Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands; , †Department of Nephrology and, ‡Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; , §Department of Nephrology and , ‖Institute for Cardiovascular Research, VU Medical Center, Amsterdam, The Netherlands; , ¶Academic Medical Center, Amsterdam, The Netherlands, *St. Luc Hospital, Montréal, Quebec, Canada.
Clin J Am Soc Nephrol. 2014 Feb;9(2):318-25. doi: 10.2215/CJN.04470413. Epub 2014 Jan 23.
Inflammation and malnutrition are important features in patients with ESRD; however, data on changes in these parameters over time are scarce. This study aimed to gain insight into changes over time in serum albumin, body mass index, high-sensitivity C-reactive protein, and IL-6 in patients with ESRD and aimed to identify clinical risk factors for deterioration of these parameters.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were analyzed from the Convective Transport Study, a randomized controlled trial conducted from June 2004 to January 2011, in which 714 patients with chronic ESRD were randomized to either online hemodiafiltration or low-flux hemodialysis. Albumin and body mass index were measured up to 6 years and predialysis C-reactive protein and IL-6 were measured up to 3 years in a subset of 405 participants. Rates of change in these parameters over time were estimated across strata of predefined risk factors with linear mixed-effects models.
Albumin and body mass index decreased and C-reactive protein and IL-6 increased over time. For every incremental year of age at baseline, the yearly excess decline in albumin was 0.003 g/dl (-0.004 to -0.002; P<0.001) and the excess decline in body mass index was 0.02 kg/m(2) per year (-0.02 to -0.01; P<0.001). In patients with diabetes mellitus, there was a yearly excess decline of 0.05 g/dl in albumin (-0.09 to -0.02; P=0.002). Compared with women, men had an excess decline of 0.03 g/dl per year in albumin (-0.06 to -0.001; P=0.05) and an excess increase of 11.6% per year in IL-6 (0.63%-23.6%; P=0.04).
Despite guideline-based care, all inflammatory and nutritional parameters worsened over time. The deterioration of some of these parameters was more pronounced in men, older patients, and patients with diabetes mellitus. Special focus on the nutritional status of at-risk patients by individualizing medical care might improve their prognosis.
炎症和营养不良是终末期肾病（ESRD）患者的重要特征；然而，关于这些参数随时间变化的数据却很少。本研究旨在深入了解 ESRD 患者血清白蛋白、体重指数、高敏 C 反应蛋白和白细胞介素 6 随时间的变化，并确定这些参数恶化的临床危险因素。
设计、设置、参与者和测量：本研究对 2004 年 6 月至 2011 年 1 月期间进行的一项名为 Convective Transport 研究的数据进行了分析，该研究为一项随机对照试验，共纳入 714 例慢性 ESRD 患者，随机分为在线血液透析滤过组或低通量血液透析组。在 405 名参与者的亚组中，在 6 年内测量白蛋白和体重指数，在 3 年内测量透析前 C 反应蛋白和白细胞介素 6。使用线性混合效应模型，根据预先设定的危险因素分层估计这些参数随时间的变化率。
白蛋白和体重指数随时间下降，C 反应蛋白和白细胞介素 6 随时间升高。与基线时相比，每增加 1 岁，白蛋白的年过量下降为 0.003 g/dl（-0.004 至-0.002；P<0.001），体重指数的年过量下降为 0.02 kg/m2/年（-0.02 至-0.01；P<0.001）。在糖尿病患者中，白蛋白每年过量下降 0.05 g/dl（-0.09 至-0.02；P=0.002）。与女性相比，男性白蛋白每年过量下降 0.03 g/dl（-0.06 至-0.001；P=0.05），白细胞介素 6 每年过量增加 11.6%（0.63%-23.6%；P=0.04）。
尽管进行了基于指南的治疗，但所有炎症和营养参数随时间恶化。这些参数中的一些在男性、老年患者和糖尿病患者中恶化更为明显。通过个体化医疗关注高危患者的营养状况，可能会改善他们的预后。
