Avram M M, Mittman N, Bonomini L, Chattopadhyay J, Fein P
Division of Nephrology, Long Island College Hospital, Brooklyn, NY 11201, USA.
Am J Kidney Dis. 1995 Jul;26(1):209-19. doi: 10.1016/0272-6386(95)90176-0.
Serum biochemical markers suggestive of undernutrition are directly correlated with mortality in hemodialysis and peritoneal dialysis patients. In particular, serum albumin is the most powerful predictor of survival. We have prospectively examined the relationship of single baseline measurements of serum albumin, cholesterol, creatinine, apoproteins, and prealbumin in 250 hemodialysis patients and 140 patients maintained on continuous ambulatory peritoneal dialysis (CAPD) monitored up to 7 years (1987 to 1994). Other variables studied included age, race, gender, diabetes, and number of months on dialysis. Observed survival was computed by the Kaplan-Meier method. Cox's proportional hazards model was used to determine independent predictors of mortality risk. Age, diabetes, prior months on dialysis, and low levels of serum albumin, creatinine, and cholesterol were important and independent predictors of mortality risk in hemodialysis patients. For peritoneal dialysis patients, the independent predictors of mortality risk were age, diabetes, and low serum albumin and serum creatinine. Prealbumin, a serum protein with rapid turnover and relatively small pool, was an important and independent risk predictor in both hemodialysis and CAPD patients. In addition, prealbumin was more highly correlated with other nutritional markers than was albumin. In summary, these findings suggest that biochemical measures associated with visceral and somatic protein depletion are predominant long-term mortality risk factors in patients maintained on hemodialysis and CAPD.
提示营养不良的血清生化标志物与血液透析和腹膜透析患者的死亡率直接相关。特别是血清白蛋白是生存的最有力预测指标。我们前瞻性地研究了250例血液透析患者和140例接受持续性非卧床腹膜透析（CAPD）治疗长达7年（1987年至1994年）患者的血清白蛋白、胆固醇、肌酐、载脂蛋白和前白蛋白的单次基线测量值之间的关系。研究的其他变量包括年龄、种族、性别、糖尿病以及透析月数。采用Kaplan-Meier法计算观察到的生存率。使用Cox比例风险模型确定死亡风险的独立预测因素。年龄、糖尿病、透析前月数以及血清白蛋白、肌酐和胆固醇水平低是血液透析患者死亡风险的重要且独立的预测因素。对于腹膜透析患者，死亡风险的独立预测因素是年龄、糖尿病以及血清白蛋白和血清肌酐水平低。前白蛋白是一种周转迅速且储备相对较少的血清蛋白，在血液透析和CAPD患者中都是重要且独立的风险预测指标。此外，前白蛋白与其他营养标志物的相关性比白蛋白更高。总之，这些发现表明，与内脏和体细胞蛋白消耗相关的生化指标是维持性血液透析和CAPD患者长期死亡风险的主要因素。
