腹膜透析患者残余肾功能下降与营养不良的关系

Relationship between loss of residual renal function and malnutrition in peritoneal dialysis patients

目的观察残余肾功能(RRF)下降对腹膜透析(PD)患者营养状况的影响。方法选取1年内肾小球滤过率下降≥50%的32名腹膜透析患者,以肾脏尿素与肌酐清除率评估患者RRF,同时密切随访血清白蛋白、饮食蛋白摄入(DPI)和主观综合营养评估情况。结果随患者RRF下降,尿量明显减少(P<0.01),血清白蛋白显著增加(P<0.01),DPI增加明显。用主观综合评估(SGA)得到的营养不良发生率从开始透析时的62.5%降低到研究结束时的18.8%(P<0.05)。结论腹膜透析患者RRF迅速下降并不一定导致DPI下降与营养状况恶化。

Objective To evaluate the effect of declining residual renal function （RRF） on peritoneal dialysis patients＇ nutritional status. Method 32 patients whose glomerular fdtration rate （GFR） had decreased by more than 50% in one year were selected for the present analysis. Patients＇ residual renal function was assessed by the average renal urea and creatinine clearances. SerLun albumin（ALB）, dietary protein intake（DPI） and subjective global assessment（SGA） were closely followed up. Results RRF was significantly decreased （P 〈 0.05） with a significant decrease of urine volume（ P 〈 0. 01 ）, while serum ALB was signifi- cantly increased （P 〈 0.01）, and also DPI was significantly increased. The prevalence of malnutrition（by SGA） was decreased from 62.5 % at the start of dialysis to 18.8 % at the end of this study（ P 〈 O. 05）. Conclusion The present study suggests that rapid decline of residual renal function in PD patients does not necessarily lead to a decreased dietary protein intake and deteriorated nutritional status.