残余肾功能对血液透析患者营养状况及死亡率的影响

The effect of residual renal function on nutritional status and mortality rate in hemodialysis patients

目的观察残余肾功能(RRF)对血液透析患者的影响。方法103例血液透析患者分为2组:透析间期24h尿量大于200ml,存在RRF(A组);反之,RRF丧失(B组)。测定透析前透析后尿素氮、肌酐、碳酸氢根、透析间期尿量、透析前血浆白蛋白、血红蛋白。观察1年后两组患者的死亡率,对存活病例重复测定上述指标。结果A组患者58例,平均24h尿量(455±521)ml。血浆白蛋白A组为(3.42±1.28)g/dl显著高于B组(3.12±1.76)g/dl(P<0.05);血浆碳酸氢根A组(22.1±3.12)mEq/l显著高于B组(19.2±2.78)mEq/l;Kt/VA组(1.41±0.27)低于B组(1.53±0.37)(P<0.05)。一年后A组死亡率为8.6%,显著低于B组31.1%(P<0.01);A组患者尿量减至(234±453)ml;血浆白蛋白、血红蛋白A组B组较前均无明显变化。经过Cox回归分析,RRF是血液透析患者死亡的预测因子。结论RRF对血液透析患者营养状况有一定影响,RRF即使在低水平状态,也可减少血液透析患者的死亡率。

Objective To evaluate the effect of residual renal function (RRF) on hemodialysis patients. Methods One hundred and three hemodialysis patients were classified into two groups: with RRF, urine volume > 200ml/24h; without RRF, urine volume <200ml/24h. The impact of RRF on nutritional status and mortality rate were examined over a 1-year period. Results The serum albumin and pre-albumin and transferrin were higher in patients with RRF than those without RRF. During that period, the death rate was 8.6% in patients with RRF and 31.1% in patients without RRF (P<0.05). Upon Cox proportional hazard analysis, RRF was a significant independent predictor of mortality. Conclusions RRF had a beneficial effect on nutritional parameters. Even at a low level RRF, is associated with a lower mortality risk in hemodialysis patients.