Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients
Inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients
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DOI：
10.1046/j.1523-1755.2001.00804.x
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发表时间：
2001-07-01
影响因子：
19.6
通讯作者：
Levin, NW
中科院分区：
文献类型：
--
作者：
Kaysen, GA;Chertow, GM;Levin, NW
背景横断面研究表明，血液透析患者血清C反应蛋白（CRP）与血清白蛋白浓度呈负相关。随着时间的推移，炎症和膳食蛋白质摄入对营养指标的净影响尚不清楚。为探讨CRP和标准化蛋白分解率（nPCR）对血清白蛋白和肌酐的影响，我们分析了364例血液透析患者连续6个月的实验室数据。采用多变量保守偏置混合模型。血清白蛋白随时间推移的总体趋势为轻微阳性（0.039 g/dL/月），血清肌酐为轻微阴性（-0.052 mg/dL/月）。随着CRP的增加，血清白蛋白显著下降（log CRP每单位增加-0.124 g/dL/月，经年龄、性别、种族、糖尿病和nPCR校正，P < 0.0001）。血清白蛋白随着nPCR的增加而增加（0.021 g/dL/月/0.1 g/kg/天，P < 0.0001）。在非裔美国人中，CRP对白蛋白的影响减弱，且nPCR较高。肌酐的相应值反映了白蛋白的相应值。随着CRP升高，肌酐显著下降[log CRP每单位增加-0.142 mg/dL/月，根据年龄、性别、种族、糖尿病（自透析开始以来的时间：年份）、Kt/V和nPCR进行校正，P = 0.002]。血清肌酐随着nPCR的增加而增加（0.183 mg/dL/月/g/kg/天，Pt 0.0001）。炎症和膳食蛋白质摄入对血液透析患者血清白蛋白和肌酐产生竞争性影响。这些数据为在有持续炎症和营养不良生化证据的血液透析患者中进行膳食蛋白补充剂的前瞻性试验提供了依据。".
Background. Cross-sectional studies have shown an inverse correlation between serum C-reactive protein (CRP) and serum albumin concentration in hemodialysis patients. The net effects of inflammation and dietary protein intake on nutritional markers over time are unknown.Methods. To explore the effects of CRP and normalized protein catabolic rate (nPCR) on serum albumin and creatinine, we analyzed six consecutive months of laboratory data from 364 hemodialysis patients. using a multivariable Mixed model with conservative biases.Results. The overall trend over time in serum albumin was slightly positive (0.039 g/dL/month) and in serum creatinine slightly negative (-0.052 mg/dL/month). With increasing CRP, serum albumin declined significantly (-0.124 g/dL/month per unit increase in log CRP, adjusted for age, gender, race, diabetes, and nPCR, P < 0.0001). Serum albumin increased with increasing nPCR (0.021 g/dL/month per 0.1 g/kg/day, P < 0.0001). The effect of CRP on albumin was attenuated in African Americans and at a higher nPCR. Corresponding values for creatinine mirrored those for albumin. With increasing CRP, creatinine declined significantly [-0.142 mg/dL/month per unit increase in log CRP, adjusted for age, gender, race, diabetes (time since initiation of dialysis: vintage), Kt/V. and nPCR, P = 0.002]. Serum creatinine increased with increasing nPCR (0.183 mg/dL/month per g/kg/day, Pt 0.0001).Conclusions. Proxies of inflammation and dietary protein intake exert competing effects on serum albumin and creatinine in hemodialysis patients. These data provide a rationale for prospective testing of dietary protein supplementation in hemodialysis patients with biochemical evidence of ongoing inflammation and "malnutrition.".