He Lian, Liu Xihui, Li Zi, Abreu Zita, Malavade Tushar, Lok Charmaine E, Bargman Joanne M
Department of Nephrology, Peking University 3 Hospital, Beijing, P.R. China University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada.
Division of Nephrology, Linyi People's Hospital, Linyi, Shandong, P.R. China University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada.
Perit Dial Int. 2016 May-Jun;36(3):334-9. doi: 10.3747/pdi.2016.00024. Epub 2016 Apr 4.
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There is a paucity of information on whether peritoneal dialysis (PD) slows the decline of residual kidney function (RKF) compared to the natural slope of RKF decline prior to dialysis start. Our aim was to analyze the RKF decline before and after initiating PD, and to determine the principal factors affecting this decline during the PD period. ♦
We determined individual glomerular filtration rates (GFR) for approximately 12 months before and after PD in 77 new PD patients in a large academic medical center (2008 - 2012). The GFR was estimated by the Modification of Diet in Renal Disease (MDRD) equation in the predialysis period and by averaging 24-hour urine creatinine and urea clearances in the PD period. The rate of RKF decline was calculated using unadjusted linear regression analysis. Wilcoxon signed rank test was used to compare RKF decline before and after PD initiation. Multivariate linear regression was used to identify independent risk factors for RKF decline in the PD phase. ♦
A significantly slower mean rate of RKF decline was observed in the PD period compared with the predialysis period (-0.21 ± 0.30 vs -0.59 ± 0.55 mL/min/1.73 m(2)/month, p < 0.01). Higher baseline RKF, higher serum phosphate, and older age were independently associated with faster decline of RKF (all p < 0.01). ♦
In patients with advanced chronic kidney disease, initiating PD was associated with a slower rate of RKF decline compared to the rate in the predialysis period.
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关于腹膜透析（PD）与透析开始前残余肾功能（RKF）下降的自然斜率相比是否能减缓RKF下降的信息较少。我们的目的是分析开始PD前后RKF的下降情况，并确定在PD期间影响这种下降的主要因素。♦
我们在一家大型学术医疗中心对77例新的PD患者在PD前后约12个月内测定了个体肾小球滤过率（GFR）（2008 - 2012年）。透析前阶段通过肾脏病饮食改良（MDRD）方程估算GFR，PD阶段通过平均24小时尿肌酐和尿素清除率估算。使用未调整的线性回归分析计算RKF下降率。采用Wilcoxon符号秩检验比较PD开始前后RKF的下降情况。多变量线性回归用于确定PD阶段RKF下降的独立危险因素。♦
与透析前阶段相比，PD期间观察到RKF下降的平均速率明显较慢（-0.21±0.30对-0.59±0.55 mL/min/1.73 m²/月，p<0.01）。较高的基线RKF、较高的血清磷酸盐水平和较高的年龄与RKF更快下降独立相关（所有p<0.01）。♦
在晚期慢性肾脏病患者中，与透析前阶段相比，开始PD与RKF下降速率较慢相关。
