Bontić Ana, Gajić Selena, Bjelić Danka, Pavlović Jelena, Stanković-Popović Verica, Radović Milan, Kezić Aleksandra
Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia.
Clinic for Nephrology, University Clinical Center of Serbia, Pasterova 2, 11000 Belgrade, Serbia.
J Clin Med. 2023 Apr 3;12(7):2670. doi: 10.3390/jcm12072670.
Increased peritoneal protein loss has been associated with the fast transport of small molecules, diabetes mellitus (DM), and a reduced survival in patients on peritoneal dialysis (PD), although some studies did not confirm the association with survival. In this single-center retrospective study, we investigated the relationship of baseline peritoneal albumin and protein loss with transport status, comorbidities including DM, and survival in 106 incident PD patients during the period of July 2005-June 2014. Five-year survival rate was determined using Cox-regression analysis. There were not significant differences in D/Pcr or peritoneal protein and albumin loss between diabetics and non-diabetics. In the group of 66 non-diabetics, high and high-average transporters for creatinine had higher values for both peritoneal protein (11.85 ± 6.77 vs. 7.85 ± 4.36 g/day; = 0.002) and albumin (5.03 ± 2.32 vs. 3.72 ± 1.54 g/day; = 0.016) loss as compared to slow transporters. However, in the group of 40 diabetics, this association was not observed. Upon multivariable regression analysis, the independent association of D/PCr with peritoneal albumin (β = 0.313; = 0.008) and protein (β = 0.441; = 0.001) loss was found only in non-diabetics in whom ultrafiltration also appeared as a significant predictor of peritoneal protein loss ( = 0.330; = 0.000). A high comorbidity grade, older age, and low serum albumin were associated with mortality, but both peritoneal protein and albumin loss as well as D/Pcr were not determinants of survival. Baseline peritoneal protein and albumin loss was not associated with DM and did not predict survival. The clinical significance of the absence of association between fast peritoneal transport status and peritoneal protein flux in diabetics should be evaluated in a prospective study comprising a greater number of diabetics with evaluation of overhydration as a main inducing variable of protein leak.
腹膜蛋白丢失增加与小分子快速转运、糖尿病（DM）以及腹膜透析（PD）患者生存率降低有关，尽管一些研究未证实其与生存率的关联。在这项单中心回顾性研究中，我们调查了2005年7月至2014年6月期间106例新发PD患者的基线腹膜白蛋白和蛋白丢失与转运状态、包括DM在内的合并症以及生存率之间的关系。使用Cox回归分析确定五年生存率。糖尿病患者和非糖尿病患者之间的D/Pcr或腹膜蛋白及白蛋白丢失无显著差异。在66例非糖尿病患者组中，肌酐高转运者和高平均转运者的腹膜蛋白（11.85±6.77 vs. 7.85±4.36 g/天；P = 0.002）和白蛋白（5.03±2.32 vs. 3.72±1.按1.54 g/天；P = 0.016）丢失值均高于低转运者。然而，在40例糖尿病患者组中，未观察到这种关联。多变量回归分析显示，仅在非糖尿病患者中发现D/PCr与腹膜白蛋白（β = 0.313；P = 0.008）和蛋白（β = 0.441；P = 0.001）丢失存在独立关联，其中超滤也是腹膜蛋白丢失的重要预测因素（β = 0.330；P = 0.000）。高合并症分级、高龄和低血清白蛋白与死亡率相关，但腹膜蛋白和白蛋白丢失以及D/Pcr均不是生存的决定因素。基线腹膜蛋白和白蛋白丢失与DM无关，也不能预测生存率。糖尿病患者中腹膜快速转运状态与腹膜蛋白通量缺乏关联的临床意义，应在前瞻性研究中进行评估，该研究纳入更多糖尿病患者，并将水过多作为蛋白渗漏的主要诱导变量进行评估。
