腹膜透析开始时的血清白蛋白可预测安徽汉族持续性非卧床腹膜透析患者的长期预后：一项回顾性队列研究

Serum Albumin at Start of Peritoneal Dialysis Predicts Long-Term Outcomes in Anhui Han Patients on Continuous Ambulatory Peritoneal Dialysis: A Retrospective Cohort Study.

作者信息

Jiang Jun, Wang Li-Hua, Fei Yun-Yun, Zhou Xiao-Wan, Peng Li, Lan Lei, Ren Wei

机构信息

Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.

出版信息

Kidney Dis (Basel). 2018 Nov;4(4):262-268. doi: 10.1159/000492426. Epub 2018 Sep 3.

DOI:10.1159/000492426

PMID:30574503

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6276754/

Abstract

OBJECTIVE

This study assessed the relationship between serum albumin (ALB) at start of peritoneal dialysis (PD) and long-term outcomes of continuous ambulatory PD (CAPD) in Anhui Han patients.

METHODS

A total of 149 Anhui Han CAPD patients were enrolled in this study and followed up for 3 years. They were initially diagnosed with the end-stage renal disease and underwent surgical PD catheter placement from January 2009 to December 2013. According to serum ALB at start of PD, the patients were divided into two groups: low ALB group (ALB < 35 g/L) and high ALB group (ALB ≥35 g/L). Demographic, hematologic, biochemical, and dialysis-related data were collected. Kaplan-Meier survival analysis and log-rank test were conducted to compare patient mortality, cardiovascular mortality and technique failure between the low ALB group and the high ALB group. Cox regression analysis was performed to analyze the risk factors, calculate the hazard ratio (HR), adjusted HR (AHR) and 95% confidence interval (CI).

RESULTS

The low ALB group showed a greater number of diabetes mellitus compared with the high ALB group. Patient mortality, cardiovascular mortality, and technique failure in the high ALB group were significantly lower than those in the low ALB group. In Cox regression analysis, serum ALB < 35 g/L was an independent predictor of patient mortality (AHR 3.043, 95% CI 1.085-8.536, 0.034), cardiovascular mortality (AHR 11.587, 95% CI 1.466-91.574, 0.020), and technique failure (AHR 3.148, 95% CI 1.603-6.182, 0.001) in CAPD patients after adjustment for sex, age, estimated glomerular filtration rate, primary renal disease, diabetes mellitus, and cardiovascular disease.

CONCLUSIONS

In Anhui Han patients on CAPD, the levels of serum ALB at start of PD are inversely correlated with patient mortality, cardiovascular mortality, and technique failure, and the long-term outcomes of patients with hypoalbuminemia at start of PD are poor. To improve the long-term outcomes of Anhui Han CAPD patients, patients with hypoalbuminemia at start of PD should be closely monitored.

摘要

目的

本研究评估安徽汉族患者腹膜透析（PD）开始时血清白蛋白（ALB）与持续性非卧床腹膜透析（CAPD）长期预后之间的关系。

方法

本研究共纳入149例安徽汉族CAPD患者，并进行了3年的随访。他们最初被诊断为终末期肾病，并于2009年1月至2013年12月接受了PD导管置入手术。根据PD开始时的血清ALB水平，将患者分为两组：低ALB组（ALB<35 g/L）和高ALB组（ALB≥35 g/L）。收集人口统计学、血液学、生化和透析相关数据。采用Kaplan-Meier生存分析和对数秩检验比较低ALB组和高ALB组患者的死亡率、心血管死亡率和技术失败率。进行Cox回归分析以分析危险因素，计算风险比（HR）、调整后HR（AHR）和95%置信区间（CI）。

结果

与高ALB组相比，低ALB组糖尿病患者数量更多。高ALB组的患者死亡率、心血管死亡率和技术失败率显著低于低ALB组。在Cox回归分析中，在调整性别、年龄、估计肾小球滤过率、原发性肾病、糖尿病和心血管疾病后，血清ALB<35 g/L是CAPD患者全因死亡（AHR 3.043，95%CI 1.085 - 8.536，P = 0.034）、心血管死亡（AHR 11.587，95%CI 1.466 - 91.574，P = 0.020）和技术失败（AHR 3.148，95%CI 1.603 - 6.182，P = 0.001）的独立预测因素。