Associations between renal function, volume status and endotoxaemia in chronic kidney disease patients
Associations between renal function, volume status and endotoxaemia in chronic kidney disease patients
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DOI：
10.1093/ndt/gfl273
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发表时间：
2006-10-01
影响因子：
6.1
通讯作者：
Riella, Miguel C.
中科院分区：
文献类型：
--
作者：
Goncalves, Simone;Pecoits Filho, Roberto;Riella, Miguel C.
炎症是慢性肾脏病（CKD）患者心血管发病率和死亡率增加的重要预测因素，但免疫系统慢性激活背后的机制尚不清楚。CKD患者发生体液超负荷，这被认为是由于大分子从肠道移位而引起的炎症激活的刺激。我们假设，在1-5期CKD患者中，液体超负荷与全身炎症和内毒素血症的体征相关。本前瞻性研究的目的是评价我们门诊一组CKD患者的肾功能、液体状态[通过下腔静脉直径（IVCD）和可耐受性指数（CI）评价]、全身炎症[C反应蛋白（CRP）、纤维蛋白原和白蛋白的血浆水平]和内毒素血症（通过鲎试剂酶法测定）之间的相关性。人口74人（平均57例;范围23-83岁; 47%男性）伴肾小球滤过率的CKD患者（基于尿素和肌酐清除率的平均值）为34 ml/min。（Rho = 0.25; P = 0.05）和纤维蛋白原（Rho = -0.48; P < 0.0001）与肾小球滤过率（GFR）显著相关。根据IVCD，84%的患者液体超负荷，而CI认为83%的患者超负荷。在所有患者中均检测到内毒素血症体征。与IVCD正常值的患者（0.61 +/- 0.05 ng/l; P < 0.05）相比，有液体超负荷体征的患者（0.85 +/- 0.11 ng/l）的内毒素水平更高。内毒素水平与IVCD（Rho = 0.33，P < 0.005）和CI（Rho =-0.25，P < 0.05）相关。内毒素水平与GFR、CRP和纤维蛋白原无相关性。总之，尽管大多数CKD患者存在与内毒素血症相关的液体超负荷体征，但内毒素血症与全身炎症之间无相关性，表明内毒素血症可能不是该组患者炎症状态的主要决定因素。
Inflammation is an important predictor of increased cardiovascular morbidity and mortality in patients with chronic kidney disease (CKD), but the mechanisms behind the chronic activation of the immune system are not clearly understood. CKD patients develop fluid overload, which has been proposed to be a stimulus for inflammatory activation due to the translocation of macromolecules from the gut. We hypothesize that fluid overload is associated with signs of systemic inflammation and endotoxaemia in stages 1-5 CKD patients. The aim of this prospective study was to evaluate the associations between renal function, fluid status [evaluated by the inferior vena cava diameter (IVCD) and the collapsibility index (CI)], systemic inflammation [plasma levels of C-reactive protein (CRP), fibrinogen and albumin] and endotoxaemia (through the Limulus amebocyte lysate enzymatic assay) in a group of CKD patients in our out-patient clinic. The population consisted of 74 (mean of 57; range 23-83 years of age; 47% males) CKD patients with glomerular filtration rate (based on the mean of urea and creatinine clearances) of 34 ml/min. Both albumin (Rho = 0.25; P = 0.05) and fibrinogen (Rho = -0.48; P < 0.0001) were significantly correlated to glomerular filtration rate (GFR). According to the IVCD, 84% of the patients were fluid overloaded, while 83% were considered overloaded by the CI. Signs of endotoxaemia were detected in all patients. Endotoxin levels were higher in patients with signs of fluid overload (0.85 +/- 0.11 ng/l) when compared with patients with normal values of IVCD (0.61 +/- 0.05 ng/l; P < 0.05). Endotoxin levels correlated to both IVCD (Rho = 0.33, P < 0.005) and CI (Rho = -0.25, P < 0.05). There was no correlation between endotoxin levels and GFR, CRP or fibrinogen. In summary, although most CKD patients presented signs of fluid overload that was associated with endotoxaemia, there was no association between endotoxaemia and systemic inflammation, suggesting the endotoxaemia may not be the main determinant of the inflammatory status in this group of patients.