影响腹膜透析患者腹膜水转运和溶质转运功能的相关因素研究

Research on factors affecting peritoneal water transport and solute transport function in peritoneal dialysis patients

目的探寻影响新入腹膜透析患者腹膜水转运和溶质转运变化趋势的影响因素。方法纳入2016年1月1日—2019年4月30日在北京大学第一医院的新入腹膜透析患者,收集人口学、临床生化学、透析充分性、透析方案及透析记录等资料。采用Spearman相关分析探寻患者基线每克葡萄糖超滤量和24小时透析液(dialysate,D)和血浆(plasma,P)的肌酐(creatinine,Cr)比值(24h D/P Cr)的相关因素,利用混合线性模型分析影响患者每克葡萄糖超滤量和24h D/P Cr的变化趋势的相关因素。结果本研究共纳入197名临床状况稳定的新入腹膜透析患者。持续性透析(r=0.227,P=0.001)、透析液葡萄糖含量(r=0.140,P=0.049)与基线24h D/P Cr呈正相关。基线每克葡萄糖超滤量与心血管疾病(r=0.144,P=0.043)、新发腹膜炎(r=0.168,P=0.018)、透析液葡萄糖含量(r=0.252,P<0.001)呈正相关,而与基线血白蛋白(r=-0.192,P=0.007)、残余肾尿素清除指数(Kt/V)(r=-0.340,P<0.001)呈负相关。利用混合线性模型观察到新入腹膜透析患者的每克葡萄糖超滤量呈现逐步递增趋势(t=-4.196,P<0.001),且该趋势与年龄、性别、是否患糖尿病、心血管疾病、Charlson合并症评分、基线血红蛋白、基线血白蛋白、基线超敏C反应蛋白(hs-CRP)、基线门诊舒张压、基线门诊收缩压、新发腹膜炎、是否间歇性透析、基线残余肾Kt/V、水通道蛋白(aquaporin-1,AQP1)启动子基因型无关(P>0.05)。24h D/P Cr在随访过程中维持相对稳定(t=-1.486,P=0.138)。结论新入腹膜透析患者的每克葡萄糖超滤量呈现递增趋势,24h D/P Cr呈现稳定,可能与递增式透析和节糖策略相关,进一步支持腹膜透析患者的腹膜功能受到环境和遗传的综合作用。

Objective To explore the factors affecting the long-term trends of peritoneal water transport and solute transport in incident peritoneal dialysis patients.Methods Incident peritoneal dialysis patients were recruited at Peking University First Hospital from January 1,2016,to April 30,2019.Baseline data including demographics,clinical biochemistry,dialysis prescription,and dialysis adequacy and transport test were collected.Spearman's correlation analysis was used to explore the factors affecting patients'baseline ultrafiltration per glucose load and 24-hour dialysate-to-plasma creatinine ratio(24h D/P Cr).Factors that influenced the trends of patients'ultrafiltration per glucose load and 24h D/P Cr were analyzed using mixed linear modeling.Results A total of 197 incident peritoneal dialysis patients who were clinically stable were included in this study.A positive correlation between continuous dialysis(r=0.227,P=0.001),baseline exposure of glucose(r=0.140,P=0.049)and baseline 24h D/P Cr was observed.Cardiovascular disease(r=0.144,P=0.043),new-onset peritonitis(r=0.168,P=0.018),and baseline exposure of glucose at baseline(r=0.252,P<0.001)were positively correlated with baseline ultrafiltration per glucose load.In contrast,baseline blood albumin(r=-0.192,P=0.007)and renal Kt/V(r=-0.340,P<0.001)showed a negative correlation with ultrafiltration per glucose load.A gradual increasing trend in ultrafiltration per glucose load(t=-4.196,P<0.001)was observed in our peritoneal dialysis patients using mixed linear modeling but was not associated with age,gender,diabetes,cardiovascular disease,Charlson comorbidity score,baseline hemoglobin,baseline blood albumin,baseline hypersensitive C-reactive protein(hs-CRP),baseline diastolic blood pressure,baseline systolic blood pressure,new-onset peritonitis,intermittent or continuous dialysis,baseline renal Kt/V,and aquaporin-1(AQP1)promoter genotype(P>0.050).Meanwhile,24h D/P Cr remained relatively stable(t=-1.486,P=0.138)during follow-up.Conclusion This study demonstrated that an increasing trend in ultrafiltration per glucose load and a stable trend in 24h D/P Cr were observed in our incident peritoneal dialysis patients,which may be associated with our incremental dialysis and glucose-sparing strategies.This supported that peritoneal membrane function in peritoneal dialysis patients is influenced by a combination of environmental and genetic factors.