残余肾功能对腹膜透析患者营养状况影响的临床研究

Clinical study of the effects of residual renal function on nutritional status of patients with peritoneal dialysis

目的 :前瞻性观察长期持续性非卧床腹膜透析 (CAPD)患者的营养状况 ,探讨残余肾功能对营养状况的影响。方法 :采用常规处方透析 ,留取尿液、腹透液 ,并抽血检测生化、血脂及蛋白营养指标 ,计算残余肾功能(RRF)、KT/V值、肌酐清除率 (Ccr)、单位透析剂量 (PV/S)及蛋白质分解率 (PCR) ,评估每日蛋白质摄入量 (DPI)。结果 :RRF与KT/V、Ccr及残余尿量呈正相关 ,(分别r =0 5 6、0 83及 0 80 ) ,与透析时间、透析超滤量呈负相关 (分别r=- 0 4 1、0 3 3 ) ,与PV/S无关。A组 (RRF <3ml/min)患者Ccr、KT/V及血浆前白蛋白 (PA)、视黄醇结合蛋白(RBP)、转铁蛋白 (Tf)明显低于B组 (RRF≥ 3ml/min) ,但PCR高于B组。然而 ,A、B两组间Alb、TG及TC却无明显差别。结论 :RRF与腹膜透析充分性密切相关 ,并影响腹透患者的营养状况 ,根据RRF下降程度及时调整透析剂量及方案 ,是预防CAPD患者营养不良发生的最主要手段。

Objective:To observe the nutritional status of patients with continuous ambulatory peritoneal dialysis(CAPD)prospectively and investigate the impact of residual renal function (RRF). Methods: Urine and peritoneal dialysate of patients with regularly prescribed dialysis were collected and blood urea nitrogen(BUN), serum creatinine (Scr), blood lipid and blood albumin were measured to calculate RRF, KT/V, clearance of creatinine(Ccr), PV/S and protein catabolic rate(PCR)and to evaluate daily protein intakes(DPI). Results: RRF was correlated positively with KT/V?Ccr and volume of residual urine(r=0.56, 0.83, 0.80 respectively),negatively with dialysis time, ultrafiltration rate(r=-0.41, and -0.33 respectively),and no correlation with PV/S. Compared with patients in Group B(RRF≥3 ml/min),level of Ccr, KT/V, prealbumin(PA), retinol-binding protein(RBP)and transferrin(TF)were significantly lower in Group A(RRF<3 ml/min)while PCR was higher. However,no significant difference between the two groups was found in Alb, TG and TC. Conclusion: RRF is closely related with the adequacy of peritoneal dialysis and affect nutritional status of patients with CAPD. The most principal way in preventing malnutrition in patients with CAPD is to adjust dialysis prescripition timely based on their RRF.