高血脂对腹膜透析患者的残余肾功能影响

目的：观察高血脂对连续性不卧床腹膜透析（CAPD）患者的残余肾功能（RRF）的作用。方法：定期监测共72例CAPD患者血脂成分及残余肾功能,根据血脂的变化将患者分为胆固醇（TC）增高组、三酰甘油（TG）增高组及二者均增高组与TC、TG正常组,比较各组残余肾功能变化。结果：CAPD治疗初期残余肾功能无明显变化（P〉0.05）。第12月时,TC增高组RRF较同组透析初月时下降（P〈0.05）。TG增高组及TC、TG均增高组的RRF分别与透析初月时同组RRF比较显著下降（P〈0.001）。第18月时3个血脂增高组RRF与TC、TG组比较均有下降（P〈0.05）。RRF下降数值与TC（r=0.234,P〈0.05）、TG（r=0.528,P〈0.05）均呈正相关。结论：CAPD患者的RRF随着透析时间的延长而降低。高血脂与RRF改变值有正相关性。     

残余肾功能对腹膜透析患者营养状况影响的临床研究

目的：前瞻性观察长期持续性非卧床腹膜透析（CAPD）患的营养状况,探讨残余肾功能对营养状况的影响。方法：采用常规处方透析,留取尿液、腹透液,并抽血检测生化、血脂及蛋白营养指标,计算残余肾功能（RRF）、KT／V值、肌酐清除率（Ccr)、单位透析剂量（PV／S）及蛋白质分解率（PCR）,评估每日蛋白质摄入量（DPI)。结果：RRF与KT／V、Ccr及残余尿量呈正相关,（分别r=0.56、0．83及0．80）,与透析时间、透析超滤量呈负相关（分别r=-0.41、0．33）,与PV／S无关。A组（RRF＜3ml/min)患Ccr、KT／V及血浆前白蛋白（PA）、视黄醇结合蛋白（RBP）、转铁蛋白（Tf)明显低于B组（RRF≥3ml/min),但PCR高于B组。然而,A、B两组间Alb、TG及TC却无明显差别。结论：RRF与腹膜透析充分性密切相关,并影响腹透患的营养状况,根据RRF下降程度及时调整透析剂量及方案,是预防CAPD患营养不良发生的最主要手段。     

高通量透析改善老年血液透析患者微炎症状态的临床研究

目的:探讨高通量透析对老年维持性血液透析患者微炎症状态的影响。方法:将常规血液透析老年患者80例,随机分为高通量组及常规透析组。检测各组患者治疗前后的血清超敏C反应蛋白、白细胞介素6、肿瘤坏死因子α、同型半胱氨酸、丙二醛、白蛋白、转铁蛋白、血红蛋白、全段甲状旁腺素等,治疗观察时间为3个月。结果:高通量透析组(A组)和常规透析组(B组)患者治疗前后血清学CRP、IL-6、TNF-α、Hcy、MDA、iPTH水平比较,A组治疗3月后各项指标较治疗前明显下降(P<0.05),而B组治疗后各项指标下降不明显,治疗3月时A、B两组间各项指标差异有统计学意义(P<0.05);MHD组患者CRP与IL-6、TNF-α、Hcy、MDA、iPTH呈显著正相关(分别为r=0.526,P<0.01;r=0.511,P<0.01;r=0.269,P<0.05;r=0.302,P<0.05;r=0.712,P<0.01)。结论:高通量血液透析可以改善血透患者微炎症状态。     

血压对腹膜透析患者残余肾功能、透析充分性及不良心血管事件发生的影响

目的:探讨血压对腹膜透析患者残余肾功能(RRF)、透析充分性、不良心血管事件发生的影响。方法:选取我院2017年10月—2019年10月收治的腹膜透析患者108例,根据患者的血压控制情况分组,血压控制130～140/80～90 mmHg者纳入A组(n=52),血压控制为120～130/70～80 mmHg者纳入B组(n=56)。比较两组透析前、透析6个月的RR指标,包括尿素清除指数(KT/V)、残肾KT/V、总内生肌酐清除率(Ccr)、残肾Ccr。观察两组治疗前后血肌酐(Cr)、尿素氮(BUN)水平以及Cr峰值浓度、BUN峰值浓度、每周尿素氮清除量。记录两组6个月内不良心血管事件发生率。结果:两组治疗后总KT/V、残肾KT/V、总Ccr、残肾Ccr均显著低于治疗前,但B组显著高于A组(P0.05)。两组治疗后血清Cr、BUN水平显著低于治疗前,且B组显著低于A组(P0.05)。B组每周尿素氮清除量显著高于A组(P0.05)。B组不良心血管事件发生率为5.36%,显著低于A组的17.31%(P0.05)。结论:将血压控制为120～130/70～80 mmHg,对腹膜透析患者RRF有保护作用,可提升透析充分性,降低不良心血管事件发生率。     

生物电阻抗分析法指导血液透析超滤联合 α-酮酸配伍低蛋白饮食对患者残余肾功能的影响

目的通过生物电阻抗分析法指导血液透析超滤,观察结合α-酮酸配伍低蛋白饮食对新进入血液透析患者残余肾功能(residual renal function,RRF)的影响。方法选取2016年1月至2017年10月在江阴市人民医院血液净化中心新进入血液透析的终末期肾病患者160例,随机分为A组(α-酮酸配伍低蛋白饮食)、B组(生物电阻抗分析)、C组(α-酮酸配伍低蛋白饮食联合生物电阻抗分析)、D组(对照组),动态随访各组治疗前后6个月的RRF变化。A组患者采用α-酮酸配伍低蛋白饮食,并根据患者心胸比、透析间期体质量增长量及透析间期低血压、口干、肌肉抽搐等不良反应等传统方式指导透析超滤量;B组为生物电阻抗分析指导透析超滤,饮食为正常蛋白饮食;C组患者采用α-酮酸配伍低蛋白饮食,并通过生物电阻抗分析指导透析超滤,D组为正常蛋白饮食,与A组相同的传统方式指导透析超滤量。比较4组随访前后的24 h尿量、RRF、平均动脉压、血透超滤量及透析不良事件的发生率。结果 4组24 h尿量、RRF、平均动脉压、平均透析超滤量随访前后自身相比较,差异均有统计学意义(P0.01),4组白蛋白随访前后比较,差异无统计学意义(P0.05)。随访6个月后,4组RRF及24 h尿量均呈下降趋势,差异有统计学意义(F_(组间)=5.530,F_(组内)=352.146,P0.05和F_(组间)=765 426.35,F_(组内)=59 645.256,P0.001);其中C组RRF(6.0±0.6) mL/min在4组中保护程度最好,有显著性差异(P0.05),且下降速度较其余3组更平缓,而A组(4.6±0.5) mL/min、B组(4.8±0.6) mL/min、C组(6.0±0.6) mL/min均较D组(3.7±0.6) mL/min保护程度更好,差异显著(P0.05)。A组24 h尿量(922.4±85.1)mL、B组24 h尿量(901.9±97.9)mL、C组24 h尿量(1 187.1±211.4)mL均高于D组24 h尿量(653.2±74.2)mL,差异有统计学意义(P0.05);4组透析期间平均超滤量之间比较,差异有统计学意义(F_(组间)=15.341,F_(组内)=32.625,P0.01),其中A组(0.85±0.21)L、C组(0.60±0.25)L低于B组(0.92±0.17)L、D组(1.31±0.52)L,差异有统计学意义(P0.05),B、D 2组之间比较,差异有显著性(P0.05)。随访期间各组发生透析不良事件比较,A组发生6起,B组3起,C组1起,D组8起,差异有统计学意义(χ~2=3.771,P=0.013)。随访后各组收缩压、舒张压、白蛋白比较均无统计学意义(P0.05)。结论在生物电阻抗分析法指导血液透析超滤的基础上,透析患者采用α-酮酸配伍低蛋白饮食,能维持患者营养状况,避免低蛋白血症,同时可精确评估透析超滤量,有利于延缓RRF下降速度,保护RRF,同时能显著减少透析期间不良事件的发生率。     

腹膜透析患者血清白蛋白变化与容量变化关系的临床纵向观察

目的:探讨持续性非卧床腹膜透析(CAPD)患者容量动态变化对血清白蛋白水平的影响。方法:对符合入选条件的129例来自南京医科大学附属淮安第一医院肾内科的CAPD患者随访18个月,每6个月对患者容量状态(overhydration,OH)、血清白蛋白(Alb)及透析充分性等指标进行监测。随访前后Alb的变化表示为ΔAlb(Alb18月~Alb0月),OH的变化表示为ΔOH(OH18月~OH0月)。结果:根据△Alb将患者分为三组,即A组(ΔAlb≥3 g/L)、B组(2 g/L≥ΔAlb≥-2 g/L)及C组(ΔAlb≤-3 g/L),结果显示ΔOH在三组间有明显不同[(-1.04±1.6)L,(0.16±1.62)L,(0.26±1.34)L;P0.05)],而患者年龄、透析龄及残余肾尿素清除率(r Kt/V)在各组间差异无统计学意义;基于基线资料的多因素线性回归分析提示OH、年龄及r Kt/V是影响Alb水平的独立因素(R2=0.301,P0.05);而Logistic回归分析表明在矫正性别、糖尿病及r Kt/v下降速率等因素后,随访期间平均OH水平是影响低白蛋白血症发生的独立危险因素(χ2=20.51,P0.05)。结论:腹膜透析患者持续高容量状态或容量负荷增加是导致低白蛋白血症发生的主要危险因素之一,而残肾功能下降并不一定伴有Alb水平的下降。     

腹膜透析剂量与残余肾功能及透析质量的关系研究

目的观察慢性肾脏病5期患者应用非透析治疗、不同腹膜透析剂量治疗对肾功能的影响。方法选取慢性肾脏病5期的非糖尿病肾病患者,采用非透析保守治疗者20例,腹膜透析剂量4升／天者26例、6升／天者35例及8升／天者43例。随访观察1年,检查各项指标及肾功能的变化。结果随访1年后,非透析患者血压的控制较4升／天腹膜透析组差（P〈0．05）,血清白蛋白水平、血钙水平低于4升／天透析组,血磷及甲状旁腺素水平高于不同剂量透析组。各组尿量及残余肾功能均有不同程度的下降,其中腹膜透析各组尿量、肾功能及非透析组肾功能均较观察前具有统计学差异（P〈0．05）,而各组之间肾功能下降的幅度未见显著性差异（P〉0．05）。结论慢性肾脏病5期患者早期的腹膜透析治疗对患者钙磷代谢、蛋白质营养改善及血压的控制优于非透析治疗。腹膜透析治疗对残余肾功能的保护与非透析治疗相比未见明显优势,不同的透析剂量在1年的观察期内未显示对肾功能的影响。     

替米沙坦联合尿毒清对腹膜透析患者残余肾功能的影响

目的：探讨替米沙坦联合尿毒清颗粒在延缓腹膜透析患者残余肾功能（RRF）丢失的作用.方法：将入选的75例病情稳定的维持性腹膜透析患者随机分为替米沙坦联合尿毒清治疗组、替米沙坦组和对照组.定期检测3组的RRF、高敏C反应蛋白（hsCRP）、Kt/V、肌酐清除率（Ccr）、血钾,并记录尿量、血压情况.结果：研究结束时,3组患者RRF、尿量均显著下降,联合用药组较对照组及替米沙坦组RRF丢失延缓,尿量保持更好（P〈0.05）,且联合用药组较对照组及替米沙坦组hsCRP显著下降（P〈0.05）.结论：替米沙坦联合尿毒清颗粒能更好地延缓腹膜透析患者RRF的丢失,并改善其微炎症状态.     

不同透析频率对维持性血液透析患者残余肾功能的影响

目的 研究不同透析频率对维持性血液透析患者的残余肾功能的影响.方法 根据透析方案的不同将53例慢性肾功能衰竭维持性血液透析患者分为3组.A组:19例,每周透析3次;B组:15例,每周透析2次;C组:19例,每2周透析3次.1年后分别标记为A1组、B1组、C1组.检测各组患者的残余肾功能.结果 A组、B组、C组患者残余肾功能分别为(6.5±1.7)ml/min、(7.0±2.2)ml/min、(6.0±2.4)ml/min.A1组、B1组、C1组残余肾功能分别为(2.7±1.5)ml/min、(3.3±1.8)ml/min、(4.1±2.6)ml/min.透析1年后,A组、B组、C组患者残余肾功能比较差异均有统计学意义(t分别=9.605、8.393、12.026,P均＜0.01);A1组与C1组比较差异也有统计学意义(t=2.416,P＜0.05).C组残余肾功能下降最少.结论 透析频度影响维持性血液透析患者残余肾功能的下降速度,血液透析频率较低(每2周透析3次)的患者残余肾功能的下降速度低于每周透析3次患者.     

腹膜透析患者不同透析剂量临床疗效比较

目的 比较腹膜透析患者不同透析剂量的临床疗效.方法 横断面调查西安交通大学医学院第一附属医院腹膜透析中心透析超过3个月但处于稳定状态的腹膜透析患者,根据透析剂量不同分为3组,A组≤4000ml,B组≤6000ml,C组≥8000ml.比较3组患者的透析充分性、血浆白蛋白、校正的蛋白分解率、24 h腹透液蛋白定量、体表面积、用尿尿素氮清除率与尿肌酐清除率的均值计算肾小球滤过率.结果 3组患者总尿素氮清除指数和总肌酐清除率比较差异无统计学意义(P>0.05);A组患者腹膜Kt/V和腹膜总肌酐清除率与B、C组比较差异有统计学意义(P<0.01);c组患者残肾Kt/V和残肾总肌酐清除率及肾小球滤过率与A、B组比较差异有统计学意义(P<0.01);A组患者白蛋白与C组比较差异有统计学意义(P<0.15);3组间蛋白分解率比较差异无统计学意义(P>0.05).A组患者24 h腹透液蛋白定量与C组比较差异有统计学意义(P<0.05).A组患者体表面积与B、C组比较差异有统计学意义(P<0.0).A组患者促红素用量及医药费用最低.结论 (1)大多数患者使用6000 ml或6000 ml以下的透析剂量可以达到充分透析;(2)残肾功能好,体表面积小的患者,小剂量透析可以维持良好的营养状况,医疗费用越低;(3)透析时间长、残肾差、体表面积大的患者需要更高透析剂量才能维持充分透析,但腹膜透析液蛋白丢失增多,蛋白摄入不足,残肾对毒素清除减少可能使营养状况恶化.     

阿魏酸哌嗪在腹膜透析患者残余肾功能中的应用

目的 探索持续性腹膜透析(CAPD)的尿毒症患者使用阿魏酸哌嗪对残余肾功能(RRF)的影响.方法 43例CAPD治疗的尿毒症患者随机分为治疗组与对照组,治疗组22例,对照21例;治疗组在对照组基础上加用中成药阿魏酸哌嚷,每次150mg,每天3次,疗程12个月;观察治疗前、后的血压(BP)、体重(BW)、血色素(Hb)、血尿素氮(BUN)、肌酐(Scr)、血白蛋白(Alb)等指标;分别检测二组治疗6、12、18个月的RRF及尿量.结果 与对照组相比,治疗后的治疗组RRF下降速度减慢(P＜0.05).尿量减少明显减缓(p＜0.01),BP控制对照组满意(p＜0.05).Hb、BW、Alb好于对照组(P＜0.05～0.01).结论 阿魏酸哌嗪对CAPD尿毒症患者的RRF有保护作用,延缓尿量的减少,改善患者营养,提高CAPD患者的生活质量.     

Cystatin C as marker of residual renal function in patients on peritoneal dialysis: relation with parameters of peritoneal function

INTRODUCTION: Cystatin C (CysC) is a nonglycosylated protein of low molecular weight not influenced by age, sex or inflammation. The aim of this paper is to ascertain the usefulness of serum CysC level determination in peritoneal dialysis (PD) patients. MATERIAL AND METHODS: CysC serum levels were determined in 80 PD patients. The mean age of patients was 53.7 +/- 15 years, with 15.3 +/- 25.8 months on PD. Thirty-three percent were on continuous ambulatory peritoneal dialysis (CAPD) and 66.3% on automated peritoneal dialysis (APD). Fourteen patients (17%) had no residual renal function (RRF). RESULTS: Mean CysC levels were 5.8 +/- 1.4 mg/L, without differences between men (5.5 +/- 1.4 mg/L) and women (5.6 +/- 1.5 mg/L, NS). There was no correlation between CysC levels and age, weight, height or time on PD. Anuric patients had CysC levels significantly higher than non-anuric (6.7 +/- 1.4 vs. 5.3 +/- 1.3 mg/L, p<0.001). CysC levels showed an inverse correlation with RRF (r=-0.60, p<0.001) and residual urine volume (r=-0.58, p<0.001). CONCLUSIONS: In conclusion, serum CysC levels had the same statistical significance as plasma creatinine levels, and they are not influenced by peritoneal transport in PD patients. Consequently, both parameters are valid RRF markers.     

Association between residual renal function, inflammation and patient survival in new peritoneal dialysis patients.

BACKGROUND: The recent ADEMEX study (Paniagua R, Amato D, Vonesh E et al. J Am Soc Nephrol 2002; 13: 1307-1320) indicates that peritoneal small solute clearance is not as critical for the survival of peritoneal dialysis (PD) patients as thought previously. On the other hand, low residual renal function (RRF), inflammation and an increased peritoneal transport rate (PTR) as evaluated by the peritoneal equilibration test (PET) are reported to be associated with increased mortality in PD patients, but the relationships between these factors and their separate and combined impact on the survival of PD patients are not clear. In this retrospective analysis, we evaluated possible relationships between RRF, inflammation and initial PTR in patients starting PD and the impact of these factors on patient survival. METHODS: A total of 117 patients with initial assessments for RRF, serum C-reactive protein (CRP) and PET at a mean period of 0.4+/-0.2 months (range 0.1-1.0 months) after start of PD were included in this study. Based on RRF (cut-off point, 4 ml/min/1.73 m(2)), serum CRP (cut-off point, 10 mg/l), and the dialysate to plasma creatinine ratio at 4-h of dwell (mean+1 SD), the patients were divided into different groups: low RRF and high RRF group, high CRP and normal CRP group and high PTR and other PTR group, respectively. RESULTS: Of 117 patients, 54 patients (46%) were in low RRF (<4 ml/min/1.73 m(2)) group, 36 patients (31%) were in high serum CRP (> or = 10 mg/l) group and 17 patients (15%) were in high PTR group. Forty-nine patients (42%) had one of these characteristics, 26 patients (22%) had two of these characteristics, two patients (2%) had three, and 40 patients (34%) had none of these characteristics. Patients with low RRF were older and had a higher prevalence of high CRP, lower normalized protein equivalent of total nitrogen appearance (nPNA), lower total Kt/V(urea) and lower total creatinine clearance (CCr) whereas patients with high CRP were older and had a higher proportion of men, lower serum albumin, lower nPNA, lower RRF and lower total CCr. Patients with high PTR had lower serum albumin, higher RRF and higher total CCr compared with patients with other PTR. Upon logistic multiple regression analysis, age and RRF were identified as factors affecting inflammation. Overall patient survival was significantly lower in the patients with low RRF, with high CRP, and in patients with more than two of the following: low RRF, high CRP and high PTR. In contrast, in patients with none of the discriminators low RRF, high CRP and high PTR, the 5-year survival was 100%. A high PTR was associated with decreased survival during the initial year on PD, but not thereafter. Patients who died during the follow-up period had a higher prevalence of high CRP and lower serum albumin, lower RRF, lower Kt/V(urea) and lower total CCr. Upon Cox proportional hazards multivariate analysis, age and RRF were predictors of mortality. CONCLUSIONS: These results indicate that in patients starting PD, low initial RRF is associated with inflammation, and low RRF and inflammation are both associated with high overall mortality. A high PTR was associated with higher mortality, but only during the initial year on PD, whereas Kt/V(urea) did not predict mortality. These results indicate the importance of RRF and inflammation as predictors of mortality in PD patients whereas the predictive power of PTR as such may lose its significance if these two parameters are taken into consideration.     

Importance of residual renal function in continuous ambulatory peritoneal dialysis: its influence on different parameters of renal replacement treatment.

OBJECTIVE: To study the influence of residual renal function (RRF) on different parameters of the renal substitutive treatment offered by peritoneal dialysis. METHODS: We analyzed the impact of RRF on dialysis dose, nutrition parameters, anemia and phosphocalcic metabolism in 37 patients with end-stage renal disease (ESRD) treated by continuous ambulatory peritoneal dialysis (CAPD). Analytical controls were done every 6 months after an initial assessment at the end of the first month of treatment. Multiple lineal regression models were used as the statistical method to analyze the influence of RRF on different theoretically dependent factors. RRF was calculated as a mean of creatinine and urea clearances. Three observations per patient were used: one at the end of the first month of treatment; a final one at the end of follow-up (mean time 24.2 +/- 11.4 months), and at a mean time between them (13.4 +/- 6.7 months), with a final number of 111 observations. RESULTS: Dialysis dose: RRF was the most important factor in terms of creatinine clearance (r(2) = 0.94; beta = 0.999), KT/V (r(2) = 0. 68; beta = 0.819) and beta(2)-microglobulin levels (r(2) = 0.46; beta = -0.489). Nutrition parameters: RRF was a determinant factor for normalized protein catabolic rate (r(2) = 0.53; beta = 0.471), percent lean body mass (r(2) = 0.45; beta = 0.446) and albumin levels (r(2) = 0.25; beta = 0.229). Anemia: RRF was the most important factor when studying hemoglobin levels (r(2) = 0.28; beta = 0.407). Phosphocalcic metabolism: Between the analyzed factors, RRF was the only one which reached significance on serum phosphate levels (r(2) = 0.19; beta = -0.594). RRF did not show any relationship with either calcium or PTH levels. CONCLUSIONS: Independent of other factors, RRF in CAPD is positively and directly related to dialysis dose, beta(2)-microglobulin levels, nutrition parameters (albumin, normalized protein catabolic rate and percent lean body mass, hemoglobin and serum phosphate levels.     

The contribution of residual renal function to overall nutritional status in chronic haemodialysis patients.

BACKGROUND: The benefits of residual renal function (RRF) in peritoneal dialysis patients have been described frequently. However, previous reports have shown that RRF diminished faster in haemodialysis (HD) patients than in peritoneal dialysis patients, and in most of the studies in HD patients, RRF was ignored. In this study, the RRF in chronic HD patients was studied to assess its impact on patients' nutritional status. METHODS: In 41 chronic HD patients with at least a 2-year history of HD treatment, RRF was determined by a urine collection for 7 consecutive days. Nutritional parameters, such as percentage body fat, fat-free mass index, serum albumin concentration and normalized protein catabolic rate, were also measured. RESULTS: In all 41 patients, mean weekly total Kt/V urea was 4.88 and renal Kt/V urea was 0.65. RRF was well correlated with serum albumin concentration, but dialysis Kt/V urea was not. One year after the start of this study, RRF and nutritional indices were re-examined and patients were classified into two groups: with RRF, preserved residual renal diuresis over 200 ml/day (mean, 720 ml; range, 230-1640 ml), N=23; and without RRF, persistent anuria (mean, 51 ml; range, 0-190 ml), N=18. At the start of this study, the mean serum albumin concentration and mean normalized protein catabolic rate in patients with RRF were 3.84 g/dl and 1.16 g/kg/day, respectively, which were significantly higher than those in patients without RRF (P=0.02 and P=0.0002, respectively), despite total (renal+dialysis) Kt/V urea being equal in both groups. During the 1-year study period, there was no significant change in total Kt/V urea in either group. Mean serum albumin concentration increased to 4.05 g/dl in patients with RRF, but did not change significantly (from 3.66 to 3.62 g/dl) in patients without RRF. The same trend was observed in all other parameters. CONCLUSION: Over half of our HD patients had sufficient RRF. RRF itself may have a beneficial effect on nutritional parameters, and it is important to determine RRF over time, even in chronic HD patients.     

Low prevalence of hyperphosphatemia independent of residual renal function in peritoneal dialysis patients.

OBJECTIVE: Our objective was to evaluate serum phosphorus control in patients undergoing continuous ambulatory peritoneal dialysis, with and without residual renal function, by investigating the metabolic balance of phosphorus. METHODS: We assessed serum phosphorus levels in 205 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The clinical factors related to serum phosphorus were also examined, including dietary phosphate intake, dietary protein intake (DPI), phosphate removal through urine and dialysate, doses of phosphorus binder and vitamin D, and serum intact parathyroid hormone (PTH) levels. Nutritional indexes, including serum albumin (Alb), lean body mass (LBM), hand-grip strength (HGS), and subjective global assessment (SGA), were also assessed. Dialysis adequacy and residual renal function (RRF) were calculated by a standard technique. Patients with RRF <2 mL/min were viewed as having no significant RRF. Hyperphosphatemia was diagnosed in patients with serum phosphorus levels >1.78 mmol/L. RESULTS: The mean serum phosphorus level of all patients was 1.6 +/- 0.5 mmol/L (mean +/- SD). Only 58 of 205 patients (28%) had hyperphosphatemia. The average DPI was 0.8 +/- 0.3 g/kg/d, whereas the average dietary phosphorus intake was 691 +/- 201 mg/d. There were no differences in mean serum phosphorus levels or incidents of hyperphosphatemia between patients with and without RRF (1.6 +/- 0.4 mmol/L vs. 1.7 +/- 0.5 mmol/L, P = .256; 22% vs. 31%, P = .336). Although total phosphorus removal through urine and dialysate was lower in the 115 patients without RRF than in the 90 patients with RRF (270 +/- 106 mg vs. 333 +/- 129 mg, P = .000), they simultaneously had a lower dietary phosphorus intake (656 +/- 191 mg vs. 713 +/- 215 mg, P = .046). In addition, patients without RRF had significantly lower DPI, Alb, LBM, and right HGS levels than patients with RRF (P < .01-.05). In those without RRF, the 79 patients without hyperphosphatemia had significantly lower DPI, LBM, and HGS levels, and a higher prevalence of malnutrition diagnosed by SGA, than the 36 patients with hyperphosphatemia (P < .001-.05). However, in patients with RRF, there was no difference in nutritional index between patients with and without hyperphosphatemia (P > .05). CONCLUSION: A relatively lower prevalence of hyperphosphatemia existed in CAPD patients both with and without RRF, which may be associated with incremental dialysis, the correct administration of phosphorus binder, and a lower protein and phosphorus intake. However, patients without RRF, especially those without hyperphosphatemia, ran the risk of malnutrition, despite a well-controlled phosphorus intake.     

Proinflammatory Cytokines,Hepatocyte Growth Factor and Adipokines in Peritoneal Dialysis Patients

Chronic inflammation is a well‐recognized complication in dialysis patients and a potential role of the adipose tissue as an important tissue of origin contributing to inflammation has been proposed. Stable peritoneal dialysis (PD) patients were enrolled to investigate the relationship between serum levels of proinflammatory cytokines and adipokines. Our results revealed that there was a strong association between high sensitivity C‐reactive protein and interleukin (IL)‐6 and tumor necrosis factor‐alpha (TNF‐α) but not with IL‐10 and IL‐18. IL‐6 correlated with TNF‐α, IL‐10, and IL‐18. No association was found between IL‐10 and IL‐18. Adiponectin was positively correlated with all proinflammatory cytokines, except IL‐10. No significant association was found between resistin and proinflammatory cytokines. Hepatocyte growth factor (HGF) was directly related to proinflammatory cytokines but not with adipokines. The presence of residual kidney function (RKF) affected IL‐6, TNF‐α, and HGF levels. The peritoneal transport property did not influence inflammatory cytokine and adipokine levels. In conclusion, there was a close relationship between proinflammatory cytokines and adipokines. HGF correlated with proinflammatory cytokines but not with adipokines. The PD‐related factors such as RKF, peritoneal property and dialysis glucose load affected levels of proinflammatory cytokines. Body mass index was an important determinant of leptin and adiponectin in PD patients.     

Baseline peritoneal solute transport rate is not associated with markers of systemic inflammation or comorbidity in incident Korean peritoneal dialysis patients.

BACKGROUND: It is controversial whether comorbid status or systemic inflammation has an influence on the peritoneal solute transport rate (PSTR). Our aim is to elucidate whether baseline PSTR is associated with markers of systemic inflammation or degree of comorbidity in incident peritoneal dialysis (PD) patients. METHODS: One hundred and ninety-five incident PD patients were prospectively included. Results of their baseline peritoneal equilibration test (PET) using 3.86% glucose PD fluid were analysed. Clinical and laboratory parameters of inflammation, comorbidity, nutritional status, dialysis adequacy and residual renal function (RRF) were assessed at the time of PET. RESULTS: Mean dialysate-to-plasma ratio for creatinine at 4 h (D/Pcr(4)) of our patients was 0.72 +/- 0.11. High-sensitivity C-reactive protein (hsCRP), serum interleukin-6 (IL-6) and serum albumin concentrations were closely interrelated to one another and these markers of systemic inflammation were also related to the Davies comorbidity score. No differences in age, sex ratio, body mass index, body surface area and presence of diabetes were found among four transport groups. RRF, total Kt/V, haemoglobin, nitrogen appearance and the Davies comorbidity score were not different either. High-sensitivity CRP, serum IL-6 and albumin concentrations were not associated with the baseline PSTR. By multiple linear regression analysis, only the serum albumin concentration measured at the time of PET (beta = -0.081 +/- 0.020, P < 0.001) remained significantly associated with D/Pcr(4). CONCLUSION: In our study with incident Korean PD patients, the baseline PSTR was not influenced by markers of systemic inflammation or comorbidity. For a subgroup of PD patients without serious comorbidity, other mechanisms of high baseline PSTR need to be elucidated.     

Association between inflammation and changes in residual renal function and peritoneal transport rate during the first year of dialysis.

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 I; n=54) groups. RESULTS: Initially, group I had a lower proportion of high transporters and more often high serum C-reactive protein (sCRP, > or =10 mg/l) and lower RRF compared with the DUC group. In group I, 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 D/P Cr, and higher changes in D/P Cr compared to patients with a decrease in RRF < or =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 D/P 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.