慢性肾脏病患者尿钠和容量超负荷的相关性

Association of urinary sodium excretion with fluid overload in patients with chronic kidney disease

目的探讨慢性肾脏病(CKD)非透析患者24 h尿钠与容量超负荷之间的关系。方法入选2019年12月至2021年1月于江苏省人民医院肾内科住院治疗并接受生物电阻抗检查的CKD 1~4期患者,依据是否发生容量超负荷将入选患者分为两组,比较两组患者临床指标的差异;使用Spearman相关性分析探索水分过多/细胞外液(OH/ECW)与临床指标的相关性。采用多因素logistic回归模型分析24 h尿钠与容量超负荷之间的关系。容量超负荷定义为OH/ECW≥7%。结果共纳入385例CKD 1~4期患者,年龄(46±15)岁,男216例(56.1%),发生容量超负荷的患者共150例(39.0%)。Spearman相关性分析显示OH/ECW与24 h尿钠(r=0.147,P=0.004)、24 h尿蛋白(r=0.555,P<0.001)、收缩压(r=0.241,P<0.001)呈正相关,与估算肾小球滤过率(eGFR)(r=-0.111,P=0.030)、血清白蛋白(r=-0.659,P<0.001)呈负相关。经校正年龄、收缩压、糖尿病、24 h尿蛋白、血清白蛋白、血钠、血氯、尿钙、尿磷和利尿剂使用与否后,多因素logistic回归分析结果显示,高水平24 h尿钠的CKD患者发生容量超负荷的风险更高(OR=1.005,95%CI:1.000~1.011,P=0.048)。结论高水平24 h尿钠与CKD非透析患者发生容量超负荷相关。

Objective To investigate the relationship between urinary sodium excretion and fluid overload(FO)in non-dialysis patients with chronic kidney disease(CKD).Methods Patients with CKD stage 1-4 who underwent bioelectrical impedance(BIA)in the Department of Nephrology,Jiangsu Province Hospital from December 2019 to January 2021 were recruited.All enrolled patients were categorized into two groups according to whether or not they develop FO.Further,clinical parameters were compared between the two groups.Spearman correlation analysis was used to investigate the association between over hydration/extracellular water(OH/ECW)and clinical characteristics.Multivariate logistic regression analysis was performed to evaluate the relationship between urinary sodium excretion and FO(FO was defined as OH/ECW≥7%).Results A total of 385 patients with CKD stage 1-4 were finally included in the study,with a mean age of(46±15)years.There were 216 male cases(56.1%),and 150 cases(39.0%)existed FO.Spearman correlation analysis indicated that OH/ECW positively correlated with urinary sodium excretion(r=0.147,P=0.004),urinary protein excretion(r=0.555,P<0.001)and systolic blood pressure(r=0.241,P<0.001),but inversely related to estimated glomerular filtration rate(eGFR)(r=-0.111,P=0.030)and serum albumin(r=-0.659,P<0.001).After adjusting for confounding factors including age,systolic blood pressure,diabetes,urinary protein excretion,serum albumin,serum sodium,serum chlorine,urinary calcium excretion,urinary phosphorus excretion and use of diuretics,multivariate logistic regression analysis demonstrated that higher level of urinary sodium excretion was associated with increased risk of FO in patients with CKD(OR=1.005,95%CI:1.000-1.011,P=0.048).Conclusion High urinary sodium excretion is independently associated with fluid FO in non-dialysis patients with CKD.