Factors Affecting Serum Albumin Level in Uremic Patients Receiving Continuous Ambulatory Peritoneal Dialysis

影響腹膜透析病患低血清白蛋白之因素

李智威(Chih-Wei Lee) ； 莊雅雯(Ya-Wen Chuang) ； 游棟閔(Tung-Min Yu) ； 陳呈旭(Cheng-Hsu Chen) ； 吳明儒(Ming-Ju Wu) ； 鄭志雄(Chi-Hung Cheng) ； 徐國雄(Kuo-Hsiung Shu)

《Acta Nephrologica》 22卷3期 (2008/09) Pp. 173-179

摘要

目的：探討在腹膜透析病患族群中，影響血清白蛋白值高低之因素。
方法：125位末期腎病變並接受腹膜透析患者納人此一橫斷面之研究。36位接受腹膜透析少於12個月以及6位同時接受血液透析治療之患者排除在此研究之外，剩下之83位患者納入研究之中並依血清白蛋白之值分成正常及低血清白蛋白兩組。最近的營養指標、透析清除率，腹膜運送功能以及血清中C-反應蛋白皆從病歷中收集。有週邊水腫、肺水腫或是鬱血性心臟衰竭皆視為細胞外液過多。一年之中發生過的腹膜炎、導管出口感染，全身性感染以及住院次數皆加以紀錄。
結果：統計顯示低血清白蛋白之病患接受較長的透析時間以及較多的比率有糖尿病。臨床數據分析顯示低血清白蛋白與進入透析前之血清白蛋白、血比容、以及鐵質結合能力成正相關。與年齡、透析時間、腹膜運送功能、導管出口感染、全身性感染、細胞外液過剩、心臟與胸廓比值、及住院次數成負相關。透析清除率、腹膜運送功能、以及C-反應蛋白則無顯著相關。多變項回歸分析顯示年齡、血比容、鐵質結合能力、全身性感染、以及細胞外液過剩是血清白蛋白的獨立預測因子。
結論：影響腹膜透析病患低血清白蛋白之原因是多方面的。此研究顯示年齡、血比容、鐵質結合能力、全身性感染、以及細胞外液過剩是影響血清白蛋白之獨立因素。

關鍵字

腹膜透析 ； 血清白蛋白 ； 貧血 ； 感染 ； 細胞外液

並列摘要

Objective: To examine the factors affecting serum albumin level in uremic patients receiving continuous ambulatory peritoneal dialysis (CAPD).
Methods: One hundred and twenty-five patients with end-stage renal disease on CAPD in our center were recruited for this cross-sectional study. Patients receiving GAPD for less than 12 months (n=36) or receiving con current intermittent hemodialysis (n=6) were excluded. The remaining 83 patients were included in the analysis and stratified according to serum albumin level, as either normal (serum albumin≥3.6 gmldl) group or hypoalbuminemia (＜3.6 gmldl) group. Latest data of nutrition parameter, dialysis adequacy and peritoneal transport function were collected from medical charts. Presence of peripheral edema, pulmonary edema or congestive heart failure (CHF) was considered as extracellular water (ECW) excess. Concurrent serum level of C-reactive protein (CRP) was recorded. Episodes of peritonitis, exit-site infection, systemic infection and hospitalization due to various causes within one year were also collected.
Results: Demographic data showed that patients with hypoalbuminemia were associated with longer duration of dialysis and higher prevalence of diabetes mellitus (DM). Clinical characteristic analysis showed that serum albumin level just prior to initiation of CAPD, hematocrit, and total iron binding capacity (TIBC) were positively correlated with the current serum albumin level. Age, duration of dialysis, presence of diabetes mellitus, exit-site infection, systemic infection, ECW excess, cardiothoracic ratio, and all-cause hospitalization were negatively correlated with sermon albumin level. Kt/V of urea, 4-hour dialysate-to-plasmna (D/P) creatinine ratio, and seruni CRP were not significantly correlated with serum albumin level. In multiple regression analysis, age, hematocrit, TIBC, systemic infection and ECW excess were independently associated with hypoalbuminemia.
Conclusion: The causes of hypoalbutninemia in patients undergoing CAPD are multifactorial. Age, hematocrit, TIBC, systemic infection and ECW excess are independent factors that affect serum albumin level.

並列關鍵字

peritoneal dialysis ； serum albumin ； anemia ； infection ； extracellular water