Albumin at the start of peritoneal dialysis predicts the development of peritonitis
Albumin at the start of peritoneal dialysis predicts the development of peritonitis
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DOI：
10.1053/ajkd.2003.50128
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发表时间：
2003-03-01
影响因子：
13.2
通讯作者：
Fried, L
中科院分区：
文献类型：
--
作者：
Wang, Q;Bernardini, J;Fried, L
背景腹膜炎和血清白蛋白水平与腹膜透析（PD）患者的发病率和死亡率相关。严重的腹膜炎病例会导致低白蛋白血症。然而，尚不清楚低白蛋白血症是否预示腹膜炎的发生。方法：我们对从宾夕法尼亚州西部和西弗吉尼亚州的六个中心前瞻性收集的数据库进行了回顾性分析。选择在PD治疗开始时具有Charlson Comorbid Index（CCI）评分且在开始治疗后30天内测量血清白蛋白水平的偶发PD患者。Poisson回归用于分析腹膜炎的预测因素。结果：393例患者在PD治疗开始时测量了CCI评分和血清白蛋白水平。总体腹膜炎发生率为0.65次/透析年。显著的单变量预测因子为白蛋白水平（率比[RR]，每1 g/dL [10 g/L]升高0.79; 95%置信区间[CI]，0.65 - 0.95; P = 0.015），男性（P = 0.003），在退伍军人管理局（RR，1.97; 95% CI，1.48 ~ 2.62; P < 0.001）或其他中心（RR，1.68; 95% CI，1.92 ~ 5.62; P < 0.001）进行透析。尽管CCI评分与白蛋白水平呈负相关（r = -0.305; P < 0.001），但CCI评分仅对腹膜炎有轻微预测作用（P = 0.068）。在多变量分析中，预测因子是白蛋白水平（RR，0.74; 95% CI，0.31至1.75; P = 0.002）和种族（RR，1.36; P = 0.024）。初始血清白蛋白水平低于2.9 g/dL（29 g/L）的患者腹膜炎发生率为1.5次/透析年，而初始血清白蛋白水平≥ 2.9 g/dL的患者腹膜炎发生率为0.6次/透析年（P < 0.001）。结论腹膜透析治疗开始时的低白蛋白血症是腹膜炎的独立预测因素。需要进行干预研究以降低这一高危患者亚组的腹膜炎风险。
Background. Both Peritonitis and serum albumin level are associated with morbidity and mortality in peritoneal dialysis (PD) patients. Severe cases of peritonitis result in hypoalbuminemia. However, it is not clear whether hypoalbuminemia predicts the development of peritonitis. Methods: We performed a retrospective analysis of a prospectively collected database from six centers in western Pennsylvania and West Virginia. Incident PD patients with a Charlson Comorbidity Index (CCI) score at the start of PD therapy and serum albumin level measured within 30 days of initiation were selected. Poisson regression was used to analyze predictors of peritonitis. Results: Three hundred ninety-three patients had a CCI score and serum albumin level measured at the start of PD therapy. Overall peritonitis rate was 0.65 episodes/dialysis-year. Significant univariate predictors were albumin level (rate ratio [RR], 0.79 per 1-g/dL [10-g/L] increase; 95% confidence interval [CI], 0.65 to 0.95; P = 0.015), male sex (P = 0.003), and being dialyzed in the Veterans Administration (RR, 1.97; 95% Cl, 1.48 to 2.62; P < 0.001) or other center (RR, 1.68; 95% Cl, 1.92 to 5.62; P < 0.001). Although CCI score correlated inversely with albumin level (r = -0.305; P < 0.001), CCI score was only marginally predictive of peritonitis (P = 0.068). In multivariate analysis, predictors were albumin level (RR, 0.74; 95% Cl, 0.31 to 1.75; P = 0.002) and race (RR, 1.36; P = 0.024). Patients with an initial serum albumin level less than 2.9 g/dL (29 g/L) had a peritonitis rate of 1.5 episodes/dialysis-year compared with 0.6 episodes/ dialysis-year for patients with an initial serum albumin level of 2.9 g/dL or greater (P < 0.001). Conclusion Hypoalbuminemia at the start of PD therapy is an independent predictor of subsequent peritonitis. Intervention studies to decrease peritonitis risk in this high-risk subset of patients are needed.