Association between inflammation and changes in residual renal function and peritoneal transport rate during the first year of dialysis
Association between inflammation and changes in residual renal function and peritoneal transport rate during the first year of dialysis
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DOI：
10.1093/ndt/16.11.2240
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发表时间：
2001-11-01
影响因子：
6.1
通讯作者：
Lindholm, B
中科院分区：
文献类型：
--
作者：
Chung, SH;Heimbürger, O;Lindholm, B
背景资料。腹膜转移率是腹膜透析(PD)患者生存的主要决定因素，大多数患者在腹膜透析开始时腹膜转移率增加，而在其他患者腹膜转移率可能下降。虽然多种因素可能导致腹膜转运速率的改变，但炎症与高腹膜转运速率有关，而残余肾功能(RRF)在PD开始后经常下降，也可能与炎症有关。因此，我们推测PD患者第一年腹膜转运速率的变化和RRF的下降可能与炎症有关。共76例帕金森病患者(男性40例。平均年龄56.8+/-14.1岁)，在开始腹膜透析后平均0.4个月和1年接受了两次腹膜平衡试验。包括在这项研究中。根据透析后第1年透析液血肌酐浓度比值(D/Pcr)的变化。将患者分为DUC降低或无变化组(DUC；n=22)和增加组(第1组，n=54)。最初，与DUC组相比，I组的高转运蛋白比例较低，血清C反应蛋白(sCRP，大于或等于10 mg/L)较高，RRF较低。第1组患者治疗后第1年血清白蛋白和RRF显著降低，透析液蛋白丢失和葡萄糖吸收显著增加。根据RRF变化的中位数(1.9ml/min)将患者分为两组，第一年RRF和GT下降1.9mlmin的患者与RRF下降小于或等于1.9ml/min的患者相比，高sCRP比例、高DPcr和D/Pcr变化更大。一年内sCRP升高的患者包括PD开始时sCRP升高的比例较高、dTcr升高较高、血清白蛋白较低的患者。与sCRP正常的患者相比，PD患者的RRF较低，且在第一年的RRF下降更多。在PD的第一年，RRF与D/Pcr的变化呈负相关(r=-0.28)。P=0.02)。多元回归分析显示，影响D/P-Cr变化的因素仅为高sCRP和低RRF。我们的初步短期研究表明，PD患者第一年腹膜转运率的变化可能与炎症和残余肾功能下降有关。炎症和残余肾功能被确定为在PD的第一年中决定腹膜转运率的唯一独立因素。炎症可能同时导致腹膜转运速率的增加和残余肾功能的下降，或者残余肾功能的下降和腹膜转运速率的增加可能导致或加重炎症。需要进一步的研究来证实这些发现。
Background. Peritoneal transport rate, a major determinant of peritoneal dialysis (PD) patient survival, increases in most patients starting on PD, while in other patients peritoneal transport rate may decline. Although several factors may contribute to changes in peritoneal transport rate, inflammation is known to be associated with a high peritoneal transport rate, and residual renal function (RRF), which often declines after start of PD, may also be related to inflammation. Therefore, we hypothesized that changes in peritoneal transport rate during patients' first year on PD and declining RRF may be linked with inflammation.Methods. A total of 76 PD patients (40 males. mean age 56.8 +/- 14.1 years), who underwent two peritoneal equilibration tests at a mean of 0.4 months and 1 year after beginning PD. were included in the study. Based on the change in dialysate to plasma creatinine concentration ratio at 4-h dwell (D/P Cr) during first year on PD. the patients were divided into decreased or unchanged (group DUC; n = 22) and increased (group 1, n = 54) groups.Results. Initially, group I had a lower proportion of high transporters and more often high serum C-reactive protein (sCRP, greater than or equal to 10 mg/l) and lower RRF compared with the DUC group. In group 1, serum albumin and RRF decreased significantly and dialysate protein loss and glucose absorption increased significantly during the first year on PD. When patients were divided into two groups based on median change in RRF (1.9 ml/min), patients with a decrease in RRF > 1.9 ml min during first year on PD had a higher proportion of high sCRP, higher DP Cr, and higher changes in D/P Cr compared to patients with a decrease in RRF less than or equal to 1.9 ml/min. Patients with elevated sCRP at one year included a higher proportion of patients who had high sCRP at the start of PD, higher increase in DT Cr, lower serum albumin. lower RRF, and more decrease in RRF during first year on PD compared with patients having normal sCRP. RRF was inversely correlated with changes in D/P Cr during the first year on PD (r = -0.28. P = 0.02). Multiple regression analysis revealed that the only factors affecting changes in D/P Cr were high sCRP and a low RRF.Conclusions. Our preliminary short-term study suggests that changes in peritoneal transport rate during patients' first year on PD may be linked with inflammation and declining residual renal function. Inflammation and residual renal function were identified as the only independent factors determining peritoneal transport rate during the first year on PD. It is possible that inflammation may cause both an increase in peritoneal transport rate and a decline in residual renal function, or that the decline in residual renal function and the increase in peritoneal transport rate may induce or aggravate inflammation. Further studies are needed to confirm these findings.