Department of Nephrology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
UCL Center for Nephrology, Royal Free Hospital, University College London, United Kingdom.
Perit Dial Int. 2019 Mar-Apr;39(2):155-162. doi: 10.3747/pdi.2018.00016. Epub 2019 Jan 18.
Peritoneal effluent from peritoneal dialysis (PD) patients contains proteins, mainly transported from the circulation through large pores in the venular part of the peritoneal microvessels. Hydrostatic convection is the major driver for peritoneal protein transport, although in PD there is additional diffusion. Consequently, venous pressure may have a role in peritoneal protein transport. The aim of the study was to investigate the importance of venous congestion on the magnitude of peritoneal protein clearance in incident PD patients using non-invasive measurements.
A total of 316 adult PD patients, on PD for 8 - 12 weeks and collecting 24-hour urine and dialysate for total protein determination, underwent standard peritoneal equilibration testing (PET) along with measurement of N terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein (CRP), multifrequency bioimpedance analysis, and a transthoracic echocardiogram.
Statistically significant univariate relationships for peritoneal protein clearance with a Spearman correlation coefficient > 0.25 were present for 4-hour dialysate/plasma (D/P) creatinine, NT-proBNP, extracellular/total body water, extracellular water excess, left ventricular mass, and right atrial area. Negative correlations were found with serum total protein and residual renal function. On multivariate analysis, logNTproBNP (β 0.11, = 0.007) and right atrial area (β 0.01, = 0.03) were significant independent predictors of peritoneal protein clearance.
Indicators of venous congestion showed the most important relationships with peritoneal protein clearance. These indicators have not been assessed in previous studies on the presence or absence of relationships between peritoneal protein clearance and mortality.
腹膜透析（PD）患者的腹腔渗出液中含有蛋白质，这些蛋白质主要通过穿过腹膜微血管静脉部分的大孔从循环中转运而来。流体静力对流是腹膜蛋白转运的主要驱动力，尽管 PD 中还存在额外的扩散。因此，静脉压可能在腹膜蛋白转运中发挥作用。本研究旨在通过非侵入性测量来研究静脉充血对新开始 PD 患者腹膜蛋白清除率大小的重要性。
共纳入 316 例接受 PD 治疗 8-12 周的成年 PD 患者，收集 24 小时尿液和透析液以测定总蛋白，同时测定 N 末端脑钠肽前体（NT-proBNP）和 C 反应蛋白（CRP）、多频生物阻抗分析和经胸超声心动图。
对于 4 小时透析液/血浆（D/P）肌酐、NT-proBNP、细胞外/总体水、细胞外水过多、左心室质量和右心房面积，存在具有 Spearman 相关系数>0.25 的腹膜蛋白清除率的统计学显著单变量关系。与血清总蛋白和残余肾功能呈负相关。多变量分析显示，logNT-proBNP（β0.11，P=0.007）和右心房面积（β0.01，P=0.03）是腹膜蛋白清除率的独立显著预测因子。
静脉充血的指标与腹膜蛋白清除率的关系最为密切。这些指标在之前关于腹膜蛋白清除率与死亡率之间是否存在关系的研究中尚未得到评估。
