腹膜透析患者中预测残余肾功能下降的危险因素分析

The prediction of risk factors relating to the decline of residual renal function in peritoneal dialysis patients

目的观察腹膜透析(Peritoneal dialysis,PD)中不同危险因素对患者残余肾功能(Residual renal function,RRF)下降的影响情况。方法以基线24h尿量大于750ml为纳入标准,以最终24h尿量少于或等于400ml定义为终点事件发生,选取北京大学第三附属医院肾内科腹膜透析中心中的76例连续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者建立回归模型,分析其各项指标,包括血流动力学、生化、透析充分性、血压、脉搏波传导速度等基线值与残余肾功能下降发生的关系。结果研究人群的平均随访时间为(10.32±1.73)(均数±标准差)月,发生终点事件的人数为24例,占总人数的31.6%,终点事件发生的平均时间为(5.1±2.0)月。与无发生残余肾功能下降的患者相比,发生终点事件的腹膜透析患者基线值有较低的肾小球滤过率(Glomerular filtration rate,GFR)(P<0.05),较高的腹膜炎发生比例(P<0.05),较高的血肌酐水平(P<0.005),以及较低的血红蛋白含量(P<0.005)。使用Cox逐步回归模型及全变量回归模型分析,基线血浆白蛋白、基线GFR、基线收缩压在影响患者残余肾功能下降中有显著的意义。结论腹膜透析患者血浆白蛋白、GFR在影响残余肾功能下降中起保护作用,收缩压越高,残余肾功能下降越显著。

Objective To predict the risk factors relating to the decline of residual renal function （RRF） in continuous ambulatory peritoneal dialysis （CAPD） patients. Methods All patients with baseline urine volume exceeding 750ml/24h were included, and the primary outcome was defined as the occurrence of oliguria （urine volume = 400ml/ 24h）. A total of 76 CAPD patients were included in this study. We established regression models to analyze the relationship between the decline of RRF and the baseline indices of hemodynamics, blood biochemistry, dialysis adequacy, blood pressure and pulse wave velocity. Results The mean follow-up time was （10.32 ± 1.73） months. Primary outcome occurred in 24 patients （31.6%）, and their average period progressed to the primary outcome was （5.1 ± 2.0） months. The 24 patients had lower GFR （P 〈 0.05）, higher percentage of peritonitis （P 〈 0.05）, higher serum creatinine （P 〈 0.005）, and lower hemoglobin （P 〈 0.005）, as compared with those of the patients without the primary outcome. Based on the results of multivariable Cox regression analysis, serum albumin （B=-0.118, P 〈 0.05）, GFR （B = -0.371, P 〈 0.05） and systolic pressure （B=0.031, P 〈 0.01） contributed to the decline of RRF significantly. Conclusion In CAPD patients, normal serum albumin and GFR are the factors to protect RRF from decline, and the higher systolic pressure predicts rapid decline of RRF.