Kim Jwa-Kyung, Kim Young-Su, Song Young Rim, Kim Hyung Jik, Kim Sung Gyun, Moon Sung Jin
Department of Internal Medicine, Kidney Research Institute, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Korea.
Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
PLoS One. 2015 Sep 25;10(9):e0139033. doi: 10.1371/journal.pone.0139033. eCollection 2015.
Significant weight gain is a potential problem in most patients starting peritoneal dialysis (PD); however, few studies have explored the clinical effects of increased body weight (BW) in these patients. We evaluated the effect of excess weight gain during the first year after PD on residual renal function (RRF).
A total of 148 incident PD patients were analyzed in a longitudinal observational study. The mean duration of follow-up was 23.8 months. RRF was measured at baseline (within 1 month of starting PD) and thereafter at 6-month intervals for 2-3 years or until loss of RRF. BW was measured at the time of RRF measurement, and excess weight gain was defined as a BW increase over the median value (3.0%).
The median 1-year increase in BW was 2.3kg (IQR, 1.01-4.58) or 3.0% (IQR, 1.13-5.31). The mean slope of RRF decline was -0.068 ± 0.053 mL/min/month/1.73m2, and RRF loss developed in 48 patients at a mean follow-up time of 19.4 ± 6.8 months. Patients with BW increases > 3.0% showed significantly increased RRF decline rate compared to those without excess weight gain (p<0.001), and the BW increase (%/year) correlated significantly with higher hs-CRP levels and RRF decline rate. High systolic blood pressure, diabetes, large amount of proteinuria and excess BW gain significantly influenced the RRF decline rate. Also, it increased the risk of RRF loss by 4.17-fold (95% confidence intervals, 1.87-9.28; p<0.001).
Excess weight gain during the first year of PD was closely linked to systemic inflammation, diabetes and rapid decline in RRF.
显著体重增加是大多数开始腹膜透析（PD）患者的一个潜在问题；然而，很少有研究探讨这些患者体重（BW）增加的临床影响。我们评估了PD后第一年体重过度增加对残余肾功能（RRF）的影响。
在一项纵向观察性研究中分析了总共148例新发PD患者。平均随访时间为23.8个月。在基线时（开始PD后1个月内）测量RRF，此后每6个月测量一次，持续2 - 3年或直至RRF丧失。在测量RRF时测量BW，体重过度增加定义为BW增加超过中位数（3.0%）。
BW的中位数1年增加量为2.3kg（四分位间距，1.01 - 4.58）或3.0%（四分位间距，1.13 - 5.31）。RRF下降的平均斜率为-0.068±0.053 mL/min/月/1.73m²，48例患者出现RRF丧失，平均随访时间为19.4±6.8个月。与没有体重过度增加的患者相比，BW增加>3.0%的患者RRF下降率显著增加（p<0.001），且BW增加（%/年）与较高的hs-CRP水平和RRF下降率显著相关。高收缩压、糖尿病、大量蛋白尿和体重过度增加显著影响RRF下降率。此外，它使RRF丧失的风险增加4.17倍（95%置信区间，1.87 - 9.28；p<0.001）。
PD第一年体重过度增加与全身炎症、糖尿病和RRF快速下降密切相关。
