Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.
Key Laboratory of Nephrology, Committee of Health and Guangdong Province, Guangzhou, 510080, China.
BMC Nephrol. 2020 Apr 25;21(1):148. doi: 10.1186/s12882-020-01800-1.
There have been few systematic studies regarding clearance of uric acid (UA) in patients undergoing peritoneal dialysis (PD). This study investigated peritoneal UA removal and its influencing factors in patients undergoing PD.
This cross-sectional study enrolled patients who underwent peritoneal equilibration test and assessment of Kt/V from April 1, 2018 to August 31, 2019. Demographic data and clinical and laboratory parameters were collected, including UA levels in dialysate, blood, and urine.
In total, 180 prevalent patients undergoing PD (52.8% men) were included. Compared with the normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1 ± 6.2 vs. 42.0 ± 8.0 L/week/1.73m; P = 0.008). Furthermore, higher transporters (high or high-average) exhibited greater peritoneal UA clearance, compared with lower transporters (low or low-average) (42.0 ± 7.0 vs. 36.4 ± 5.6 L/week/1.73 m; P < 0.001). Among widely used solute removal indicators, peritoneal creatinine clearance showed the best performance for prediction of higher peritoneal UA clearance in receiver operating characteristic curve analysis [area under curve (AUC) 0.96; 95% confidence interval [CI], 0.93-0.99]. Peritoneal UA clearance was independently associated with continuous SUA [standardized coefficient (β), - 0.32; 95% CI, - 6.42 to - 0.75] and hyperuricemia [odds ratio (OR), 0.86; 95% CI, 0.76-0.98] status, only in patients with lower (≤2.74 mL/min/1.73 m) measured glomerular filtration rate (mGFR). In those patients with lower mGFR, lower albumin level (β - 0.24; 95%CI - 7.26 to - 0.99), lower body mass index (β - 0.29; 95%CI - 0.98 to - 0.24), higher transporter status (β 0.24; 95%CI 0.72-5.88) and greater dialysis dose (β 0.24; 95%CI 0.26-3.12) were independently associated with continuous peritoneal UA clearance. Furthermore, each 1 kg/m decrease in body mass index (OR 0.79; 95% CI 0.63-0.99), each 1 g/dL decrease in albumin level (OR 0.08; 95%CI 0.01-0.47), and each 0.1% increase in average glucose concentration in dialysate (OR 1.56; 95%CI 1.11-2.19) were associated with greater peritoneal UA clearance (> 39.8 L/week/1.73m).
For patients undergoing PD who exhibited worse residual kidney function, peritoneal clearance dominated in SUA balance. Increasing dialysis dose or average glucose concentration may aid in controlling hyperuricemia in lower transporters.
对于接受腹膜透析（PD）的患者，尿酸（UA）清除率鲜有系统性研究。本研究旨在调查 PD 患者的腹膜 UA 清除率及其影响因素。
本横断面研究纳入了 2018 年 4 月 1 日至 2019 年 8 月 31 日期间进行腹膜平衡试验和 Kt/V 评估的患者。收集了人口统计学数据和临床及实验室参数，包括透析液、血液和尿液中的 UA 水平。
共纳入 180 例 PD 患者（52.8%为男性）。与正常血清 UA（SUA）组相比，高尿酸血症组的腹膜 UA 清除率显著降低（39.1±6.2 vs. 42.0±8.0 L/周/1.73m；P=0.008）。此外，与低转运体（低或低-中转运体）相比，高转运体（高或高-中转运体）表现出更大的腹膜 UA 清除率（42.0±7.0 vs. 36.4±5.6 L/周/1.73m；P<0.001）。在广泛使用的溶质清除指标中，腹膜肌酐清除率在接受者操作特征曲线分析中对预测较高的腹膜 UA 清除率具有最佳表现[曲线下面积（AUC）0.96；95%置信区间（CI）0.93-0.99]。腹膜 UA 清除率与持续的 SUA[标准化系数（β），-0.32；95%CI，-6.42 至-0.75]和高尿酸血症[比值比（OR），0.86；95%CI，0.76-0.98]状态独立相关，仅在肾小球滤过率（mGFR）较低（≤2.74 mL/min/1.73m）的患者中如此。在这些 mGFR 较低的患者中，较低的白蛋白水平（β-0.24；95%CI-7.26 至-0.99）、较低的体质量指数（β-0.29；95%CI-0.98 至-0.24）、较高的转运体状态（β0.24；95%CI 0.72-5.88）和更大的透析剂量（β0.24；95%CI 0.26-3.12）与持续的腹膜 UA 清除率独立相关。此外，体质量指数每降低 1 kg/m（OR 0.79；95%CI 0.63-0.99）、白蛋白水平每降低 1 g/dL（OR 0.08；95%CI 0.01-0.47）和透析液中平均葡萄糖浓度每增加 0.1%（OR 1.56；95%CI 1.11-2.19）与腹膜 UA 清除率（>39.8 L/周/1.73m）的增加相关。
对于残余肾功能较差的 PD 患者，腹膜清除在 SUA 平衡中起主导作用。增加透析剂量或平均葡萄糖浓度可能有助于控制低转运体患者的高尿酸血症。
