腹膜透析患者治疗后腹膜溶质转运速率升高危险因素分析

Risk factors for increased peritoneal solute transport rate in peritoneal dialysis patients after treatment

目的:探究影响腹膜透析治疗后腹膜溶质转运速率(PSTR)升高的危险因素。方法:回顾性纳入接受腹膜透析治疗的终末期肾病患者209例,随访观察腹膜透析治疗1年后腹膜转运特征分布;复查腹膜平衡实验,观察4 h腹膜透析液与2 h血肌酐比值(D/Pcr)相比基线的变化情况,分为PSTR升高组和降低组。基于人口学特征和实验室指标,通过Logistic回归分析影响PSTR升高的危险因素。结果:入组209例腹膜透析患者,基线腹膜转运特征以低平均转运和高平均转运为主,基线D/Pcr为0.64±0.15。腹膜透析治疗1年时,约64.1%患者PSTR升高,D/Pcr值为0.73±0.12,明显高于基线D/Pcr值,差异有统计学意义(t=-6.773,P<0.05)。PSTR升高组D/Pcr、糖尿病肾病比例及透析时间大于PSTR降低组,基线D/Pcr值及基线血清白蛋白和血镁水平低于PSTR降低组,差异具有统计学意义(均P<0.05)。Logistic回归分析,基线D/Pcr值、糖尿病肾病、透析时间越长及基线血清白蛋白水平是影响PSTR升高的独立危险因素(均P<0.05)。结论:随着腹膜透析治疗时间延长,D/Pcr值逐渐升高,患者腹膜溶质转运速率呈增高趋势;基线低D/Pcr、透析时间越长、糖尿病肾病及基线血清白蛋白水平降低是影响腹膜透析治疗后腹膜溶质转运速率升高的独立危险因素。

Objective:To explore the Risk factors for increased peritoneal solute transport rate(PSTR)in peritoneal dialysis patients after treatment.Methods:A total of 209 patients with end-stage renal disease treated with peritoneal dialysis were retrospectively enrolled.The characteristics and distribution of peritoneal transport were observed after 1 year of peritoneal dialysis treatment.Peritoneal balance test was reviewed to observe the change of the ratio of peritoneal dialysate to 2-hour serum creatinine(D/Pcr)compared with the baseline D/Pcr value,which was divided into increased and decreased PSTR groups.Based on demographic characteristics and laboratory indicators,Logistic regression analysis was performed to explore the risk factors affecting the increase of PSTR.Results:Of 209 peritoneal dialysis patients,baseline peritoneal transport characteristics were mainly low mean transport and high mean transport,and baseline D/Pcr was 0.64±0.15.At 1 year of peritoneal dialysis treatment,64.1%of patients with increased PSTR,D/Pcr value of 0.73±0.12,significantly higher than baseline D/Pcr value(t=-6.773,P<0.05).The D/Pcr,diabetic nephropathy and dialysis age of increased PSTR group were higher than those of decreased PSTR group,and the baseline D/Pcr value,serum albumin and blood magnesium levels were lower than those of decreased PSTR group,the differences were statistically significant(all P<0.05).Logistic regression analysis showed that baseline D/Pcr value,diabetic nephropathy,dialysis age and baseline serum albumin level were independent risk factors for increased PSTR(all P<0.05).Conclusion:With the extension of peritoneal dialysis treatment time,D/Pcr value gradually increased,and the transport rate of peritoneal solute shows an increasing trend.Low D/Pcr at baseline,long dialysis age,diabetic nephropathy and lower serum albumin level at baseline were independent risk factors for increasing peritoneal solute transport rate after peritoneal dialysis treatment.