Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand.
J Nephrol. 2020 Dec;33(6):1275-1287. doi: 10.1007/s40620-020-00716-1. Epub 2020 Mar 4.
Evidence shows that lower serum albumin concentrations are associated with the risk of peritoneal dialysis (PD)-related peritonitis. However, little is known regarding its relationship and magnitude of change before PD initiation and peritonitis risk.
We performed a multicenter retrospective cohort study on 1169 adult cases of PD in Thailand. The associations of serum albumin at concentration (< 2.5, 2.5-3.5, > 3.5 [reference] g/dL) and changes (unchanged + 0.1 to - 0.1 [reference], decrease or increase > 0.1 g/dL) over 3- and 6-month before PD initiation with PD-related peritonitis were examined. Time-to-first and longitudinal rates of peritonitis were examined using the multivariable Cox proportional hazards model and Poisson regression analyses, respectively.
At baseline PD initiation, patients with serum albumin concentration < 2.5 and 2.5-3.5 g/dL had an adjusted hazard ratio (HR) of 1.69 and 2.0 times higher peritonitis (vs. > 3.5 g/dL), respectively. Compared to the unchanged group, patients with a decrease and increase in serum albumin concentrations during transitioning to dialysis were significantly associated with higher and lower risk of peritonitis, adjusted HR of 2.25 (95% confidence interval [CI] 1.85-2.75) and 0.53 (95% CI 0.42-0.68) over three-month, and 1.43 (95% CI 1.15-1.79) and 0.64 (95% CI 0.52-0.79) over six-month, respectively. Similar trends of longitudinal rates of serum albumin concentrations and peritonitis risk were observed.
Serum albumin concentrations at PD initiation and its magnitude of change during the transition to dialysis are strongly associated with subsequent risk of peritonitis. Further studies are required on strategies modifying serum albumin concentration during the transition to PD.
有证据表明，血清白蛋白浓度较低与腹膜透析（PD）相关腹膜炎的风险相关。然而，在开始 PD 之前及其与腹膜炎风险的关系和变化幅度方面，人们对此知之甚少。
我们在泰国对 1169 例成人 PD 病例进行了一项多中心回顾性队列研究。研究检查了血清白蛋白浓度（<2.5、2.5-3.5、>3.5[参考]g/dL）和 3 个月和 6 个月前开始 PD 前变化（不变+0.1 至-0.1[参考]，减少或增加>0.1g/dL）与 PD 相关腹膜炎的关系。使用多变量 Cox 比例风险模型和泊松回归分析分别检查首次发生时间和纵向腹膜炎发生率。
在开始 PD 时，血清白蛋白浓度<2.5 和 2.5-3.5g/dL 的患者发生腹膜炎的调整后危险比（HR）分别为 1.69 和 2.0 倍（与>3.5g/dL 相比）。与不变组相比，在向透析过渡期间血清白蛋白浓度下降和升高的患者发生腹膜炎的风险显著更高和更低，调整后的 HR 分别为 2.25（95%置信区间 [CI] 1.85-2.75）和 0.53（95% CI 0.42-0.68）在三个月内，1.43（95%CI 1.15-1.79）和 0.64（95%CI 0.52-0.79）在六个月内。观察到血清白蛋白浓度和腹膜炎风险的纵向率的相似趋势。
开始 PD 时的血清白蛋白浓度及其在向透析过渡期间的变化幅度与随后发生腹膜炎的风险密切相关。需要进一步研究在向 PD 过渡期间改变血清白蛋白浓度的策略。
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