腹膜透析患者体质量指数与腹膜透析充分性的关系

Association between body mass index and dialysis adequacy in patients on peritoneal dialysis

目的探讨腹膜透析患者体质量指数(BMI)与腹膜透析充分性的关系。方法回顾性分析2016年1月—2020年5月在苏州大学附属第一医院肾内科行腹膜透析并规律随访的282例患者。按BMI分为低体质量组(BMI<18.5 kg/m^(2))、正常体质量组(18.5~23.9 kg/m^(2))、超体质量组(24~27.9 kg/m^(2))和肥胖组(BMI≥28 kg/m^(2)),连续观察12个月,收集临床资料并进行统计学分析。结果4组患者的BMI、糖尿病、增加透析剂量、增加腹膜透析液浓度、腹膜炎发生率比较,差异有统计学意义(P<0.05)。低体质量组、正常体质量组、超体质量组、肥胖组患者腹膜透析开始后1个月、6个月及12个月Kt/V、D/Pcr比较,采用重复测量设计的方差分析,结果:①不同时间点Kt/V、D/Pcr有差异(F=2.115和2.384,P=0.144和0.589);②4组患者的Kt/V、D/Pcr有差异(F=4.151和0.286,P=0.033和0.834);③4组患者的Kt/V、D/Pcr变化趋势无差异(F=0.545和1.346,P=0.476和0.644)。多元线性回归分析结果显示,性别、残余肾功能、血白蛋白是腹膜透析1个月后每周总Kt/V的影响因素(b=0.314、0.061和0.016,P=0.001、0.001和0.020);性别及BMI是腹膜透析12个月后每周总Kt/V的影响因素(b=0.386和-0.029,均P=0.001);性别、BMI、糖尿病是腹膜透析12个月后D/Pcr的影响因素(b=-0.047、0.081和-0.005,P=0.006、0.003和0.047)。多因素Logistics回归分析结果显示:高BMI[OR=1.110(95%CI:1.006,1.225)]、高龄[OR=1.049(95%CI:1.022,1.077)]及低白蛋白[OR=0.911(95%CI:0.852,0.975)]是腹膜透析12个月后发生腹膜炎的危险因素(P<0.05)。结论高BMI腹膜透析患者可能具有较低的腹膜透析充分性,更容易发生腹膜透析相关性腹膜炎,BMI可作为远期腹膜功能评估指标。

Objective To investigate the association between body mass index(BMI)and dialysis adequacy in patients on peritoneal dialysis.Methods We retrospectively analyzed 282 patients undergoing peritoneal dialysis in our hospital between January 2016 and May 2020.The patients were categorized into the underweight group(BMI<18.5 kg/m^(2)),normal weight group(18.5 to 23.9 kg/m^(2)),overweight group(24 to 27.9 kg/m^(2))and obese group(BMI≥28 kg/m^(2))according to their BMI,and they were continuously observed for 12 months.The clinical data of these patients were collected and analyzed.Results The BMI,the proportion of patients with diabetes mellitus,the increase in dialysis dose and the concentration of the peritoneal dialysate,and the incidence of peritonitis were different among the four groups(P<0.05).The Kt/V and D/Pcr at 1 month,6 months,and 12 months since the start of peritoneal dialysis were compared in the four groups of patients via repeated measures analysis of variance,and the results showed that Kt/V,D/Pcr were different among the time points(F=2.115 and 2.384,P=0.144 and 0.589)and the groups(F=4.151 and 0.286,P=0.033 and 0.834),but there was no difference in the changing trend of Kt/V,D/Pcr among the four groups(F=0.545 and 1.346,P=0.476 and 0.644).The multiple linear regression analysis revealed that sex,residual renal function,and blood albumin were factors affecting the total Kt/V over a week at 1month since the start of peritoneal dialysis(b=0.314,0.061 and 0.016,P=0.001,0.001 and 0.020),sex and BMI were factors affecting the total Kt/V over a week at 12 months since the start of peritoneal dialysis(b=0.386 and-0.029,both P=0.001),and that sex,BMI and diabetes mellitus were factors affecting the D/Pcr at 12 months since the start of peritoneal dialysis(b=-0.047,0.081 and-0.005,P=0.006,0.003,and 0.047).The multivariable Logistic regression analysis revealed that high BMI[OR=1.11(95%CI:1.006,1.225)],older age[OR=1.04(95%CI:1.022,1.077)],and low blood albumin[OR=0.91(95%CI:0.852,0.975)]were risk factors for the occurrence of peritonitis 12 months after the start of peritoneal dialysis(P<0.05).Conclusions The dialysis adequacy may be lower in patients with a high BMI,who are more likely to develop peritonitis related to the peritoneal dialysis.BMI could be established as a long-term assessment indicator for peritoneal function.