Wang Zheng, Yu Dahai, Cai Yamei, Ma Shuang, Zhao Bin, Zhao Zhanzheng, Simmons David
Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK.
Medicine (Baltimore). 2020 May 22;99(21):e20447. doi: 10.1097/MD.0000000000020447.
Different measures of rates of transfer of glucose during the peritoneal equilibrium test (PET), undertaken during peritoneal dialysis (PD) might provide additional information regarding a patient's risk of future cardiovascular mortality. This study aimed to characterize the heterogeneity of dialysate glucose (DG) response phenotypes during the PET and compare the cardiovascular mortality rates associated with the different phenotypes. Our cohort was derived from Henan peritoneal dialysis registry. A total of 3477 patients initiating PD in 2007 to 2014 had the DG measured at 0, 2-hour and 4-hour (D0, D2, and D4 respectively) during the PET for estimation of D2/D0 and D4/D0. Deaths mainly due to CVD within 2 years since the initiation of PD were defined as the outcome. Latent class mixed-effect models were fitted to identify distinct phenotypes of the DG response during the PET. Multivariable unconditional Logistic regression models with adjustment for cardiometabolic risk factors were used to compare the 2-year risk of cardiovascular mortality among patients in the different latent classes. Three distinct DG response phenotypes during the PET were identified. Those with consistently high D2/D0 and D4/D0 ratios had a 1.22 [95% confidence interval: 1.02, 1.35] excess risk of a cardiovascular death within 2 years of commencing PD compared with patients with the lowest D2/D0 ratio and decreased D4/D0 ratio after adjustment for cardiometabolic risk factors. Consistently elevated D2/D0 and D4/D0 ratios during the PET are associated with an increased risk of 2-year cardiovascular mortality independent of other cardiometabolic risk factors. In view of the potential bias due to unmeasured confounders (eg, Family history of cardiovascular diseases, and dietary patterns), this association should be further validated in other external cohorts.
在腹膜透析（PD）过程中进行的腹膜平衡试验（PET）期间，不同的葡萄糖转运速率测量方法可能会提供有关患者未来心血管死亡风险的额外信息。本研究旨在描述PET期间透析液葡萄糖（DG）反应表型的异质性，并比较与不同表型相关的心血管死亡率。我们的队列来自河南腹膜透析登记处。2007年至2014年开始进行PD的3477例患者在PET期间分别于0小时、2小时和4小时（分别为D0、D2和D4）测量DG，以估算D2/D0和D4/D0。将PD开始后2年内主要因心血管疾病（CVD）导致的死亡定义为研究结局。采用潜在类别混合效应模型来识别PET期间DG反应的不同表型。使用对心脏代谢危险因素进行调整的多变量无条件逻辑回归模型来比较不同潜在类别患者2年内心血管死亡的风险。在PET期间识别出三种不同的DG反应表型。与D2/D0比值最低且D4/D0比值下降的患者相比，那些D2/D0和D4/D0比值持续较高的患者在开始PD后2年内发生心血管死亡的风险高出1.22倍[95%置信区间：1.02，1.35]，在对心脏代谢危险因素进行调整后依然如此。PET期间D2/D0和D4/D0比值持续升高与2年内心血管死亡风险增加相关，且独立于其他心脏代谢危险因素。鉴于未测量的混杂因素（如心血管疾病家族史和饮食模式）可能导致的潜在偏倚，这种关联应在其他外部队列中进一步验证。
