血尿酸水平对腹膜透析病人残余肾功能的影响

Impact of serum uric acid level on residual renal function in peritoneal dialysis patients

目的分析血尿酸水平对连续性腹膜透析(CAPD)病人残余肾功能(RRF)变化的影响。方法研究对象为2010年1月至2016年1月西安交通大学第一附属医院肾内科规律随访的143例CAPD病人,通过5次访视,收集其人口学特征,原发病,血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、利尿剂、别嘌醇的使用情况,血尿酸、血白蛋白、尿素氮、血钙、总胆固醇、血红蛋白、超敏C反应蛋白、血磷、血清全段甲状旁腺激素、血清肌酐、三酰甘油以及肌酐清除率等生化指标。结果高尿酸组病人的血尿酸水平在访视过程中变化显著(F=6.269,P<0.001),上升率达到22.72%,非高尿酸组的血尿酸水平变化不显著(F=1.215,P=0.305);两组病人的RRF均出现下降,高尿酸组较非高尿酸组下降速率更快(41.34%比28.13%);高尿酸组血尿酸水平与RRF之间关系的单因素分析结果(t=−2.968,P=0.002)与多因素分析结果(t=−3.185,P=0.011)均显示,高尿酸血症(HUA)为CAPD病人RRF下降的独立危险因素;非高尿酸组CAPD病人的血尿酸水平与RRF变化差异无统计学意义(P>0.05)。结论HUA为CAPD病人RRF下降的独立危险因素。

Objective To analyze the impact of serum uric acid level on residual renal function(RRF)in continuous ambulatory peritoneal dialysis(CAPD)patients.Methods A total of 143 CAPD patients were recruited in the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to January 2016.The demographic characteristics,primary disease,usage of ACEI/ARB,diuretics,allopurinol,and biochemical indices of uric acid,Alb,BUN,serium calcium,CHO,HB,Hs-CRP,serium phosphorus,iPTH,SCr,TG,CCr were collected through five visits.Results The uric acid level in the high uric acid subgroup varied significantly during 5 visits(F=6.269,P<0.001),with the growth rate of 22.72%.And the uric acid level in the normal uric acid subgroup had no significant varying(F=1.215,P=0.305).The RRF mean values in the high uric acid subgroup and the normal uric acid subgroup significantly declined during 5 visits.However,the high uric acid subgroup declined faster than the normal subgroup(41.34%vs.28.13%).The univariate analysis(t=−3.185,P=0.011)and multivariate analysis(t=−3.185,P=0.011)of the relationship between uric acid and RRF in the high uric acid subgroup showed that hyperuricemia was an independent risk factor for the decline of RRFin CAPD patients.There was no significant difference between uric acid and RRF in the normal uric acid subgroup(P>0.05).Conclusion Hyperuricemia is an independent risk factor for decreased RRF in CAPD patients.