Song Panai, Yang Dong, Li Jine, Zhuo Ning, Fu Xiao, Zhang Lei, Zhang Hongqing, Liu Hong, Sun Lin, Liu Yinghong
Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, Changsha, China.
Front Med (Lausanne). 2022 Aug 2;9:917603. doi: 10.3389/fmed.2022.917603. eCollection 2022.
Serum albumin levels at a single time point have been shown to predict mortality in peritoneal dialysis (PD) patients. However, we believe that the dynamic change in albumin after PD may be more significant. In this study, we investigated the relationship between dynamic serum albumin and the clinical outcome of patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
The participants in this study enrolled 586 patients who underwent CAPD at the peritoneal dialysis center of Second Xiangya Hospital in China. We retrospectively reviewed medical records from January 1, 2010, to December 31, 2019. Baseline serum albumin (Alb), time-averaged albumin level (TA-ALB) and serum albumin reach rate (SR: defined as the percentage of serum albumin measurements that reached ≥ 35 g/L) were applied as the predictor variables. All-cause mortality and cardiovascular mortality were used as the outcome variables. Hazard function of all-cause mortality and cardiovascular mortality in the study participants were examined by using Cox proportional hazard regression models.
Age (HR = 1.03, 95% CI 1.00-1.05), cardiovascular disease (HR = 1.80, 95% CI 1.07-3.03) and TA-ALB (HR = 0.92, 95% CI 0.85-0.99) were independent risk factors for all-cause mortality in PD patients. Patients with TA-ALB of <33 g/L (HR = 2.33, 95% CI 1.17-4.62) exhibited a higher risk for all-cause mortality than those with TA-ALB ≥ 36 g/L. Stratified SR showed a similar trend. Patients with a <25% SR exhibited a significantly increased risk for all-cause mortality (HR = 2.72, 95% CI, 1.24-5.96) by fully adjusted analysis. However, neither TA-ALB nor SR were associated with the risk of cardiovascular mortality after adjusted analysis.
This study demonstrated that age, cardiovascular disease, and TA-ALB were independent risk factors for all-cause mortality in PD patients. TA-ALB and SR can better predict the prognosis of PD patients than baseline Alb. Dynamic changes in Alb are more clinically significant than baseline Alb in predicting mortality risk.
已证明单次时间点的血清白蛋白水平可预测腹膜透析（PD）患者的死亡率。然而，我们认为PD后白蛋白的动态变化可能更具意义。在本研究中，我们调查了动态血清白蛋白与持续非卧床腹膜透析（CAPD）患者临床结局之间的关系。
本研究的参与者纳入了在中国中南大学湘雅二医院腹膜透析中心接受CAPD治疗的586例患者。我们回顾性分析了2010年1月1日至2019年12月31日的病历。将基线血清白蛋白（Alb）、时间平均白蛋白水平（TA-ALB）和血清白蛋白达标率（SR：定义为血清白蛋白测量值达到≥35 g/L的百分比）用作预测变量。全因死亡率和心血管死亡率用作结局变量。使用Cox比例风险回归模型检查研究参与者全因死亡率和心血管死亡率的风险函数。
年龄（HR = 1.03，95% CI 1.00-1.05）、心血管疾病（HR = 1.80，95% CI 1.07-3.03）和TA-ALB（HR = 0.92，95% CI 0.85-0.99）是PD患者全因死亡率的独立危险因素。TA-ALB<33 g/L的患者（HR = 2.33，95% CI 1.17-4.62）全因死亡率风险高于TA-ALB≥36 g/L的患者。分层SR显示出类似趋势。经充分调整分析，SR<25%的患者全因死亡率风险显著增加（HR = 2.72，95% CI，1.24-5.96）。然而，调整分析后，TA-ALB和SR均与心血管死亡率风险无关。
本研究表明，年龄、心血管疾病和TA-ALB是PD患者全因死亡率的独立危险因素。与基线Alb相比，TA-ALB和SR能更好地预测PD患者的预后。在预测死亡风险方面，Alb的动态变化比基线Alb在临床上更具意义。
