Verger Christian, Ronco Claudio, Van Biesen Wim, Heaf James, Vrtovsnik François, Vera Rivera Manel, Puide Ilze, Azar Raymond, Gauly Adelheid, Atiye Saynab, De Los Ríos Tatiana
Registre de Dialyse Péritonéale de Langue Française, Pontoise, France.
Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy.
Front Med (Lausanne). 2021 Dec 24;8:737165. doi: 10.3389/fmed.2021.737165. eCollection 2021.
The nutritional status of patients on peritoneal dialysis (PD) is influenced by patient- and disease-related factors and lifestyle. This analysis evaluated the association of PD prescription with body composition and patient outcomes in the prospective incident Initiative for Patient Outcomes in Dialysis-Peritoneal Dialysis (IPOD-PD) patient cohort. In this observational, international cohort study with longitudinal follow-up of 1,054 incident PD patients, the association of PD prescription with body composition was analyzed by using the linear mixed models, and the association of body composition with death and change to hemodialysis (HD) by means of a competing risk analysis combined with a spline analysis. Body composition was regularly assessed with the body composition monitor, a device applying bioimpedance spectroscopy. Age, time on PD, and the use of hypertonic and polyglucose solutions were significantly associated with a decrease in lean tissue index (LTI) and an increase in fat tissue index (FTI) over time. Competing risk analysis revealed a -shaped association of body mass index (BMI) with the subdistributional hazard ratio () for risk of death. High LTI was associated with a lower subdistributional , whereas low LTI was associated with an increased subdistributional when compared with the median LTI as a reference. High FTI was associated with a higher subdistributional when compared with the median as a reference. Subdistributional for risk of change to HD was not associated with any of the body composition parameters. The use of polyglucose or hypertonic PD solutions was predictive of an increased probability of change to HD, and the use of biocompatible solutions was predictive of a decreased probability of change to HD. Body composition is associated with non-modifiable patient-specific and modifiable treatment-related factors. The association between lean tissue and fat tissue mass and death and change to HD in patients on PD suggests developing interventions and patient counseling to improve nutritional markers and, ultimately, patient outcomes. The study has been registered at Clinicaltrials.gov (NCT01285726).
腹膜透析（PD）患者的营养状况受患者及疾病相关因素和生活方式的影响。本分析在透析-腹膜透析患者预后前瞻性队列研究（IPOD-PD）中，评估了PD处方与身体成分及患者预后之间的关联。在这项对1054例新发PD患者进行纵向随访的观察性国际队列研究中，采用线性混合模型分析PD处方与身体成分之间的关联，并通过竞争风险分析结合样条分析来分析身体成分与死亡及转为血液透析（HD）之间的关联。使用生物电阻抗光谱法的身体成分监测仪定期评估身体成分。随着时间推移，年龄、PD治疗时间以及高渗和多聚葡萄糖溶液的使用与瘦组织指数（LTI）降低和脂肪组织指数（FTI）增加显著相关。竞争风险分析显示，体重指数（BMI）与死亡风险的亚分布风险比（）呈U形关联。与作为参照的中位LTI相比，高LTI与较低的亚分布相关，而低LTI与较高的亚分布相关。与作为参照的中位FTI相比，高FTI与较高的亚分布相关。转为HD风险的亚分布与任何身体成分参数均无关联。使用多聚葡萄糖或高渗PD溶液可预测转为HD可能性增加，而使用生物相容性溶液可预测转为HD可能性降低。身体成分与不可改变的患者特异性因素和可改变的治疗相关因素有关。PD患者的瘦组织和脂肪组织量与死亡及转为HD之间的关联提示，应制定干预措施并为患者提供咨询，以改善营养指标，最终改善患者预后。该研究已在Clinicaltrials.gov注册（NCT01285726）。
