Peritoneal Solute Transport in Peritoneal Dialysis Patients: Longitudinal Changes and Influence on Survival

腹膜平衡試驗值之改變與腹膜透析病人存活率預測之關係

李宜哲(Yi-Jer Lee) ； 林鈺琳(Yu-Ling Lin) ； 彭聖曾(Sheng-Jeng Peng) ； 馮祥華(Shyang-Hwa Ferng) ； 洪崇尹(Chung-Ying Hung) ； 楊垂勳(Chwei-Shiun Yang)

《Acta Nephrologica》 21卷3期 (2007/10) Pp. 195-200

摘要

背景：腹膜透析病人比一般人有較高的死亡率，本研究評估腹膜透析病人腹膜平衡試驗值的改變以及對存活率的預測。
方法：本單一醫學中心研究包括從1992年到2004年9月開始腹膜透析，並且到2005年9月為止持續1年以上的患者。腹膜透析初始3個月內及往後每年接受腹膜平衡試驗。我們回溯性分析腹膜平衡試驗的結果和其他危險因子與腹膜透析病人存活的關係。
結果：一年後的腹膜平衡試驗值和平均值之差距顯著小於初始腹膜透析時所做的腹膜平衡試驗值和平均值之差距。單變數Cox proportional hazards models顯示年紀，性別，糖尿病，心血管疾病，殘餘腎功能，蛋白質代謝率，血清白蛋白濃度，第一年的腹膜平衡試驗值及心臟胸廓比率和死亡率有顯著相關。經由多變數分析校正後顯示心血管疾病，低白蛋白血症，年老者及較高的第一年腹膜平衡試驗值和死亡率有顯著獨立相關。
結論：腹膜平衡試驗的結果在初期並不穩定，較穩定的第一年腹膜平衡試驗值是存活超過一年的腹膜透析病人獨立的預後因子。

關鍵字

腹膜透析 ； 腹膜平衡試驗 ； 存活率

並列摘要

Background: Peritoneal dialysis (PD) patients have a higher mortality rate than the general population. This study aimed to evaluate the longitudinal changes of peritoneal solute transport and its influence on the prediction of survival in PD patients.
Methods: This is a single center retrospective study on patients commencing PD between January 1992 and September 2004, and staying in treatment for at least one year until the end of the study period in September 2005. Patients were evaluated by peritoneal equilibration test (PET) with the 4-h dialysate/plasma creatinine ratio (D/Pcrea) within three months after initiation of dialysis and at one-year intervals.
Result: The variation between D/Pcrea at one year and mean D/Pcrea was significantly less than that between initial D/Pcrea and mean D/Pcrea. Upon Cox proportional hazards, age, gender, diabetes mellitus, cardiovascular disease (CVD), residual renal function, normalized protein catabolic rate, albumin, D/Pcrea at one year and cardiothoracic ratio (CTR) were significantly associated with mortality. Multivariate analysis showed the presence of CVD, lower serum albumin concentration, older age, and higher D/Pcrea at one year were the independent predictors of mortality.
Conclusion: Longitudinal changes in peritoneal solute transport occurred in early course of PD. A stable D/Pcrea at one year, instead of initial D/Pcrea, is an independent prognostic factor for PD patients surviving more than one year.

並列關鍵字

Peritoneal dialysis ； solute transport ； survival