慢性炎症状态对维持性血透患者静脉补铁的影响

目的观察慢性微炎症状态对血透患者静脉补铁后体内铁代谢指标的影响.方法选择48例维持性血透患者,静脉补充铁剂(科莫非),每次100 mg稀释后静脉滴注,每周2次,共10次,观察8周,根据C反应蛋白(CRP)值分为2组:CRP增高组(n=26)和CRP降低组(n=22),观察治疗前后血红蛋白(Hb)、红细胞压积(HCT)、血清铁蛋白(SF)、血清总铁结合力(TIBC)及常规生化指标、Kt/V.结果经补铁后CRP增高组Hib、HCT升高程度明显低于CRP降低组(P＜0.05),而CRP增高组SF(11.68±3.63μmol/L)明显高于CRP降低组(7.34±2.12 μmol/L),CRP降低组TIBC(68.34±12.16μmol/L)下降显著高于CRP增高组(51.16±9.83 μmol/L).结论研究表明慢性炎症状态下维持性血透患者对铁剂治疗反应降低,但易于发生高铁蛋白血症,导致体内铁堆积.     

Successful treatment of hypoalbuminemic hemodialysis patients with a modified regimen of oral essential amino acids.

OBJECTIVE: To evaluate compliance and the change in serum albumin associated with essential amino acid (EAA) therapy in hypoalbuminemic hemodialysis subjects. Design and Setting: Open label, single intervention, pilot study conducted at 2 outpatient hemodialysis centers located in Baltimore, Maryland. SUBJECTS: Eighteen patients with a mean 3-month prestudy serum albumin of <3.8 g/dL and a mean Kt/V of > or =1.0, without any recent hospitalizations or infections, who provided informed consent, and who demonstrated > or =90% compliance rate during a 2 week run-in period, were enrolled in the study. The mean age was 61.3 years, 44% were male, 78% were black, and 50% were diabetic. INTERVENTION: Subjects were instructed to take 3 Aminess N tablets (Recip AB, Stockholm, Sweden) 3 times each day with meals (total of 6.8 g of EAA per day) for 4 months. Main outcome measure: Median 4-month compliance and the change in mean follow-up serum albumin levels (mean of the serum albumin levels at day 30, day 60, day 90, and day 120 after the start of therapy) compared with mean baseline serum albumin levels (mean of the serum albumin levels at day -90, day -60, day -30, and day 0 before therapy). Secondary outcomes included changes in grip strength and body weight. Data was also collected on C-reactive protein levels, dialysis adequacy (Kt/V), and serum bicarbonate. A 2-day dietary recall was obtained at both the start and finish of the study. RESULTS: Monthly compliance with EAA tablets remained relatively stable over the study period, with median compliance rates of 86%, 88%, 82%, and 82% at months 1 through 4, and an overall median compliance of 82%. Seventy-eight percent of patients had an overall compliance rate of 70% or greater. Serum albumin improved from baseline to follow-up by a mean (95% confidence interval) of 0.20 g/dL (95% confidence interval, 0.04 to 0.30; P =.001). Lowest postdialysis weight increased from a mean of 74.5 kg to 77.1 kg (P =.05), and there was a nonsignificant increase in grip strength. C-reactive protein levels increased in 33%, remained constant in 11%, and decreased in 56% of subjects, and there was no significant correlation between change in C-reactive protein levels and improvement in serum albumin. Dietary recalls did not show any significant change in the spontaneous protein or caloric intakes in association with the use of the EAA tablets. CONCLUSION: Although uncontrolled, these results support the feasibility and benefits of moderate dose oral EAA supplementation in hypoalbuminemic hemodialysis subjects.     

慢性肾脏病5期患者炎性反应与营养不良的临床观察

目的 探讨慢性肾脏病(CKD)5期患者机体炎性反应和营养状态的变化及其相互关系.方法 90例CKD 5期患者分为非透析(ND)组、血液透析(MHD)组和腹膜透析(CAPD)组,每组各30例,检测其炎性反应指标血浆高敏C反应蛋白(hs-CRP)和营养指标(血浆白蛋白、血红蛋白),并与30例健康体检者(健康对照组)进行比较.结果CKD 5期患者血浆hs-CRP水平高于健康对照组(P<0.01),MHD组和CAPD组患者血浆hs-CRP水平均高于ND组(P<0.05),MHD组与CAPD组患者血浆hs-CRP水平比较差异无统计学意义.血浆白蛋白<35 g/L和血红蛋白<90 g/L的CKD 5期患者血浆hs-CRP增高更为明显,且血浆hs-CRP水平与血浆白蛋白和血红蛋白呈负相关(r=-0.535,P<0.01;r=-0.220,P<0.05).结论 CKD 5期患者血浆hs-CRP水平增高,且与血浆白蛋白和血红蛋白之间存在负相关,炎性反应可能是导致或加重CKD患者营养不良的原因之一.     

Correlation between Vascular Calcification and Serum Sclerostin in MHD Patients

Objective Investigate the correlation between serum sclerostinlevel and chronic kidney disease-mineral and bone disorder(CKD-MBD),especially vascular calcification,in maintenance hemodialysis(MHD)patients.Methods This is across-sectional study,a total of 72 MHD patients were included from the first affiliated hospital of Jinan university.Measure the biochemical indicators of mineral metabolism,renal function,and serum sclerostin level by ELISA.The abdominal aorta calcification score(AACS)was assessed according to Kauppila method on lateral spine imaging using DEXA.Patients were distributed into two groups according to the level of serum sclerostin:low sclerostingroup(≤125 pg/ml)and high sclerostingroup(>125 pg/ml).Analyze the association of serum sclerostin level with the indicators of CKD-MBD.Results There was significant difference in i PTH level between high sclerost in group and low sclerost in group.Multivariate Logistic regression analysis demonstrated that dialysis duration,male and anuria were independent risk factor of high sclerostin level,and i PTH and Kt/V were protective factors.Conclusion Dialysis duration,man,anuria was independent risk factors and i PTH,Kt/V were protective factors of high serum sclerostin level in MHD patients.There was no correlation between abdominal aorta calcification and serum sclerostin level.     

维持性血液透析患者透析充分性的影响因素分析

目的 采用生物电阻抗法（bioelectrical impedance analysis,BIA）探讨影响维持性血液透析（maintenance hemodialysis,MHD）患者透析充分性的人体成分、营养因素以及影响程度。方法 选取2017年11月 - 2019年5月在四川某三甲医院血液透析中心进行MHD的140例患者,收集患者一般情况、体成分和血液检查指标,并以尿素氮清除率（the urea clearance index,Kt/V）作为透析充分性的评价指标。根据Kt/V的结果分为透析充分组（Kt/V≥1.2）与透析不充分组（Kt/V＜1.2）,将可能影响透析充分性的人体成分因素与营养指标纳入多元逐步回归分析,确定影响MHD患者透析充分性的因素。结果 透析充分组的男性构成比（χ2 = 7.265,P = 0.007）、白蛋白（t = 4.235,P＜0.001）、相位角（t = 3.974,P＜0.001）均高于透析不充分组,细胞内水分（t = - 3.476,P = 0.001）、细胞外水分（t = - 4.753,P＜0.001）、细胞总水分（t = - 4.186,P＜0.001）、细胞外水分/细胞总水分（Z = - 4.307,P＜0.001）、去脂体重（t = - 4.076,P＜0.001）、身体质量指数（t = - 3.861,P＜0.001）、身体细胞量（t = - 3.367,P = 0.001）、骨矿物质含量（t = - 4.035,P＜0.001）、肌肉减少构成比（χ2 = 7.875,P = 0.005）均低于透析不充分组。logistic回归分析结果显示,白蛋白（OR = 0.886,95%CI:(0.803～0.977),P = 0.016）、细胞外水分/细胞总水分（OR = 2.386,95%CI:1.932～2.948,P = 0.001）、身体质量指数（OR = 1.197,95%CI:(1.031～1.389),P = 0.019）、身体细胞量（OR = 1.154,95%CI:1.054～1.264,P = 0.002）为透析充分性的独立影响因素。结论 白蛋白、身体质量指数、身体细胞量、细胞外水分/细胞总水分影响血液透析患者透析充分性,定期监测人体成分与营养状况,提高营养状况,有助于达到透析充分性,保障血液透析治疗效果,提高患者的生存质量。     

腹膜透析患者营养指标的评估

目的 :　对腹膜透析患者的一些营养指标进行评估。方法 :　对 90例持续性不卧床腹膜透析 ( CAPD腹透 )患者进行主观综合性营养评估 ( SGA)、膳食调查、直接人体测量、生化参数的测定 ,计算氮出现率相当蛋白 ( n PNA)、瘦体重和 %瘦体重。结果 :　依据 SGA评分 ,在营养良好、轻中度营养不良及重度营养不良三组间进行以下指标比较 :平均每日每公斤体重能量和蛋白质摄入 ( DEI、DPI)、血白蛋白、n PNA、瘦体重及 %瘦体重 ,均有显著性差异 ( P<0 .0 0 1～ 0 .0 5 )。但营养良好组的 DPI和 DEI异常率 70 .2 1 % ,血白蛋白和 %瘦体重异常率 31 .91 %和 5 1 .0 6% ,而轻中度营养不良组血白蛋白和 %瘦体重正常率为 49.39%和 67.74% ,仅重度营养不良组中各指标异常率均在 80 %以上。直接人体测量指标体重指数、三头肌皮褶厚度和上臂肌围在本组患者中的异常率为 4.44% ,6.67%及 1 3.33%。血前白蛋白、转铁蛋白与白蛋白有显著相关 ( P<0 .0 0 1 ) ,与 DPI、DEI、n PNA及 %瘦体重均无相关。结论 :　SGA是评价腹透患者营养状况的简便方法 ,但还需其它反映营养状况不同侧面的指标的补充 ,如 DEI、DPI、血白蛋白、n PNA、瘦体重及 %瘦体重。其中用肌酐动力学公式计算瘦体重是反映肌肉蛋白质贮存的有效方法。直接人体测?     

Maternal and neonatal iron status in Ivory Coast

Despite the high prevalence of neonatal anemia in C?te d'Ivoire, complete blood counts and iron studies have not been adequately explored. The authors studied complete blood counts (from peripheral blood mononuclear cells), hemoglobin electrophoresis results, and serum iron, ferritin and transferrin levels in 40 newborns and their mothers. The neonatal results (mean +/- SD) were: hemoglobin: 14.96 +/- 2.24 g/dl; serum iron: 16.88 +/- 7.29 micromol/l; total iron-binding capacity (TIBC): 39.88 +/- 14.85 micromol/l; transferrin: 2 +/- 0.65 g/l; ferritin: 116.20 +/- 105.25 microg/l; and hemoglobin electrophoresis: 22.5% of infants showed some hemoglobinopathy (FAC, FAS, FSA(2)). Maternal serum iron levels were positively correlated with the newborns' TIBC (r = 0.362, p<0.05), maternal ferritin with neonatal transferrin (r = 0.374, p<0.05), maternal transferrin coefficient of saturation (CS) with neonatal TIBC (r = 0.554, p<0.01). These results suggest a high prevalence of iron deficiency in mothers and a consequent potential risk of iron deficiency in their newborns in the absence of iron supplementation.     

老年维持性血液透析患者住院原因及相关因素分析

目的分析老年血液透析患者住院的原因及相关因素。方法对2011年3月～2012年2月某院年龄≥65岁的55例长期维持性血液透析患者进行回顾性分析,探讨其住院的原因,比较住院和非住院患者的年龄、透析龄、收缩压、舒张压、血红蛋白、血糖,透析前血肌酐、血尿素氮、血钾、血浆白蛋白、血钙、血磷、三酰甘油、总胆固醇、低密度脂蛋白、高密度脂蛋白、铁蛋白、全段甲状旁腺激素、尿素清除率和透析充分性等临床指标,利用多元逐步回归的方法分析血液透析患者住院的相关因素。结果 12个月中,55例老年患者24例有住院记录;共计住院38例次,平均每例住院次数为0.69次;每次住院时间(19.7±9.7)d;住院的主要原因分别是肺部感染和心血管病。住院组患者的舒张压、透析前血肌酐、尿素氮、血浆白蛋白、高密度脂蛋白、尿素清除率均显著低于非住院组(74.2±8.6 vs 79.4±10.6,P=0.029)mmHg(1mmHg=0.133kPa),(609.0±172.9 vs 779.2±268.9,P=0.002)μmol/L,(16.8±5.8 vs 24.0±7.0,P=0.000)mmol/L,(31.4±6.2 vs 36.8±4.3,P=0.000)g/L,(1.0±0.4 vs 1.2±0.4,P=0.023)mmol/L,(0.6±0.1 vs 0.7±0.1,P=0.003)(1.2±0.2 vs 1.4±0.2,P=0.011)。多元逐步回归分析结果发现,血红蛋白、血尿素氮和透析充分性是影响老年患者住院的相关因素(β分别是-0.494、-0.303和-0.281)。结论心血管系统疾病和肺部感染是老年血液透析患者住院的重要原因。透析前血尿素氮、血红蛋白和透析充分性是影响老年血液透析患者住院的相关因素。     

Serum albumin and clinical outcome in pediatric cardiac surgery

OBJECTIVE: We evaluated the behavior of serum albumin concentrations in response to metabolic stress that is associated with cardiac surgery and the role of this protein as a predictor of clinical outcome in children at high surgical risk who undergo operative correction of congenital heart defects. METHODS: Serum albumin concentrations were measured in 30 children who had heart disease and were at high surgical risk. Analyses were performed before surgery, on the second postoperative day, and on discharge from the intensive care unit. Preoperative serum concentrations of albumin were compared with those of a control group that consisted of 20 healthy and well-nourished children. RESULTS: Preoperative albumin concentrations of patients were lower than those of the control group (3.4+/-0.25 g/dL versus 4.0+/-0.18 g/dL, P<0.05). Serum levels decreased on the second postoperative day and at discharge from the intensive care unit (3.1+/-0.65 g/dL and 3.2+/-0.44 g/dL, P<0.05) compared with preoperative concentrations. Preoperative concentrations lower than 3.0 g/dL were associated with increased postsurgical infection (P=0.0026) and with increased mortality (P=0.0138). Patients whose postoperative levels were lower than 3.0 g/dL had longer hospital stays compared with those whose concentrations were higher than 3.0 g/dL (14.5+/-1.3 d versus 10+/-2.2 d, P<0.05). CONCLUSION: The results suggest that hypoalbuminemia is common among children who have heart disease and are at high surgical risk, and serum albumin concentrations lower than 3 g/dL may be related to outcome in the period after cardiac surgery.     

Net protein anabolism with hypocaloric parenteral nutrition in obese stressed patients

Thirteen obese patients requiring parenteral nutrition for postoperative complications were studied prospectively to evaluate the efficacy of hypocaloric, high-protein parenteral feeding. Nonprotein caloric intake averaged 881 kcal/d or 51.5% of the patients' measured resting energy expenditure. Protein intake averaged 2.13 +/- 0.59 g/kg IBW. Serum albumin and TIBC increased significantly (2.8 +/- 0.5 g/dL to 3.2 +/- 0.4 g/dL, p less than 0.01, and 196 +/- 39 micrograms/dL to 248 +/- 49 micrograms/dL, p less than 0.05, respectively), and subjects lost weight (120.0 +/- 60.0 kg to 109.7 +/- 32.5 kg, p less than 0.05). Nitrogen balance studies in eight subjects suggested nitrogen equilibrium or positive balance can be achieved (+2.4 +/- 1.9 g/d). All patients exhibited complete tissue healing of wounds and abscess cavities and closure of fistulae. In obese, protein-depleted surgical patients net protein anabolism and clinical efficacy can be achieved with hypocaloric, high-protein feeding. Abundant endogenous fat stores provide obligatory energy.     

Appetite and inflammation, nutrition, anemia, and clinical outcome in hemodialysis patients

BACKGROUND: Malnutrition-inflammation complex syndrome, an outcome predictor in maintenance hemodialysis (MHD) patients, may be related to anorexia. OBJECTIVES: We examined whether subjectively reported appetite is associated with adverse conditions and increased morbidity and mortality in MHD patients. DESIGN: A cohort of 331 MHD outpatients was asked to rate their recent appetite status on a scale from 1 to 4 (very good, good, fair, and poor appetite, respectively). Anemia indexes and nutritional and inflammatory markers-including serum concentrations of C-reactive protein, tumor necrosis factor alpha, and interleukin 6-were measured. The malnutrition-inflammation score was used to evaluate the malnutrition-inflammation complex syndrome, and the SF36 questionnaire was used to assess quality of life (QoL). Mortality and hospitalization were followed prospectively for up to 12 mo. RESULTS: Patients were aged 54.5 +/- 14.4 y. Diminished appetite (fair to poor) was reported by 124 patients (38%). Hemoglobin, protein intake, and QoL scores were progressively lower, whereas markers of inflammation, malnutrition-inflammation scores, and the required erythropoietin dose were higher across the worsening categories of appetite. The adjusted odds ratios of diminished versus normal appetite for increased serum tumor necrosis factor alpha and C-reactive protein concentrations were significant. Significant associations between a poor appetite and an increased rate of hospitalization and mortality were observed. The hazard ratio of death for diminished appetite was 4.74 (95% CI: 1.85, 12.16; P = 0.001). CONCLUSION: Diminished appetite (anorexia) is associated with higher concentrations of proinflammatory cytokines and higher levels of erythropoietin hyporesponsiveness and poor clinical outcome, including a 4-fold increase in mortality, greater hospitalization rates, and a poor QoL in MHD patients. Appetite status may yield significant insight into the clinical status of dialysis patients.     

The effect of dietary supplements on the nPCR in stable hemodialysis patients.

OBJECTIVE: To investigate whether (1) dietary supplements raise the normalized protein catabolic rate (nPCR) and/or further improve the nutritional status of stable hemodialysis patients who have both a low nPCR and a low dietary protein intake, <1.2 g/kg body weight/day; and if (2) protein intake measured by nPCR reflects protein intake measured by estimated food diaries in stable patients. DESIGN: Prospective experimental study with a single intervention group. SETTING: Hospital outpatient hemodialysis unit. SUBJECTS: Seventeen stable chronic hemodialysis patients (10 men, 7 women) were studied over 8 months. INTERVENTION: Subjects with both a low nPCR and dietary protein intake <1.2 g/kg body weight/day received dietary supplements for the first 2 months. Measurements to assess protein intake and nutritional status were taken at baseline and repeated at the end of 2 months, and at 6 months postintervention. MAIN OUTCOME MEASURE: nPCR, dietary protein intake using 7-day estimated food diaries, serum urea, serum albumin, serum creatinine, serum bicarbonate, dialysis adequacy (Kt/V), and body mass index (BMI). RESULTS: Dietary supplements significantly increased both the nPCR and the total protein intake at 2 months (1.21 +/- 0.26, 1.10 +/- 0.12, respectively) compared with baseline (0.95 +/- 0.18, 0.75 +/- 0.19, respectively) and 8 months (0.99 +/- 0.12, 0.78 +/- 0.21, respectively), P <.0001, respectively. There was no change in the nutritional status of the subjects. There was a significant difference between the nPCR and the dietary protein intake at baseline, P <.004; at 2 months, P <.047; and at 8 months, P <.001. CONCLUSION: Dietary supplements can significantly increase the nPCR and dietary protein intake in stable hemodialysis patients with a low nPCR and dietary protein intake. Because a low nPCR is associated with a high morbidity and mortality rate, it may be prudent to supplement such patients. The use of the nPCR to quantify dietary protein intake in stable hemodialysis patients should be used with caution.     

应用主观全面评定法评价维持性血液透析患者营养状况

目的应用主观全面评定法（SGA）对维持性血液透析患者（MHD）的营养状态进行评价。方法对116例MHD患者应用SGA方法进行营养评估，测定肱三头肌皮褶厚度、上臂围、上臂肌围（MAMC）等人体测量学指标和血清白蛋白（ALB）、C反应蛋白（CRP）等实验室指标，并进行相关性分析。结果SGA法的评定结果与年龄、透析时间、肱三头肌皮褶厚度、上臂围、MAMC、体质指数（BMI）、ALB、CRP均有显著相关性（P〈0．01）；与总蛋白、血清肌酐无相关性（P〉0．05）。多因素分析显示，在调节年龄、BMI后，SGA评分与CRP、ALB、MAMC仍存在显著相关性（相关系数分别为0．2816、0．3368、0．6143，P〈0．05）。结论SGA法在我国MHD患者的营养评价中适用，是一种经济、有效的营养评定方法。     

Malnutrition in tubefed nursing home patients with pressure sores.

This study compares the nutritional status and dietary intake of 14 tubefed nursing home patients with pressure sores (age: 70 +/- 5 years, mean +/- SEM) to 12 tubefed patient-controls without sores (age: 60 +/- 7 years). Patients tended to have higher calorie intake (32 +/- 3 kcal/kg) than patient-controls (26 +/- 2 kcal/kg, p = 0.11). Protein intake was significantly higher in patients (1.4 +/- 0.2 g/kg) than patient-controls (0.9 +/- 0.1 g of protein per kg, p less than 0.05). Despite increased calorie and protein intake, biochemical measures of nutritional status were worse in the patients. Serum albumin was lower in patients (33 +/- 1 g/L) than in patient-controls (37 +/- 1 g/L, p less than 0.05) as was level of hemoglobin (patients: 117 +/- 5; patient-controls: 132 +/- 5 g/L, p less than 0.05). Patients with stage IV (severe) sores had lower serum cholesterol levels (3.46 +/- 0.31 mmol/L, n = 5) than patients with stage II/III (milder) sores (4.58 +/- 0.23 mmol/L, n = 9, p less than 0.05). Plasma zinc was low in both patients (11.2 +/- 0.6 mumol/L) and patient-controls (11.5 +/- 0.7 mumol/L, p = NS). Pressure sore surface area was positively correlated with calorie intake per kilogram of body weight (r = +0.59, p less than 0.04) and negatively correlated with body mass index (r = -0.70, p less than 0.03), hemoglobin (r = -0.55, p less than 0.07) and serum cholesterol (r = -0.57, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

慢性肾脏病5期患者炎性反应与营养不良的临床观察

目的探讨慢性肾脏病（CKD）5期患者机体炎性反应和营养状态的变化及其相互关系。方法90例CKD5期患者分为非透析（ND）组、血液透析（MHD）组和腹膜透析（CAPD）组,每组各30例,检测其炎性反应指标血浆高敏c反应蛋白（hs-CRP）和营养指标（血浆白蛋白、血红蛋白）,并与30例健康体检者（健康对照组）进行比较。结果CKD5期患者血浆hs-CRP水平高于健康对照组（P〈0．01）,MHD组和CAPD组患者血浆hs—CRP水平均高于ND组（P〈0．05）,MHD组与CAPD组患者血浆hs—CRP水平比较差异无统计学意义。血浆白蛋白〈35g／L和血红蛋白〈90g／L的CKD5期患者血浆hs—CRP增高更为明显,且血浆hs-CRP水平与血浆白蛋白和血红蛋白呈负相关（r=-0．535,P〈0．01;r=-0．220,P〈0．05）。结论CKD5期患者血浆hs．CRP水平增高,且与血浆白蛋白和血红蛋白之间存在负相关,炎性反应可能是导致或加重CKD患者营养不良的原因之一。     

The relationship between serum albumin and hydration status in hemodialysis patients.

OBJECTIVE: A decreased serum albumin level predicts poor survival in end-stage renal failure. Hypoalbuminemia is multifactorial and related to poor nutrition, inflammation, and comorbid disease. Overhydration is also common in renal replacement therapy patients, and hemodilution may also contribute to a low serum albumin level. DESIGN: Crosssectional observational study. SETTING: Outpatient hemodialysis unit of a district general hospital. SUBJECTS: We investigated the relationship of serum albumin to C-reactive protein (CRP) and hydration state in 49 unselected hemodialysis patients (28 men). METHODS: Patients were assessed predialysis and postdialysis at their clinical dry weight. Extracellular fluid volume (Vecf) and total body water (Vtbw) were estimated by whole-body bioelectric impedance. Vecf was expressed as a percentage of Vtbw (Vecf%Vtbw). Predialysis CRP, predialysis and postdialysis serum albumin, and body weight were measured. Normalized protein catabolic rate (nPCR) and KT/V urea were calculated. RESULTS: Predialysis and postdialysis serum albumin levels were 36.9 g/L (95% CI, 35.7 and 38.1) and 41.4 g/L (95% CI, 39.7 and 43.3), respectively (P <.0001). Mean weight change was 2.0 +/- 1.2 kg. Predialysis and postdialysis serum albumin levels were negatively correlated with CRP (before: r = -0.393, P <.005; after: r = -0.445, P =.001) and positively with nPCR (before: r = 0.336, P =.018; after: r = 0.353, P =.013). Predialysis serum albumin level correlated with predialysis Vecf%Vtbw (r = -0.384, P =.006) and postdialysis serum albumin level with postdialysis Vecf%Vtbw (r = -0.654, P <.0001). In multivariate analysis, predialysis albumin was dependent on nPCR (P =.04), CRP (P <.0001), and predialysis Vecf%Vtbw (P =.002), and postdialysis albumin was dependent on nPCR (P =.01), CRP (P =.002), and postdialysis Vecf%Vtbw (both P <.0001). The increase in albumin was strongly correlated with both change in actual weight (r = -0.651, P <.0001) and change in Vecf%Vtbw (r = -0.684, P <.0001). CONCLUSION: In unselected hemodialysis patients, serum albumin level is dependent on nPCR, CRP, and extracellular fluid volume. This relationship persists after dialysis, suggesting that many patients remain fluid overloaded at their postdialysis dry weight.     

透析液流量对透析充分性的影响作用研究

目的 分析不同透析液流量对维持性血液透析患者透析充分性的影响作用.方法 将48例维持性血液透析患者根据透析液流量的不同分为500ml/min组、600ml/min组、700ml/min组、800ml/min组,每组12例,均治疗6周.每组治疗前和治疗后采血检测白蛋白(Alb)、血红蛋白(Hb)、红细胞压积(Hct)、血尿素氮(BUN)、血清肌酐(SCr)、甲状旁腺激素(iPTH),并计算尿素清除指数(Kt/V)和尿素下降率(URR).结果 500 ml/min组和600 ml/min组的Kt/V比较差异无统计学意义(P＞0.05),即透析液流量由500ml/min增加至600ml/min不能提高Kt/V,即不能提高透析充分性;500ml/min组、600ml/min组、700ml/min组和800ml/min组Kt/V比较差异有统计学意义,800ml/min组对透析充分性的影响作用更佳.采用自身对照方式比较不同透析液流量对透析充分性的影响,Kt/V随着透析液流量的增加而增加,即透析充分性与透析液流量呈正相关.结论 高透析液流量透析能提高患者的Kt/V,对提高透析充分性的作用显著.

Abstract：

Objective To analyze the dialysis adequacy of the maintenance hemodialysis patients under different dialyzate flow.Methods Forty-eight patients under maintenance hemodialysis were divided into four groups according to dialyzate flow:500 ml/min group,600 ml/min group,700 ml/min group and 800 ml/min group,with 12 patients in each group.Each group was treated 6 weeks.The albumin (Alb),hemoglobin(Hb),hematocrit(Hct),blood urea nitrogen (BUN),serum creatinine(SCr) and parathyroid hormone(iPTH) levels before and after treatment were examined,Kt/V and urea reduction ratio(URR) were calculated separately.Results There was no significant difference in Kt/V between 500 ml/min group and 600 ml/min group.Kt/V was no increased when the dialyzate flow rate increased from 500 ml/min to 600 ml/min,that was to say they could not improve the dialysis adequacy.There was statistically significant difference in Kt/V among 500 ml/min group,600 ml/min group,700 ml/min group and 800 ml/min group,and 800 ml/min group on the dialysis adequacy was better.Different dialyzate flow on the impact of the dialysis adequacy was compared in self-control method.Kt/V increased along with the increase of dialyzate flow,and the dialysis adequacy and dialyzate flow showed positive correlation.Conclusion The high dialyzate flow of dialysis treatment can improve Kt/V and has significant effect in enhancing the dialysis adequacy.     

Serum transferrin and serum prealbumin are early predictors of serum albumin in chronic hemodialysis patients.

Protein-calorie malnutrition is a known risk factor for increased morbidity and mortality in maintenance hemodialysis patients (MHD). Serum albumin is the most commonly measured nutritional index in MHD patients because of its easy routine availability and association with outcomes of interest. However, its long half-life of approximately 20 days makes it a late index of nutritional status, and its exclusive use may delay implementation of appropriate nutritional interventions. Serum prealbumin and transferrin have been proposed as earlier nutritional markers. However, the temporal associations among these indices and serum albumin have not been well documented. To assess the ability of serum prealbumin and serum transferrin to predict changes in serum albumin over time, we prospectively analyzed these parameters in 105 MHD patients every month for 6 consecutive months. The mixed model analysis showed that early changes in either serum transferrin or prealbumin predicted and were significantly associated with changes in serum albumin (P<.0001). Using a prototype equation, a change of 0.12 g/dL in serum albumin concentration can be predicted by a 10% change in the same direction of serum transferrin and prealbumin. We conclude that clinically significant changes in albumin can be reliably predicted by earlier changes in serum transferrin and prealbumin.     

Insulin-like growth factor 1 (IGF-1), a nutritional marker in patients with eating disorders.

BACKGROUND AND AIMS: Though low levels of insulin-like growth factor-1 (IGF-1) have been repeatedly reported in patients with eating disorders, the nutritional significance of IGF-1 has not been evaluated. The study aimed to assess the utility of IGF-1 for screening malnutrition and for monitoring nutrition intervention in patients with eating disorders. METHODS: IGF-1 and nutritional status were evaluated in 82 patients, 59 with anorexia nervosa (AN), and 23 with bulimia nervosa (BN). Nutritional assessment included the evaluation of body mass index (BMI), body fat (FAT) and muscle mass (MM), assessed by skinfold anthropometry, serum albumin, transthyretin and retinol-binding protein, energy and protein intake. IGF-1 and nutritional parameters were reevaluated in the early phase of refeeding (2-4 weeks) in 20 AN patients who entered a refeeding program. RESULTS: Mean IGF-1 z-score was -1.74+/-0.74 in AN, and -0.74+/-0.91 in BN. Serum proteins were reduced in only a minority of patients. IGF-1 correlated with BMI (r=0.64), FAT (r=0.57), MAMC (mid-arm muscle circumference) (r=0.58) and MM (r=0.66) (P<0.001), while it did not correlate with serum proteins. In the early phase of nutritional repletion serum proteins and anthropometric parameters did not vary significantly, while a prompt and marked increase (73.9%) of IGF-1 was observed. CONCLUSIONS: IGF-1 represents a biochemical marker of malnutrition and a sensitive index of nutritional repletion in patients with eating disorders.     

Effect of protein and energy intakes on body composition in non-diabetic maintenance-hemodialysis patients

This cross sectional study was performed to find the adequate amount and combination of dietary protein and energy for maintaining better nutritional status for stable non-diabetic maintenance hemodialysis (MHD) patients. The body composition including body fat, total body water, body cell mass and body protein were measured by multi-frequency bioelectrical impedance analysis in 200 stable MHD patients without diabetes (124 men, 76 women). Dietary energy intake (DEI) and dietary protein intake (DPI) were assessed by a brief self-administered diet history questionnaire (BDHQ), the DPI value being confirmed by calculating the normalized protein equivalent of total nitrogen appearance (nPNA). The nutritional status and the body composition were compared among 4 groups of patients in each gender that were divided by the combination of DEI and DPI; high energy (HE)/high protein (HP), HE/low protein (LP), low energy (LE)/HP and LE/LP groups. The mean DPI ranged between 1.17-1.23 and 0.89-0.95 g/kg IBW/d in the HP and LP groups, respectively for both genders, and the mean DEI was 35-37 and 24-25 kcal/kg IBW/d in HE and LE groups, respectively. BMI and serum albumin concentration were not different among the 4 groups. Body cell mass index (BCMI) was maintained in the HE groups regardless of DPI, and it was significantly higher in the HE/HP group than in the LE/LP group. Multiple regression analysis also showed that the BCMI was more greatly affected by DEI than DPI. These results indicated that a DPI of 0.89-0.95 g/kg IBW/d could be sufficient for maintaining BCMI, if DEI is kept over 35 kcal/kg IBW/d in stable non-diabetic MHD patients. This DPI level is lower than the recommended DPI proposed by dietary guidelines in the US and Japan.