维持性腹膜透析患者尿素清除指数达标现状及影响因素分析

The status on achieving Kt/V target and the analysis of impact factors of Kt/V in maintenance peritoneal dialysis patients

目的探讨单中心维持性腹膜透析患者尿素清除指数(Kt/V)达标现状以及影响因素。方法在泰兴市人民医院腹膜透析中心采用横断面调查,选择2014年11月至2015年5月份维持透析3个月以上的完成透析充分性及生化评估结果的腹膜透析患者77例。所有的患者均采用持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)或日间不卧床腹膜透析(daytime ambulatory peritoneal dialysis,DAPD)透析方式,调查其Kt/V达标现状。按照Kt/V是否达标(Kt/V≥1.7视为达标)分为2组,比较2组人口学资料及临床生化指标,探讨Kt/V的影响因素。结果入选患者的平均Kt/V为1.75±0.57,平均肌酐清除率为(57.44±19.58)L·周^(-1)·(1.73 m^2)^(-1),Kt/V达标率为54.54%。与Kt/V未达标组相比,达标组女性比例较高,糖尿病肾病患者比例较低,身高、体质量、体质量指数较小,24h尿量较多,残余肾功能较好(P<0.05);2组患者年龄、腹膜透析治疗方式、腹膜透析月龄及每日腹膜膜透析液治疗剂量无统计学差异(P>0.05)。Kt/V与身高(r=-0.444,P=0.001)、体质量(r=-0.457,P=0.001)、体质量指数(r=-0.240,P=0.035)呈负相关,与24h尿量(r=0.357,P=0.001)、残余肾功能(r=0.330,P=0.003)呈正相关,与年龄(r=0.118,P=0.305)、24h腹透液治疗剂量(r=-0.022,P=0.857)不相关。采用二元Logistic回归分析,女性、较小的体格、较好的残余肾功能是Kt/V达标的保护因素。结论单中心腹膜透析Kt/V达标率54.54%,性别、体格大小、残余肾功能是腹膜透析患者Kt/V达标的影响因素。

Objective To explore the present status on achieving Kt/V target and the impact factors of Kt/V in maintenance peritoneal dialysis （MPD） patients. Methods This was a cross-sectional study carried out in Peritoneal Dialysis Center of Taixing People＇s Hospital. A total of 77 clinical stable peritoneal dialysis patients with duration ~3 months who completed dialysis adequacy and biochemical assessment from November 2014 to May 2015 were enrolled in this study. All the patients used either continuous ambulatory peritoneal dialysis （CAPD） or daytime ambulatory peritoneal dialysis （DAPD）. The status on achieving Kt/V target was investigated. The demographic data and clinical characteristics were compared according to varied Kt/V. Results The total Kt/V was 1.75 ± 0. 57 and creatinine clearance rate （Ccr） was （57. 44± 19. 58） L. week ^-1. （1.73 m^2 ）^-1 for the whole patients and there was 54. 54% subjects achieving the Kt/V target. The patients with Kt/V≥1. 7 had higher proportion of female, lower proportion of diabetic nephropathy patients, smaller height, weight and body mass index （BMI）, higher urine volume and higher residual renal function （RRF） than in those with Kt/V〈1. 7 （P〈0. 05）. There was no significant difference between age, the way of peritoneal dialysis, months of peritoneal dialysis duration and dialysate volume. Kt/V was correlated inversely with height （r= - 0. 444, P = 0. 001）, weight （r= - 0. 457, P = 0. 001） and BMI （r= - 0. 240, P =0. 035）. Kt/V was correlated positively with 24-h urine volume （r = 0. 357, P = 0. 00l）, and RRF （r = 0. 330, P = 0. 003）. There was no association of Kt/V with age and dialysate volume. Binary Logistic regression analysis showed that female, smaller size, and high RRF were the protection factors. Conclusions About 67. 4% of peritoneal dialysis patients can reach the Kt/V target recommended by K/DOQI. Gender, body size and RRF were the impact factors of Kt/V in MPD patients.