液体超负荷及变化对腹膜透析患者残余肾功能的影响
The Impact of Fluid Overload and Variation on Residual Renal Function in Peritoneal Dialysis Patient.
作者信息
Tian Na, Guo Qunying, Zhou Qian, Cao Peiyi, Hong Lingyao, Chen Menghua, Yang Xiao, Yu Xueqing
机构信息
Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.
Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China.
出版信息
PLoS One. 2016 Apr 19;11(4):e0153115. doi: 10.1371/journal.pone.0153115. eCollection 2016.
BACKGROUND
The effect of fluid overload and variation on residual renal function (RRF) in peritoneal dialysis (PD) patients is controversial.
METHODS
Retrospective cohort study was designed. One-hundred and ninety PD patients with measured glomerular filtration rate (mGFR) ≧ 3 ml/min/1.73 m2 were recruit. Fluid status of every participant was assessed by bioelectrical impedance analysis (BIA) every 3 months for 1 year. The cohort was divided into three hydration groups, namely persistent overhydration (PO) group, intermittent overhydration (IO) group and normal hydration (NH) group. Additionally, participants were also divided into high or low fluid variation groups. The decline rate of RRF and the event of anuria were followed up for 1 year. The association of fluid overload with RRF loss was evaluated by Cox proportional hazard models adjusted for confounders.
RESULTS
Thirty-six (18.9%) patients developed anuria. The decline rate of mGFR in both PO and IO groups were significantly faster than that of NH group (PO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01; IO vs NH: -0.2 vs -0.1 ml/min/1.73 m2/month, p < 0.01). Kaplan-Meier analysis showed poorer RRF outcome in both PO and IO groups compared with that of NH group (PO vs NH: p < 0.001; IO vs NH: p = 0.006). Patients with high fluid variation had worse RRF survival than those with low fluid variation (p = 0.04). Adjusted Cox regression models indicated the hazard ratio of RRF loss in PO group was 8.90-folds higher (95% confidence interval 3.07-31.89) than that in NH group.
CONCLUSIONS
These findings suggested fluid overload was independently associated with the decline of RRF in PD patients.
背景
液体超负荷及其变化对腹膜透析（PD）患者残余肾功能（RRF）的影响存在争议。
方法
设计了一项回顾性队列研究。招募了190例测量肾小球滤过率（mGFR）≧3 ml/min/1.73 m²的PD患者。在1年的时间里，每3个月通过生物电阻抗分析（BIA）评估每位参与者的液体状态。该队列被分为三个水化组，即持续性液体过多（PO）组、间歇性液体过多（IO）组和正常水化（NH）组。此外，参与者还被分为高或低液体变化组。随访1年RRF的下降率和无尿事件。通过调整混杂因素的Cox比例风险模型评估液体超负荷与RRF丧失的关联。
结果
36例（18.9%）患者出现无尿。PO组和IO组的mGFR下降率均显著快于NH组（PO组 vs NH组：-0.2 vs -0.1 ml/min/1.73 m²/月，p < 0.01；IO组 vs NH组：-0.2 vs -0.1 ml/min/1.73 m²/月，p < 0.01）。Kaplan-Meier分析显示，与NH组相比，PO组和IO组的RRF结局更差（PO组 vs NH组：p < 0.001；IO组 vs NH组：p = 0.006）。液体变化大的患者的RRF生存率比液体变化小的患者更差（p = 0.04）。调整后的Cox回归模型表明，PO组RRF丧失的风险比是NH组的8.90倍（95%置信区间3.07 - 31.89）。
结论
这些发现表明，液体超负荷与PD患者RRF下降独立相关。
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