腹膜透析患者残余肾功能下降速率的相关影响因素分析

目的 探讨腹膜透析患者残余肾功能(RRF)下降速率的相关影响因素,以期为临床早期干预提供依据.方法 将纳入的95例患者按估算的肾小球滤过率(eGFR)水平分为A组[eGFR＜ 6mL·(min·1.73m2)-1]、B组[eGFR(6 ～10)mL·(min·1.73m2)-1]及C组[eGFR＞ 10mL·(min·1.73m2)-1],随访患者18个月或至终点事件发生,计算eGFR平均下降速率,并建立回归模型,分析各项指标与eGFR下降速率的关系.结果 95例患者eGFR下降速率平均为-0.156mL·(min·1.73m2)-1,其中A组为-0.091mL·(min·1.73m2)-1,B组为-0.153mL·(min·1.73m2)-1,C组为-0.251mL· (min·1.73m2)-1;共有37例(38.95％)eGFR丧失,其中A组18例(60.00％)、B组13例(40.63％),C组6例(18.18％);3组eGFR下降速率及eGFR丧失率组间比较均有显著差异(P ＜0.001).至终点时,3组死亡率、转HD治疗及行肾移植组间比较均无显著差异(P＞0.05).多因素回归分析显示,基线时eGFR、Hb、血清白蛋白、总胆固醇、NT-pro-BNP为为eGFR下降速率的独立影响因素.结论 腹膜透析患者eGFR下降速率与基线时eGFR、Hb、血浆白蛋白、总胆固醇及NT-pro-BNP水平等密切相关,临床上应识别并重视.

Related factors of decline rate of the residual renal function in peritoneal dialysis patients

Objectives To investigate related factors of decline rate of the residual renal function (RRF) in peritoneal dialysis patients,in order to provide the basis for early clinical intervention.Methods 95 patients with peritoneal dialysis were divided into group A [eGFR ＜6 mL · (min · 1.73m2)-1],Group B [eGFR(6 ～ 10)mL · (min · 1.73m2)-1] and C group[eGFR ＞ 10 mL · (min · 1.73m2)-1]according to the estimated glomerular filtration rate(cGFR).Patients were followed up for 18 months or until the end of the event.Average decline rate of eGFR was calculated.The relationship between indexes and eGFR decline rate was analyzed.Results Average decline rate of eGFR in 95 patients was-0.156 mL ·(min · 1.73m2)-1,Group A was-0.091 mL · (min · 1.73m2)-1,group B was-0.153 mL · (min ·1.73m2)-1,Group C was-0.251 mL · (min · 1.73m2)-1.eGFR loss of 37patients in 95 patients (38.95％) happened,including 18 cases (60.00％) in group A,13 cases (40.63％) in group B,6 cases (18.18％) in group C.There were significant differences in eGFR rate of decline and eGFR loss among the three groups (P ＜ 0.001).The end of follow-up,there was no significant difference in the mortality rate,hemodialysis(HD) and renal transplantation among the three groups (P ＞0.05).Multivariate regression analysis showed that baseline eGFR,Hb,Serum Albumin,total cholesterol,NT-pro-BNP were the independent factors of eGFR decline rate.Conclusions The eGFR decline rate of the peritoneal dialysis patients is closely related to baseline levels of eGFR,Hb,serum albumin,total cholesterol and NT-pro-BNP,which should be taken seriously in clinical practice.