腹膜透析(PD)患者血清硫酸吲哚酚(IS)浓度的影响因素

Influencing factors of serum indoxyl sulfate (IS) concentration in peritoneal dialysis (PD) patients

目的腹膜透析(peritoneal dialysis,PD)患者血清硫酸吲哚酚(indoxyl sulfate,IS)浓度显著低于血液透析患者,进一步分析PD患者血清IS浓度的影响因素。方法研究对象为在复旦大学附属中山医院腹透中心定期评估、病情稳定的持续不卧床PD(continuous ambulatory PD,CAPD)患者,收集患者一般人口统计学资料,检测血清IS浓度及各项实验室检查指标,进行腹膜平衡试验和透析充分性检查。结果共纳入CAPD患者169例,有尿和无尿患者的性别、年龄、肾脏基础疾病、贫血、营养等一般情况差异均无统计学意义;有尿患者血清IS浓度更低[(18.74±11.30)μg/mLvs.(28.05±13.98)μg/mL,P<0.001],透析充分性更好[tKt/v:2.20±0.60vs.1.84±0.43,P<0.001;tCcr:(71.68±22.84)L/wkvs.(53.66±11.16)L/wk,P<0.001]。依据tKt/v分组,无论有尿还是无尿,透析充分与不充分患者IS浓度差异均无统计学意义;而依据tCcr分组则发现,透析充分的有尿患者血清IS浓度显著低于透析不充分的有尿患者。不同腹膜转运特性患者间血清IS浓度无统计学意义,高转运患者微炎症状态、营养不良情况更明显。单因素及多因素分析均提示透析龄、硫酸对甲酚、尿量、tCcr、前白蛋白、血肌酐与IS浓度具有显著相关性,且校正透析龄及尿量后tCcr与IS仍显著相关。结论CAPD患者残余肾功能对IS清除极为重要,腹膜转运特性对血清IS浓度无显著影响;透析龄、硫酸对甲酚、尿量、tCcr、前白蛋白、血肌酐与血清IS浓度具有显著相关性。对于有尿CAPD患者,tCcr能够在一定程度上反映血清IS水平。

Objective Serum indoxyl sulfate (IS) concentration in peritoneal dialysis (PD) patients was significantly lower than that in hemodialysis patients.To analyze the influencing factors of serum IS concentration in PD patients. Methods Continuous ambulatory PD (CAPD) patients in stable condition and assessed regularly in Zhongshan Hospital,Fudan University were enrolled.Baseline demographic,serum IS concentration and laboratory test data were collected,peritoneal equilibration test (PET) and dialysis adequacy were performed to assess their dialysis condition. Results Total 169 CAPD patients were enrolled.Analysis results showed:there was no significant difference in sex,age,anemia and nutritional status between anuric and non-anuric patients.Anuric patients had lower IS concentration [(18.74±11.30)μg/mL vs.(28.05±13.98)μg/mL,P <0.001] and better dialysis adequacy [tKt/v:2.20 ±0.60 vs.1.84±0.43,P <0.001;tCcr:(71.68±22.84) L/wk vs.(53.66±11.16) L/wk,P < 0.001 ].Neither anuric nor non-anuric patients grouped by tKt/v there was no significant difference in IS concentration between patients with different dialysis adequacy.While grouped by tCcr,serum IS level in non-anuric patients with good PD adequacy was much lower than those with inadequate PD.There was no difference in serum IS levels among patients with different peritoneal transport characteristics.Micro-inflammation and malnutrition were more pronounced in high transport group.Univariate and multivariate analyses all showed that there were significant correlations between IS and PD duration,Scr,p-cresly sulfate (PCS),residual renal function (RRF),tCcr and prealbumin.The correlation between IS and tCcr was still significant after adjusted PD duration and urine amount. Conclusions For CAPD patients,RRF is very important for IS clearance.Peritoneal transport characteristics have no significant effect on serum IS level.PD duration,nutritional status,RRF and PD adequacy are all correlated with serum IS level independently.For non-anuric CAPD patients,tCcr maybe an effect indicator to assess serum IS concentration.