Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.
Institute of Nephrology, Peking University, Beijing, China.
Perit Dial Int. 2022 Nov;42(6):622-630. doi: 10.1177/08968608211051809. Epub 2021 Nov 1.
Trimethylamine-N-oxide (TMAO) is a gut bacteria-derived metabolite of l-carnitine and choline. A high concentration of TMAO has been proven to relate to cardiovascular disease (CVD), all-cause mortality and chronic kidney disease progression. We aimed to investigate the relation between the value of serum TMAO and outcomes for peritoneal dialysis (PD) patients.
This is a prospective cohort study with data retrospectively analysed. All incident PD patients were enrolled and followed up. Log-rank test, competing risk survival analysis and COX regression were performed to test the effect of serum TMAO on developing first-episode peritonitis, all-cause and CVD mortality.
A wide distribution of serum TMAO concentration was observed in 513 PD patients, with a median level of 72.3 (43.7, 124.7) µmol/L. Patients with lower TMAO concentration were more likely to be without diabetes and hypertension. Patients with lower TMAO concentration showed better residual kidney function and solute clearance at baseline. Participants in the higher three TMAO quartiles showed an increased risk for first-episode peritonitis ( = 0.039). By competing risk survival analysis, after adjusting for age, sex, diabetes mellitus, CVD, body mass index, albumin, high-sensitive C-reactive protein, potassium, phosphorus, residual kidney function, normalised protein equivalent of total nitrogen appearance and calendar year of catheter implantation, patients in the higher three TMAO quartiles had a statistically or marginally higher risk for first-episode peritonitis compared with patients in the lowest quartile, with hazard ratio (HR) 1.65 (1.05, 2.58), 1.46 (0.92, 2.31) and 1.66 (1.05, 2.61), respectively. In the COX model, patients in the third quartile TMAO group had significantly higher CVD mortality risk compared with the lowest quartile group, as HR 2.27 (1.02, 5.05) after adjusting for various factors. As for all-cause mortality, TMAO did not show any associated effects.
Serum TMAO concentration is associated with the risk of first-episode peritonitis and CVD mortality in PD patients. No obvious association between serum TMAO and all-cause mortality was observed.
三甲胺 N-氧化物（TMAO）是肉碱和胆碱的肠道细菌衍生代谢物。已证实高浓度的 TMAO 与心血管疾病（CVD）、全因死亡率和慢性肾脏病进展有关。我们旨在研究血清 TMAO 值与腹膜透析（PD）患者结局之间的关系。
这是一项回顾性分析的前瞻性队列研究。所有新诊断的 PD 患者均被纳入并进行随访。采用对数秩检验、竞争风险生存分析和 COX 回归检验血清 TMAO 对首发腹膜炎、全因和 CVD 死亡率的影响。
在 513 名 PD 患者中观察到血清 TMAO 浓度的广泛分布，中位数为 72.3（43.7，124.7）µmol/L。TMAO 浓度较低的患者更可能没有糖尿病和高血压。TMAO 浓度较低的患者在基线时具有更好的残余肾功能和溶质清除率。较高的 TMAO 四分位组患者首发腹膜炎的风险增加（ = 0.039）。通过竞争风险生存分析，在校正年龄、性别、糖尿病、CVD、体重指数、白蛋白、高敏 C 反应蛋白、钾、磷、残余肾功能、标准化蛋白等效总氮出现和导管植入术的日历年后，较高的 TMAO 四分位组患者与最低四分位组患者相比，首发腹膜炎的风险更高，风险比（HR）分别为 1.65（1.05，2.58）、1.46（0.92，2.31）和 1.66（1.05，2.61）。在 COX 模型中，与最低四分位组相比，TMAO 第三四分位组患者的 CVD 死亡率风险显著更高，调整各种因素后 HR 为 2.27（1.02，5.05）。对于全因死亡率，TMAO 没有显示出任何相关影响。
血清 TMAO 浓度与 PD 患者首发腹膜炎和 CVD 死亡率的风险相关。血清 TMAO 与全因死亡率之间没有明显的关联。
