Piccoli G B, Quarello F, Salomone M, Iadarola G M, Funaro L, Marciello A, Fidelio T, Ghezzi P M, Cavalli P L, Vercellone A
Nephro-Urology Institute of the University, Torino, Italy.
Nephrol Dial Transplant. 1995;10 Suppl 6:72-7. doi: 10.1093/ndt/10.supp6.72.
Albumin and cholesterol are considered reliable outcome markers in dialysis patients; their influence, however, may also be related to non-independent factors, such as age and presence of co-morbid conditions. The aim of the study was an analysis of four outcome markers, assessed at start of dialysis: age, high risk conditions, cholesterol and albumin levels. Data were obtained from the Piedmont Dialysis and Transplantation Registry (northern Italy, about 4,400,000 inhabitants, 21 dialysis centres, open acceptance since mid-1970s, 5661 patients on file at 31 December 1992). Prevalence of albumin and cholesterol in the normal range increases with age; in each age group prevalence in the range is higher in patients at high risk. However, influence of these biochemical parameters is evident also in no-risk cohorts, thus identifying a subgroup with poorer prognosis also in the population without any identified classic risk factor. The influence of albumin, more evident in the population studied compared with cholesterol, is reflected by impaired survival of low-albumin patients (age > or = 65 high risk at 1 year: 60.7% vs 76.6%, P = 0.0052; age > or = 65 non-high risk, at 1 year: 76.5% vs 90.7%, P = 0.0001). In conclusion, albumin and cholesterol, assessed at start of dialysis, are reliable outcome markers even in elderly patients, identifying, in this high mortality cohort, a subgroup with poorer prognosis. If and how their effect may be reversed by dialysis therapy remains to be assessed.
白蛋白和胆固醇被认为是透析患者可靠的预后指标；然而，它们的影响也可能与非独立因素有关，如年龄和合并症的存在。本研究的目的是分析在透析开始时评估的四个预后指标：年龄、高危状况、胆固醇和白蛋白水平。数据来自皮埃蒙特透析和移植登记处（意大利北部，约440万居民，21个透析中心，自20世纪70年代中期起开放接纳患者，截至1992年12月31日有5661名患者存档）。白蛋白和胆固醇在正常范围内的患病率随年龄增加而升高；在每个年龄组中，高危患者的该范围患病率更高。然而，这些生化参数的影响在无风险队列中也很明显，因此在没有任何已确定的经典危险因素的人群中也识别出了一个预后较差的亚组。与胆固醇相比，白蛋白的影响在研究人群中更明显，低白蛋白患者生存率受损反映了这一点（年龄≥65岁，1年时高危：60.7%对76.6%，P = 0.0052；年龄≥65岁，1年时非高危：76.5%对90.7%，P = 0.0001）。总之，在透析开始时评估的白蛋白和胆固醇即使在老年患者中也是可靠的预后指标，在这个高死亡率队列中识别出了一个预后较差的亚组。它们的影响是否以及如何能通过透析治疗得到逆转仍有待评估。
