The Impacts of Residual Renal Function on Nutritional Status and Dialysis Adequacy in CAPD Patients

腹膜透析病患其殘餘腎功能對營養的影響

馬紹銘(Shao-Ming Ma) ； 林靜皓(Ching-Hao Lin) ； 楊垂勳(Chwei-Shiun Yang)

《Acta Nephrologica》 18卷2期 (2004/05) Pp. 62-66

摘要

在腹膜透析的病患營養不良是非常普遍的。一般認為營養不良的患者有較高的罹病率及死亡率。我們研究了在本院腹膜透析超過三個月患者其殘餘腎功能對整體營養的影響。營養的指標包括了白蛋白、體質指數（簡稱BMI）及標準化蛋白質異化速率（簡稱nPCR）。總共有33個病患，收集一個星期的尿量來區分有無殘餘腎功能。完全沒有尿液定義為無殘餘腎功能。有殘餘腎功能組有23人，其餘10人為無殘餘腎功能組。兩組病患在性別、透析時間、透析液交換量及腹膜Kt/V值，統計學上並無差異。在有殘餘腎功能的組別有較高的白蛋白及nPCR，且有統計學上差異。BMI雖然較高，但未有統計上意義。總而言之，本研究顯示有殘餘腎功能的腹膜透析患者有較佳的營養狀況。因此對於已進行至末期腎衰竭的病患其殘餘腎功能的保留亦是很重要，應注意不要使用腎毒性的藥物。同時對沒有尿量的患者，應考慮適時增加換液量以提高其透析劑量來補償失去的殘餘腎功能。

關鍵字

殘餘腎功能 ； 營養 ； 腹膜透析

並列摘要

There is a high prevalence of protein-energy malnutrition in continuous ambulatory peritoneal dialysis (CAPD) patients. It is generally accepted that suboptimal nutrition status is associated with increased morbidity and mortality. We investigate the impacts of residual renal function (RRF) on nutritional parameters and dialysis adequacy in 33 (11 males, 22 females) CAPD patients who were divided into without RRF (10 patients) and with RRF (23 patients). There were no significant differences between RRF(-) and RRF(+) patients in terms of sex, hemotocrit, cholesterol, triglycerol, duration of dialysis (25.2±14.9 months vs. 25.8±4.1 months), dialysate exchange volume (9.2±1.1L vs. 9.1±1.5L) and weekly peritoneal Kt/V urea (1.6±10.4 vs. 1.64±0.31). In-group with RRF had younger age (51.2±15.8 years vs. 66.4±16.7 years, P＜0.05), higher total weekly Kt/V urea (1.64±0.31 vs. 1.61±0.4, P＜0.05) and daily urine output (486±558 cc vs. 0 cc, P＜0.001) with statistic significance than those without RRF. Higher plasma albumin concentration (4.1±0.6g/dl vs. 3.5±0.6g/dl, P＜0.05) was also observed in patients with RRF compared with that without RRF. Body mass index (BMI) tended to be higher in patients with RRF, although the difference was not statistically significant. Patients with RRF had a significantly higher total normalized protein catabolic rate (nPCR) (1.06±0.2g/kg/day vs. 0.83±0.23g/kg/day) compared with that without RRF. A positive linear correlation between nPCR and total Kt/V was observed in both groups and the increase in nPCR relating to the same increase in Kt/V urea was greater in patients with RRF. In conclusion, this study found that the presence of RRF contributed to the total dialysis dose in PD patients and givea better nutritional status.

並列關鍵字

residual renal function ； nutrition ； continuous ambulatory peritoneal dialysis