypertension (HTN) (P = 0.001) and MS (P = 0.001) were found to be independent predictors of mortality. However on multivariate Cox hazard regression analysis, only MS (HR 5.39 (95% CI 2.06-14.14), P = 0.001) was found to be the significant predictors of mortality in these patients. Among the factors other than components of MS, the presence of comorbidities (P = 0.029), serum albumin (P = 0.042), non-HDL cholesterol (P = 0.003), total cholesterol/HDL (P = 0.001) and MS (P = 0.001) were important factors predicting mortality on univariate Cox regression, while only MS (P = 0.001) and serum albumin (P = 0.013) were the independent factors predicting mortality on multivariate analysis.
Prevalence of MS in non-diabetic PD patient is high and predicts long term patient and technique survival.
代谢综合征（MS）与普通人群的更高死亡率和发病率相关。然而，MS 及其各个组成部分对非糖尿病腹膜透析（PD）患者的临床结果的影响在印度尚未得到广泛研究。我们的目的是研究至少接受 3 个月 PD 治疗的非糖尿病 PD 患者中 MS 的患病率，并分析 MS 及其各个组成部分对这些患者随后随访期间临床结果的影响。
我们前瞻性纳入了 163 名非糖尿病 PD 患者（平均年龄 45.1±16.2 岁，104 名男性）。使用改良的国家胆固醇教育计划（ATP III）标准定义 MS。比较了有和没有 MS 的患者的结局。
在 163 名非糖尿病 PD 患者中，84 名（51.5%）患者患有 MS。平均随访时间为 24.0±14.0 患者月。MS 患者的体重指数（P=0.007）、收缩压（P=0.001）、舒张压（P=0.001）、甘油三酯（P=0.002）、总胆固醇（P=0.001）水平显著更高，高密度脂蛋白（P=0.013）水平显著更低。MS 患者的平均生存（患者月）（30.7（95%CI 27.1-34.3））明显低于无 MS 患者（55.6（95%CI 50.8-60.4），P=0.001）。MS 患者的平均技术生存（38.9（95%CI 35.9-41.9））也明显低于无 MS 患者（61.5（95%CI 58.3-64.7），P=0.039）。单变量 Cox 回归分析显示，舒张压（P=0.003）、收缩压（P=0.026）、高血压（HTN）（P=0.001）和 MS（P=0.001）是死亡的独立预测因素。然而，多变量 Cox 风险回归分析显示，只有 MS（HR 5.39（95%CI 2.06-14.14），P=0.001）是这些患者死亡的显著预测因素。在 MS 以外的其他因素中，合并症的存在（P=0.029）、血清白蛋白（P=0.042）、非高密度脂蛋白胆固醇（P=0.003）、总胆固醇/高密度脂蛋白（P=0.001）和 MS（P=0.001）是死亡的重要预测因素在单变量 Cox 回归中，而只有 MS（P=0.001）和血清白蛋白（P=0.013）是死亡的独立预测因素在多变量分析中。
非糖尿病 PD 患者 MS 的患病率较高，可预测患者和技术的长期生存率。
