Sreedhara R, Avram M M, Blanco M, Batish R, Avram M M, Mittman N
Division of Nephrology, The Long Island College Hospital, Brooklyn, NY 11201, USA.
Am J Kidney Dis. 1996 Dec;28(6):937-42. doi: 10.1016/s0272-6386(96)90398-4.
Patients undergoing dialytic therapy for end-stage renal disease (ESRD) have greater morbidity and mortality than age-matched individuals with similar demographics in the general population. Risk factors for early death during treatment for ESRD include advanced age, diabetes, hypertension, and malnutrition. We questioned whether the level of serum prealbumin at the start of uremia therapy might serve as a marker of subsequent survival in patients treated with maintenance hemodialysis (HD) and peritoneal dialysis (PD). Study cohorts included 111 HD and 78 PD patients followed for up to 5 years. Selected demographic characteristics and biochemical variables were tested for correlation with survival in each cohort. Variables evaluated included age, race, gender, diabetic status, and serum concentrations of albumin, creatinine, cholesterol, and prealbumin. For comparison, expected survival was calculated with Cox proportional hazards analysis, which accounts for confounding variables. We found that a higher relative risk (RR) of death in HD patients correlated with older age, the diagnosis of diabetes, and a serum prealbumin < 30 mg/dL. In PD patients, older age and the presence of diabetes correlated with a higher RR of death than in the standard population. When nutritional variables were analyzed separately, prealbumin < 30 mg/dL was the strongest variable that predicted mortality in HD patients (RR = 2.64, P = 0.002) and also predicted increased risk of mortality in PD patients (RR = 1.8, P = 0.035). Observed and expected survival was significantly higher in patients with enrollment prealbumin greater than 30 mg/dL in both HD and PD. The serum prealbumin level correlated significantly with other measures of nutrition, including serum albumin, serum creatinine, and serum cholesterol, in both HD and PD patients. Among tested markers of nutritional status, prealbumin level appears to be the single best nutritional predictor of survival in ESRD patients.
接受终末期肾病（ESRD）透析治疗的患者比普通人群中年龄匹配、人口统计学特征相似的个体具有更高的发病率和死亡率。ESRD治疗期间早期死亡的风险因素包括高龄、糖尿病、高血压和营养不良。我们质疑尿毒症治疗开始时血清前白蛋白水平是否可作为维持性血液透析（HD）和腹膜透析（PD）患者后续生存的标志物。研究队列包括111例HD患者和78例PD患者，随访长达5年。对选定的人口统计学特征和生化变量进行检测，以确定与每个队列中的生存率是否相关。评估的变量包括年龄、种族、性别、糖尿病状态以及白蛋白、肌酐、胆固醇和前白蛋白的血清浓度。为作比较，采用Cox比例风险分析计算预期生存率，该分析考虑了混杂变量。我们发现，HD患者中较高的死亡相对风险（RR）与高龄、糖尿病诊断以及血清前白蛋白<30mg/dL相关。在PD患者中，高龄和糖尿病的存在与死亡RR高于标准人群相关。当分别分析营养变量时，前白蛋白<30mg/dL是预测HD患者死亡率的最强变量（RR = 2.64，P = 0.002），也预测了PD患者死亡风险增加（RR = 1.8，P = 0.035）。在HD和PD中，入组时前白蛋白大于30mg/dL的患者观察到的和预期的生存率均显著更高。在HD和PD患者中，血清前白蛋白水平与其他营养指标，包括血清白蛋白、血清肌酐和血清胆固醇，均显著相关。在测试的营养状况标志物中，前白蛋白水平似乎是ESRD患者生存的最佳单一营养预测指标。
