Htay Htay, Cho Yeoungjee, Pascoe Elaine M, Darssan Darsy, Hawley Carmel, Johnson David W
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
Australasian Kidney Trials Network, School of Medicine, University of Queensland, Brisbane, Australia.
Perit Dial Int. 2017 May-Jun;37(3):283-289. doi: 10.3747/pdi.2016.00206. Epub 2016 Dec 1.
♦ OBJECTIVE: Preservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients. ♦ METHODS: The study included incident PD patients who were ANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model. ♦ RESULTS: The study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m at baseline to 3.3 ± 2.8 mL/min/1.73 m at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation ( = 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation ( < 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV. ♦ CONCLUSIONS: Common modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.
♦ 目的：残余肾功能（RRF）的保留与生存率提高相关。本研究的目的是确定新发腹膜透析（PD）患者RRF和尿量（UV）的独立预测因素。♦ 方法：该研究纳入了ANZ试验参与者中的新发PD患者。主要和次要结局分别为RRF和UV。在第一个模型中使用包含人口统计学数据的混合效应线性回归分析这两个结局，在第二个模型中纳入与PD相关的参数进行分析。♦ 结果：该研究纳入了161例患者（平均年龄57.9±14.1岁，44%为女性，33%患有糖尿病，平均随访19.5±6.6个月）。残余肾功能从基线时的7.5±2.9 mL/min/1.73 m²下降至24个月时的3.3±2.8 mL/min/1.73 m²。男性、较高的基线RRF、较高的随时间变化的收缩压（SBP）、生物相容性（中性pH值、低葡萄糖降解产物）PD溶液、较低的腹膜超滤（UF）和较低的透析液葡萄糖暴露可独立预测更好地保留RRF。特别是，生物相容性溶液使RRF保留情况改善了27%。UF每增加1 L/天与RRF保留情况恶化8%相关（P = 0.007），透析液葡萄糖暴露每增加10 g/天与RRF保留情况恶化4%相关（P < 0.001）。体重指数、糖尿病、肾素 - 血管紧张素系统抑制剂、腹膜溶质转运率或PD方式不能独立预测残余肾功能。UV也观察到类似结果。♦ 结论：与保留RRF和残余UV持续相关的常见可改变风险因素是使用生物相容性PD溶液以及随着时间推移实现较高的SBP、较低水平的腹膜UF和较低的透析液葡萄糖暴露。
