Division of Nephrology, Department of Medicine, University of Washington, Seattle Washington.
Division of Nephrology, Department of Medicine, University of Washington, Kidney Research Institute, Seattle, Washington.
Clin J Am Soc Nephrol. 2020 Apr 7;15(4):530-538. doi: 10.2215/CJN.11120919. Epub 2020 Mar 9.
Residual kidney function is important to the health and wellbeing of patients with ESKD. We tested whether the kidney clearances of proximal tubular secretory solutes are associated with burden of uremic and heart failure symptoms among patients on peritoneal dialysis with residual kidney function.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled 29 patients on incident peritoneal dialysis with residual urine output >250 ml daily. We used targeted liquid chromatography-mass spectrometry to quantify plasma, 24-hour urine, and peritoneal dialysate concentrations of ten tubular secretory solutes. We calculated the kidney and peritoneal dialysis clearances of each secretory solute, creatinine, and urea, and we estimated a composite kidney and peritoneal secretion score. We assessed for uremic symptoms using the Dialysis Symptom Index and heart failure-related symptoms using the Kansas City Cardiomyopathy Questionnaire. We used linear regression to determine associations of composite secretory solute clearances and GFR with Dialysis Symptom Index symptom score and Kansas City Cardiomyopathy Questionnaire summary score.
Mean residual kidney clearances of creatinine and urea were 8±5 and 9±6 ml/min per 1.73 m, respectively, and mean GFR was 8±5 ml/min per 1.73 m. The residual kidney clearances of most secretory solutes were considerably higher than creatinine and urea clearance, and also, they were higher than their respective peritoneal dialysis clearances. After adjustments for age and sex, each SD higher composite kidney secretion score was associated with an 11-point lower Dialysis Symptom Index score (95% confidence interval, -20 to -1; =0.03) and a 12-point higher Kansas City Cardiomyopathy Questionnaire score (95% confidence interval, 0.5- to 23-point higher score; =0.04). Composite peritoneal dialysis secretion score was not associated with either symptom assessment.
Residual kidney clearances of secretory solutes are higher than peritoneal dialysis clearances. Kidney clearances of secretory solutes are associated with patient-reported uremic and heart failure-related symptoms.
残余肾功能对接受终末期肾病（ESKD）治疗的患者的健康和生活质量非常重要。我们检测了残余肾功能的腹膜透析患者近端肾小管分泌溶质的肾清除率与尿毒症和心力衰竭症状负担之间的关系。
设计、设置、参与者和测量：我们纳入了 29 名每日尿量>250ml 的新发病例腹膜透析患者。我们使用靶向液相色谱-质谱法定量检测了血浆、24 小时尿液和腹膜透析液中十种管状分泌溶质的浓度。我们计算了每个分泌溶质、肌酐和尿素的肾和腹膜透析清除率，并估计了一个复合肾和腹膜分泌评分。我们使用透析症状指数评估尿毒症症状，使用堪萨斯城心肌病问卷评估心力衰竭相关症状。我们使用线性回归确定复合分泌溶质清除率和肾小球滤过率与透析症状指数症状评分和堪萨斯城心肌病问卷总分的关系。
肌酐和尿素的残余肾清除率分别为 8±5ml/min/1.73m2和 9±6ml/min/1.73m2，平均肾小球滤过率为 8±5ml/min/1.73m2。大多数分泌溶质的残余肾清除率明显高于肌酐和尿素清除率，也高于各自的腹膜透析清除率。在校正年龄和性别后，复合肾分泌评分每增加一个标准差与透析症状指数评分降低 11 分相关（95%置信区间，-20 至-1；=0.03），堪萨斯城心肌病问卷评分升高 12 分（95%置信区间，0.5 至 23 分；=0.04）。复合腹膜透析分泌评分与两种症状评估均无关。
分泌溶质的残余肾清除率高于腹膜透析清除率。分泌溶质的肾清除率与患者报告的尿毒症和心力衰竭相关症状相关。
