高腹腔内白细胞介素-6水平预测腹膜透析患者超滤不足：一项前瞻性队列研究。

High intraperitoneal interleukin-6 levels predict ultrafiltration (UF) insufficiency in peritoneal dialysis patients: A prospective cohort study.

作者信息

Song Qianhui, Yang Xiaoxiao, Shi Yuanyuan, Yan Hao, Yu Zanzhe, Li Zhenyuan, Yuan Jiangzi, Ni Zhaohui, Gu Leyi, Fang Wei

机构信息

Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.

出版信息

Front Med (Lausanne). 2022 Aug 10;9:836861. doi: 10.3389/fmed.2022.836861. eCollection 2022.

DOI:10.3389/fmed.2022.836861

PMID:36035388

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9400905/

Abstract

INTRODUCTION

UF insufficiency is a major limitation in PD efficiency and sustainability. Our study object to investigate the efficacy of intraperitoneal inflammation marker, IL-6 level as a predictor of UF insufficiency in continuous ambulatory peritoneal dialysis (CAPD) patients.

METHODS

Stable prevalent CAPD patients were enrolled in this prospective study. IL-6 concentration in the overnight effluent was determined and expressed as the IL-6 appearance rate (IL-6 AR). Patients were divided into two groups according to the median of IL-6 AR and prospectively followed up until death, transfer to permanent HD, recovery of renal function, kidney transplantation, transfer to other centers, lost to follow-up or to the end of study (January 31, 2021). Factors associated with UF capacity as well as dialysate IL-6 AR were assessed by multivariable linear regression. Cox proportional hazards model was used to examine the association between dialysate IL-6 AR and UF insufficiency.

RESULTS

A total of 291 PD patients were enrolled, including 148 males (51%) with a mean age of 56.6 ± 14.1 years and a median PD duration of 33.4 (12.7-57.5) months. No correlation was found between dialysate IL-6 AR and UF capacity at baseline. PD duration was found positively correlated with baseline dialysate IL-6 AR, while 24h urine volume was negatively correlated with baseline dialysate IL-6 AR ( < 0.05). By the end of study, UF insufficiency was observed in 56 (19.2%) patients. Patients in the high IL-6 AR group showed a significantly inferior UF insufficiency-free survival when compared with their counterparts in the low IL-6 AR group ( = 0.001). In the multivariate Cox regression analysis, after adjusting for DM, previous peritonitis episode and 24h urine volume, higher baseline dialysate IL-6 AR (HR 3.639, 95% CI 1.776-7.456, = 0.002) were associated with an increased risk of UF insufficiency. The area under the ROC curve (AUC) for baseline IL-6 AR to predict UF insufficiency was 0.663 (95% CI, 0.580-0.746; < 0.001).

CONCLUSION

Our study suggested that the dialysate IL-6 AR could be a potential predictor of UF insufficiency in patients undergoing PD.

摘要

引言

超滤功能不全是腹膜透析效率和可持续性的主要限制因素。我们的研究旨在探讨腹腔内炎症标志物白细胞介素-6水平作为持续性非卧床腹膜透析（CAPD）患者超滤功能不全预测指标的有效性。

方法

本前瞻性研究纳入了稳定的CAPD患者。测定过夜腹透流出液中的白细胞介素-6浓度，并表示为白细胞介素-6出现率（IL-6 AR）。根据IL-6 AR的中位数将患者分为两组，并进行前瞻性随访直至死亡、转为永久性血液透析、肾功能恢复、肾移植、转至其他中心、失访或研究结束（2021年1月31日）。通过多变量线性回归评估与超滤能力以及腹透液IL-6 AR相关的因素。采用Cox比例风险模型检验腹透液IL-6 AR与超滤功能不全之间的关联。

结果

共纳入29名腹膜透析患者，其中男性148名（51%），平均年龄56.6±14.1岁，腹膜透析中位时间为33.4（12.7 - 57.5）个月。基线时腹透液IL-6 AR与超滤能力之间未发现相关性。腹膜透析时间与基线腹透液IL-6 AR呈正相关，而24小时尿量与基线腹透液IL-6 AR呈负相关（P<0.05）。到研究结束时，56名（19.2%）患者出现超滤功能不全。高IL-6 AR组患者的无超滤功能不全生存期明显低于低IL-6 AR组患者（P = 0.001）。在多变量Cox回归分析中，在调整糖尿病、既往腹膜炎发作和24小时尿量后，较高的基线腹透液IL-6 AR（HR 3.639，95%CI 1.776 - 7.456，P = 0.002）与超滤功能不全风险增加相关。基线IL-6 AR预测超滤功能不全的ROC曲线下面积（AUC）为0.663（95%CI，0.580 - 0.746；P<0.0）。