Chertow G M, Ling J, Lew N L, Lazarus J M, Lowrie E G
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Am J Kidney Dis. 1994 Dec;24(6):912-20. doi: 10.1016/s0272-6386(12)81060-2.
Hemodialysis patients who had received intradialytic parenteral nutrition (IDPN) during 1991 were identified. These patients were compared with unexposed controls after adjusting for demographic variables, baseline renal diagnosis, diabetic status, serum albumin (ALB), creatinine (CRE), and urea reduction ratio. At lower levels of ALB (< or = 3.4 g/dL), treatment with IDPN was associated with a reduction in the odds of death at 1 year, an effect that became stronger at lower levels of CRE (< or = 8.0 mg/dL). In contrast, treatment with IDPN in patients with normal ALB was associated with increased mortality. Time trend analyses of ALB and CRE demonstrated progressive increases toward pretreatment levels in IDPN recipients that were not evident in control subjects. These time trend data suggest that in undernourished hemodialysis patients, IDPN can effect the serum levels of valid biochemical surrogates of visceral and somatic protein nutrition. Albeit retrospective, the improvement in survival at year's end among patients with ALB < or = 3.4 g/dL suggests that malnutrition and its attendant ill effects in hemodialysis patients may respond to aggressive therapeutic intervention, such as IDPN. These important findings should be prospectively confirmed in a randomized clinical trial.
确定了1991年期间接受透析期间胃肠外营养（IDPN）的血液透析患者。在对人口统计学变量、基线肾脏诊断、糖尿病状态、血清白蛋白（ALB）、肌酐（CRE）和尿素清除率进行调整后，将这些患者与未接受该治疗的对照组进行比较。在较低的ALB水平（≤3.4 g/dL）时，IDPN治疗与1年时死亡几率的降低相关，在较低的CRE水平（≤8.0 mg/dL）时这种效果更强。相比之下，ALB正常的患者接受IDPN治疗与死亡率增加相关。对ALB和CRE的时间趋势分析表明，IDPN接受者的这些指标逐渐向治疗前水平升高，而在对照组中并不明显。这些时间趋势数据表明，在营养不良的血液透析患者中，IDPN可以影响内脏和躯体蛋白质营养的有效生化替代指标的血清水平。尽管是回顾性研究，但ALB≤3.4 g/dL的患者年终生存率的提高表明，血液透析患者的营养不良及其伴随的不良影响可能对积极的治疗干预（如IDPN）有反应。这些重要发现应在随机临床试验中得到前瞻性证实。
