Steubl Dominik, Roos Marcel, Hettwer Stefan, Angermann Susanne, Wen Ming, Schmaderer Christoph, Luppa Peter, Heemann Uwe, Renders Lutz
Abteilung fx00FC;r Nephrologie, Klinikum rechts der Isar, Mx00FC;nchen, Germany.
Kidney Blood Press Res. 2016;41(2):175-85. doi: 10.1159/000443419. Epub 2016 Mar 10.
BACKGROUND/AIMS: This study compares the peritoneal elimination of the low-molecular-weight-protein (LMWP) C-terminal agrin fragment (tCAF, size 22 kDa), a promising biomarker for kidney function, in continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD).
103 sets of serum, 24h-urine and dialysate samples were obtained in 15 CCPD (63 sets) and 11 CAPD (40 sets) patients. Total, renal and peritoneal substrate removals/clearances were measured/calculated for tCAF, creatinine, blood-urea-nitrogen (BUN), cystatin C and albumin and correlated with the peritoneal transport type.
Serum und urine concentrations of all biomarkers did not differ between both groups, urinary substrate removal was higher in CAPD patients for all biomarkers due to better residual renal function. Peritoneal substrate removal of tCAF and albumin were significantly higher in CAPD (tCAF: 35.3 vs. 19.3 µg/d, p<0.001; albumin: 4.3 vs. 3.7 g/d, p=0.001), whereas cystatin C and creatinine did not differ between CAPD and CCPD (cystatin: 7.7 vs. 6.1 mg/d, p=0.08, creatinine: 423.9 vs. 456.7 mg/d, p=0.241). BUN was better removed by CCPD (4846.6 vs. 3393.4 mg/d, p<0.001). CAPD patients with high-transporter characteristics had a higher peritoneal tCAF removal compared to high-average-transporters (49.8 vs. 28.4 µg/d, p<0.001), no differences could be detected in CCPD patients between these groups. CAPD patients using icodextrin twice/day had higher peritoneal clearance of tCAF compared to once daily (4.4 vs. 2.8 l/wk/1.73 m2 body-surface-area, p<0.001).
CAPD was superior to CCPD concerning peritoneal tCAF removal. This finding was pronounced in high-transporters and CAPD patients using icodextrin twice daily.
背景/目的：本研究比较了连续循环腹膜透析（CCPD）和持续性非卧床腹膜透析（CAPD）中低分子量蛋白（LMWP）C端聚集蛋白片段（tCAF，大小为22 kDa）的腹膜清除情况，tCAF是一种很有前景的肾功能生物标志物。
收集了15例CCPD患者（63组样本）和11例CAPD患者（40组样本）的103组血清、24小时尿液和透析液样本。测定/计算了tCAF、肌酐、血尿素氮（BUN）、胱抑素C和白蛋白的总清除率、肾脏清除率和腹膜清除率，并与腹膜转运类型进行相关性分析。
两组患者所有生物标志物的血清和尿液浓度均无差异，由于残余肾功能较好，CAPD患者所有生物标志物的尿清除率更高。CAPD患者tCAF和白蛋白的腹膜清除率显著更高（tCAF：35.3 vs. 19.3 μg/d，p<0.001；白蛋白：4.3 vs. 3.7 g/d，p=0.001），而CAPD和CCPD患者的胱抑素C和肌酐清除率无差异（胱抑素：7.7 vs. 6.1 mg/d，p=0.08；肌酐：423.9 vs. 456.7 mg/d，p=0.241）。CCPD对BUN的清除效果更好（4846.6 vs. 3393.4 mg/d，p<0.001）。与高平均转运者相比，具有高转运特征的CAPD患者腹膜tCAF清除率更高（49.8 vs. 28.4 μg/d，p<0.001），CCPD患者中这两组之间未检测到差异。每天使用两次艾考糊精的CAPD患者tCAF的腹膜清除率高于每天使用一次的患者（4.4 vs. 2.8 l/周/1.73 m2体表面积，p<0.001）。
在腹膜tCAF清除方面，CAPD优于CCPD。这一发现在高转运者和每天使用两次艾考糊精的CAPD患者中更为明显。
