容量负荷对腹膜透析患者残余肾功能的影响

目的 探讨容量状态及其他因素对腹膜透析患者残余肾功能（residual kidney function，RKF）下降的影响。方法 分析复旦大学附属华山医院腹膜透析中心自2010年6月至2017年8月期间进行腹膜透析（peritoneal dialysis，PD）并且规律随访患者的临床资料，筛除有腹膜炎病史、临床资料不全、中途由外院转入的患者。以患者开始规律PD第3个月的估算 肾小球滤过率（estimated glomerular filtration rate，eGFR）作为基础值，记录腹膜透析患者在≤36个月间内所有基本临床特征、透析相关变量和主要生化指标。终点事件定义为在开始PD 24个月内的eGFR下降为0。采用单因素及多因素线性回归和Cox回归模型法分析影响PD患者eGFR下降的影响因素。结果 本研究纳入96名患者，基线eGFR为（4.20±3.00） mL·min^-1·1.73 m^-2，单因素和多因素线性回归结果显示体重指数（body mass index，BMI）和时间平均后的终末段脑钠肽前体（NT-proB-type natriuretic peptide，BNP）为共同影响PD患者RKF下降的危险因素。单因素Cox回归分析结果显示BMI、标准化蛋白分解率（normalized protein catabolic rate，nPCR）、平均动脉压（mean arterial pressure，MAP）和时间平均后的BNP为影响PD患者进入终点事件的共同危险因素。多因素Cox回归分析结果显示时间平均后的BNP为影响PD患者进入终点事件的独立影响因素。结论 容量过剩与新开始PD患者RKF下降可能相关。

Volume status on residual kidney function in incident peritoneal dialysis patients

Objective To investigate the effect of fluid overload on residual kidney function in peritoneal dialysis (PD) patients. Methods We performed a chart review study recruiting patients who started and were regularly followed up in Peritoneal Dialysis Center, Huashan Hospital,Fudan University between Jun.2010 and Aug.2017.Patients with history of peritonitis,incomplete information and transferred from other centers were not recruited into this study.The estimated glomerular filtration rate (eGFR) in the third month of PD was used as eGFR baseline.The basic clinical characteristics,dialysis related variants and comprehensive metabolic panel results within the first 36 months of PD were recorded.The primary endpoint was defined as eGFR decreased to zero within the first two years of incident PD.Univariate and multivariate linear and Cox analysis were exploited to analysis the risk factors for eGFR decline in PD patients. Results A total of 96 patients were enrolled in the study.The baseline eGFR was (4.20±3.00) mL·min^-1·1.73 m^-2.Univariate and multivariate linear regression showed that body mass index (BMI) and time-averaged NT-proB-type natriuretic peptide (BNP) were the joint risk factors for residual kidney function decline in PD patients. Univariate Cox regression reveals that BMI,time-averaged nPCR,MAP and time-averaged BNP were the composite risk factors of entering the endpoint.After adjustment,multivariate Cox regression revealed that only time-averaged BNP was the independent risk factor of entering the endpoint in PD patients. Conclusion Fluid overload may associate with the decline of RKF in PD patients.