中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
2期
92-98
,共7页
田娜%陈孟华%董捷%许戎%赵慧萍%朱彤莹%任野平%王梅%郝传明
田娜%陳孟華%董捷%許戎%趙慧萍%硃彤瑩%任野平%王梅%郝傳明
전나%진맹화%동첩%허융%조혜평%주동형%임야평%왕매%학전명
腹膜透析%残余肾功能%临床状况%尿素清除指数
腹膜透析%殘餘腎功能%臨床狀況%尿素清除指數
복막투석%잔여신공능%림상상황%뇨소청제지수
Peritoneal dialysis%Residual renal function%Clinical status%Kt/Vurea
目的 探讨目前中国部分地区腹膜透析患者尿素清除指数(Kt/Vurea)的达标情况及其与患者残余肾功能(RRF)和临床状况的关系.方法 在中国不同城市的5家腹透中心进行横断面调查,入选2011年4月1日至2011年8月31日临床稳定在透3个月以上的完成透析充分性及生化评估结果的腹膜透析患者共681例,按照KtVureas是否达标及其中达标者按RRF的高低分组,比较人口学资料和临床指标.结果 (1)所有患者的总Kt/Vurea为1.95±0.59,总Ccr为(63.80±30.84)L·周-1·(1.73 m2)-1,Kt/Vurea达标率为67.4％.(2)达标组女性居多,体格较小,RRF及尿量较好,血清钙磷水平、血清胆固醇及低密度脂蛋白、C反应蛋白及全身并发症方面均优于未达标患者(均P＜ 0.05).(3)Kt/Vurea≥1.7且RRF≥2 ml/min的患者(亚组1),血清白蛋白好于而炎性反应和并发症少于Kt/Vurea≥1.7但RRF＜2ml/min(亚组2)及Kt/Vurea＜1.7(亚组3)的患者(P＜0.05),而后两者临床指标比较发现,钙磷水平亚组2优于亚组3[血清钙:(2.22±0.21) mmol/L比(2.14±0.24) mmol/L,P＜0.01；血清磷:(1.43±0.47) mmol/L比(1.66±0.52) mmol/L,P＜ 0.01],亚组3的胆固醇、低密度脂蛋白水平低于而高密度脂蛋白高于亚组2[胆固醇:(4.62±0.99) mmol/L比(4.91±1.29) mmol/L,P＜0.05；低密度脂蛋白:(1.13±0.61) mmol/L比(2.86±0.96) mmol/L,P＜0.01；高密度脂蛋白:(2.20±0.72) mmol/L比(1.08±0.33) mmol/L,P＜0.01].(4)总Kt/Vurea与RRF呈正相关(R2=0.317),RRF每下降1 ml/min,Kt/Vurea不达标的风险增加40.3％.结论 中国部分地区维持性腹膜透析患者的Kt/Vurea达标率约为67.4％；Kt/Vurea未达标者,及虽达标但残余肾功能较差的患者临床状况较差.RRF与Kt/Vurea呈正相关,是Kt/Vurea达标的保护因素.
目的 探討目前中國部分地區腹膜透析患者尿素清除指數(Kt/Vurea)的達標情況及其與患者殘餘腎功能(RRF)和臨床狀況的關繫.方法 在中國不同城市的5傢腹透中心進行橫斷麵調查,入選2011年4月1日至2011年8月31日臨床穩定在透3箇月以上的完成透析充分性及生化評估結果的腹膜透析患者共681例,按照KtVureas是否達標及其中達標者按RRF的高低分組,比較人口學資料和臨床指標.結果 (1)所有患者的總Kt/Vurea為1.95±0.59,總Ccr為(63.80±30.84)L·週-1·(1.73 m2)-1,Kt/Vurea達標率為67.4％.(2)達標組女性居多,體格較小,RRF及尿量較好,血清鈣燐水平、血清膽固醇及低密度脂蛋白、C反應蛋白及全身併髮癥方麵均優于未達標患者(均P＜ 0.05).(3)Kt/Vurea≥1.7且RRF≥2 ml/min的患者(亞組1),血清白蛋白好于而炎性反應和併髮癥少于Kt/Vurea≥1.7但RRF＜2ml/min(亞組2)及Kt/Vurea＜1.7(亞組3)的患者(P＜0.05),而後兩者臨床指標比較髮現,鈣燐水平亞組2優于亞組3[血清鈣:(2.22±0.21) mmol/L比(2.14±0.24) mmol/L,P＜0.01；血清燐:(1.43±0.47) mmol/L比(1.66±0.52) mmol/L,P＜ 0.01],亞組3的膽固醇、低密度脂蛋白水平低于而高密度脂蛋白高于亞組2[膽固醇:(4.62±0.99) mmol/L比(4.91±1.29) mmol/L,P＜0.05；低密度脂蛋白:(1.13±0.61) mmol/L比(2.86±0.96) mmol/L,P＜0.01；高密度脂蛋白:(2.20±0.72) mmol/L比(1.08±0.33) mmol/L,P＜0.01].(4)總Kt/Vurea與RRF呈正相關(R2=0.317),RRF每下降1 ml/min,Kt/Vurea不達標的風險增加40.3％.結論 中國部分地區維持性腹膜透析患者的Kt/Vurea達標率約為67.4％；Kt/Vurea未達標者,及雖達標但殘餘腎功能較差的患者臨床狀況較差.RRF與Kt/Vurea呈正相關,是Kt/Vurea達標的保護因素.
목적 탐토목전중국부분지구복막투석환자뇨소청제지수(Kt/Vurea)적체표정황급기여환자잔여신공능(RRF)화림상상황적관계.방법 재중국불동성시적5가복투중심진행횡단면조사,입선2011년4월1일지2011년8월31일림상은정재투3개월이상적완성투석충분성급생화평고결과적복막투석환자공681례,안조KtVureas시부체표급기중체표자안RRF적고저분조,비교인구학자료화림상지표.결과 (1)소유환자적총Kt/Vurea위1.95±0.59,총Ccr위(63.80±30.84)L·주-1·(1.73 m2)-1,Kt/Vurea체표솔위67.4％.(2)체표조녀성거다,체격교소,RRF급뇨량교호,혈청개린수평、혈청담고순급저밀도지단백、C반응단백급전신병발증방면균우우미체표환자(균P＜ 0.05).(3)Kt/Vurea≥1.7차RRF≥2 ml/min적환자(아조1),혈청백단백호우이염성반응화병발증소우Kt/Vurea≥1.7단RRF＜2ml/min(아조2)급Kt/Vurea＜1.7(아조3)적환자(P＜0.05),이후량자림상지표비교발현,개린수평아조2우우아조3[혈청개:(2.22±0.21) mmol/L비(2.14±0.24) mmol/L,P＜0.01；혈청린:(1.43±0.47) mmol/L비(1.66±0.52) mmol/L,P＜ 0.01],아조3적담고순、저밀도지단백수평저우이고밀도지단백고우아조2[담고순:(4.62±0.99) mmol/L비(4.91±1.29) mmol/L,P＜0.05；저밀도지단백:(1.13±0.61) mmol/L비(2.86±0.96) mmol/L,P＜0.01；고밀도지단백:(2.20±0.72) mmol/L비(1.08±0.33) mmol/L,P＜0.01].(4)총Kt/Vurea여RRF정정상관(R2=0.317),RRF매하강1 ml/min,Kt/Vurea불체표적풍험증가40.3％.결론 중국부분지구유지성복막투석환자적Kt/Vurea체표솔약위67.4％；Kt/Vurea미체표자,급수체표단잔여신공능교차적환자림상상황교차.RRF여Kt/Vurea정정상관,시Kt/Vurea체표적보호인소.
Objective To explore the present status on achieving Kt/Vurea target in Chinese peritoneal dialysis (PD) patients and its relation with residual renal function (RRF) and clinical characteristics.Methods This was a cross-sectional study carried out in 5 PD centers in different area of China.Totally 681 clinical stable PD patients with duration≥3 months who completed dialysis adequacy and biochemical test during April Pt,2011 and August 3Pt,2011 were enrolled in this study.The demographic data and clinical characteristics were compared according to varied Kt/Vureas and RRF levels.Results (1)The total Kt/Vurea was 1.95±0.59,and total Ccr was (63.80±30.84) L·week-1 ·(1.73 m2)-1 for the whole group,there were 67.4％ subjects achieving the Kt/Vures target.(2) Patients achieving Kt/Vurea target were prone to be female and had smaller size with higher RRF and urine volume (P ＜ 0.05).The serum calcium and phosphorus were controlled well in these patients (P ＜ 0.05).They also had better higher cholesterol and low-density lipoprotein,and lower CRP level and less complications (P ＜ 0.05).(3)Serum albumin was higher but inflammation and complications were less in patients with Kt/Vurea value≥ 1.7 and RRF≥2 ml· min-1· (1.73 m2)-1 (subgroup 1),as compared to those with Kt/Vurea≥1.7 but RRF＜2 ml· min-1· (1.73 m2)-1 (subgroup 2) and those with Kt/Vurea＜ 1.7 (subgroup 3) (P ＜ 0.05).The subgroup 2 and 3 were statistically different in these clinical indices,serum calcium [(2.22±0.21) mmol/L vs (2.14±0.24) mmol/L,P ＜ 0.01],serum phosphorous [(1.43±0.47)mmol/L vs (1.66±0.52) mmol/L,P ＜ 0.01],cholesterol [(4.91±1.29) mmol/L vs (4.62±0.99) mmol/L,P ＜0.05],low-density lipoprotein [(2.86±0.96) mmol/L vs (1.13 ±0.61) mmol/L,P ＜ 0.01],high-density lipoprotein [(l.08±0.33) mmol/L vs (2.20±0.72) mmol/L,P＜0.01].(4)The Kt/V was positively correlated with RRF (R2=0.317); if RRF decreased 1 ml/min,the hazard of Kt/Vutea un-targeting increased 40.3％.Conclusions About 67.4％ of PD patients can reach the Kt/Vurea target recommended by K/DOQI.RRF makes a great contribution to Kt/Vurea target.The clinical characteristics are poorer in patients who can not achieve the Kt/Vurea target,or with worse RRF.
